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De La Fouchardière C, Malka D, Cropet C, Chabaud S, Raimbourg J, Botsen D, Launay S, Evesque L, Vienot A, Perrier H, Jary M, Rinaldi Y, Coutzac C, Bachet JB, Neuzillet C, Williet N, Desgrippes R, Grainville T, Aparicio T, Peytier A, Lecomte T, Roth GS, Thirot-Bidault A, Lachaux N, Bouché O, Ghiringhelli F. Gemcitabine and Paclitaxel Versus Gemcitabine Alone After 5-Fluorouracil, Oxaliplatin, and Irinotecan in Metastatic Pancreatic Adenocarcinoma: A Randomized Phase III PRODIGE 65-UCGI 36-GEMPAX UNICANCER Study. J Clin Oncol 2024; 42:1055-1066. [PMID: 38232341 DOI: 10.1200/jco.23.00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/09/2023] [Accepted: 10/04/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE GEMPAX was an open-label, randomized phase III clinical trial designed to assess the efficacy and tolerability of gemcitabine plus paclitaxel versus gemcitabine alone as second-line treatment for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) who previously received 5-fluorouracil, oxaliplatin, and irinotecan. METHODS Patients with histologically or cytologically confirmed mPDAC were randomly assigned (2:1) to receive GEMPAX (paclitaxel 80 mg/m2 + gemcitabine 1,000 mg/m2; IV; once at day (D) 1, D8, and D15/arm A) or gemcitabine (arm B) alone once at D1, D8, and D15 every 28 days until progression, toxicity, or patient's decision. The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), objective response rate (ORR), quality of life, and safety. RESULTS Overall, 211 patients (median age, 64 [30-86] years; 62% male) were included. After a median study follow-up for alive patients of 13.4 versus 13.8 months in arm A versus arm B, the median OS (95% CI) was 6.4 (5.2 to 7.4) versus 5.9 months (4.6 to 6.9; hazard ratio [HR], 0.87 [0.63 to 1.20]; P = 0.4095), the median PFS was 3.1 (2.2 to 4.3) versus 2.0 months (1.9 to 2.3; HR, 0.64 [0.47 to 0.89]; P = 0.0067), and the ORR was 17.1% (11.3 to 24.4) versus 4.2% (0.9 to 11.9; P = 0.008) in arm A versus arm B, respectively. Overall, 16.7% of patients in arm A and 2.9% in arm B discontinued their treatment because of adverse events (AEs). One grade 5 AE associated with both gemcitabine and paclitaxel was reported in arm A (acute respiratory distress), and 58.0% versus 27.1% of patients experienced grade ≥3 treatment-related AEs in arm A versus arm B, among which 15.2% versus 4.3% had anemia, 15.9% versus 15.7% had neutropenia, 19.6% versus 4.3% had thrombocytopenia, 10.1% versus 2.9% had asthenia and 12.3% versus 0.0% had neuropathy. CONCLUSION While GEMPAX did not meet the primary end point of OS versus gemcitabine alone in patients with mPDAC in the second-line setting, both PFS and ORR were significantly improved.
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Affiliation(s)
| | - David Malka
- Department of Cancer Medicine, Gustave Roussy, University of Paris-Saclay, Villejuif, France
| | - Claire Cropet
- Department of Clinical Research and Innovation, Léon Bérard Centre, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Léon Bérard Centre, Lyon, France
| | - Judith Raimbourg
- Medical Oncology Department, ICO René Gauducheau, Nantes, France
| | - Damien Botsen
- Medical Oncology Department, Godinot Institute, Unicancer Champagne, Reims, France
| | - Simon Launay
- Medical Oncology Department, Paoli Calmettes Institute, Marseille, France
| | - Ludovic Evesque
- Pole of Medicine/Gastro-enterology, Antoine Lacassagne Centre, Nice, France
| | - Angélique Vienot
- Medical Oncology Department, Jean Minjoz Hospital, Besançon, France
| | - Hervé Perrier
- Oncology Department, Saint Joseph Hospital, Marseille, France
| | - Marine Jary
- Oncology Department, Nord Franche Comté Hospital, Montbéliard, France
| | - Yves Rinaldi
- Hepato-gastroenterology and Digestive Oncology Department, European Hospital of Marseille, Marseille, France
| | - Clélia Coutzac
- Medical Oncology Department, Centre Leon Bérard, University Lyon I, Lyon, France
| | - Jean Baptiste Bachet
- Hepato-gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Saint Cloud, France
| | - Nicolas Williet
- Hepato-gastroenterology Department, University Institute of Cancerology and Hematology of Saint-Etienne (ICHUSE), Targeting Research Unit in Oncology at the University Hospital of Saint-Etienne (URCAS), Saint-Priest-en-Jarez, France
| | - Romain Desgrippes
- Hepato-Gastroenterology and Digestive Oncology Department, Broussais Hospital, Saint-Malo, France
| | | | - Thomas Aparicio
- Gastroenterology and Digestive Cancerology Department, Saint Louis Hospital, Paris, France
| | - Annie Peytier
- Hepato-Gastroenterology Department, Hospital Centre of Bayeux, Bayeux, France
| | - Thierry Lecomte
- Hepato-gastroenterology and Digestive Oncology Department, CHU Tours, Tours, France
- Department of Nutrition, Growth and Cancer, INSERM UMR1069, University of Tours, Tours, France
| | - Gaël S Roth
- Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes, Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Université Grenoble Alpes, Grenoble, France
| | - Anne Thirot-Bidault
- Institute of Cancerology Paris Sud-Private Hospital of Antony, Antony, France
| | | | - Olivier Bouché
- Hepatogastroenterology and Digestive Cancerology Department, CHU Robert Debré, Reims, France
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Ginzac A, Thivat E, Petorin C, Richard D, Herviou P, Molnar I, Devaud H, Creveaux I, Ferrer F, Authier N, Jary M, Pezet D, Durando X. A phase-II study based on dose adjustment according to UGT1A1 polymorphism: is irinotecan underdosed in first-line FOLFIRI regimen for mCRC? Cancer Chemother Pharmacol 2024; 93:225-236. [PMID: 37932443 PMCID: PMC10901933 DOI: 10.1007/s00280-023-04603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Irinotecan has considerable importance in the treatment of metastatic colorectal cancer (mCRC). UDP-glucoronyltransferase (UGT) 1A1 is responsible for the inactivation of SN-38, a metabolite of irinotecan. Depending on UGT1A1 polymorphism, the activity of the UGT enzyme can be reduced leading to more frequent occurrence of adverse events related to irinotecan. The present study aimed to assess the safety and efficacy of different doses of irinotecan adjusted according to UGT1A1 polymorphism. METHODS Thirty-four patients treated with FOLFIRI as first-line treatment for mCRC were included in this study. The irinotecan dosage was adapted on the basis of UGT1A1 polymorphisms: *1/*1 (370 mg/m2); *1/*28 (310 mg/m2), and *28/*28 (180 mg/m2). The incidence of grades 3 and 4 toxicities (neutropenia, febrile neutropenia, and diarrhoea) was recorded. Response was assessed according to the RECIST 1.1 criteria. RESULTS On the basis of UGT1A1 genotyping, 20 patients were *1/*1 (58.8%), 12 were *1/*28 (35.3%) and 2 were *28/*28 (5.9%). Seven patients experienced at least one severe toxicity, i.e., 21% of the population, amounting to eleven adverse events. Concerning the response rate, 15 patients (44%) had partial or complete response. CONCLUSION This study demonstrates that mCRC patients treated with FOLFIRI can tolerate a higher dose of irinotecan than the standard dose, i.e., > 180 mg/m2, on the basis of their UGT1A1 genotype, without increased toxicities. TRIAL REGISTRATION NCT01963182 (registered on 16/10/2013, Clermont-Ferrand, France).
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Affiliation(s)
- Angeline Ginzac
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Centre d'Investigation Clinique, UMR501, 63000, Clermont-Ferrand, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
| | - Emilie Thivat
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
- Centre d'Investigation Clinique, UMR501, 63000, Clermont-Ferrand, France.
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, 63000, Clermont-Ferrand, France.
| | - Caroline Petorin
- Département de Chirurgie Digestive et Hépatobiliaire, Hôpital Estaing, 63000, Clermont-Ferrand, France
| | - Damien Richard
- Service de Pharmacologie Médicale, Unité de Pharmacologie et de Toxicologie Biologique, CHU Gabriel MONTPIED, 63000, Clermont-Ferrand, France
| | - Pauline Herviou
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
| | - Ioana Molnar
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Centre d'Investigation Clinique, UMR501, 63000, Clermont-Ferrand, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
| | - Hervé Devaud
- Service d'oncologie Médicale, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
| | - Isabelle Creveaux
- Département de Biochimie et Génétique Moléculaire, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Florent Ferrer
- Service de Pharmacologie Médicale, Unité de Pharmacologie et de Toxicologie Biologique, CHU Gabriel MONTPIED, 63000, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Pharmacologie Médicale/Centre Evaluation et Traitement de La Douleur, Observatoire Français des Médicaments Antalgiques, Institut Analgesia, 63001, Clermont-Ferrand, France
| | - Marine Jary
- Service de Chirurgie Digestive, U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, INRA, F-63000, Clermont-Ferrand, France
| | - Denis Pezet
- Service de Chirurgie Digestive, U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, INRA, F-63000, Clermont-Ferrand, France
| | - Xavier Durando
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Centre d'Investigation Clinique, UMR501, 63000, Clermont-Ferrand, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
- Service d'oncologie Médicale, Centre Jean PERRIN, 63000, Clermont-Ferrand, France
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Dalmasso G, Cougnoux A, Faïs T, Bonnin V, Mottet-Auselo B, Nguyen HT, Sauvanet P, Barnich N, Jary M, Pezet D, Delmas J, Bonnet R. Colibactin-producing Escherichia coli enhance resistance to chemotherapeutic drugs by promoting epithelial to mesenchymal transition and cancer stem cell emergence. Gut Microbes 2024; 16:2310215. [PMID: 38374654 PMCID: PMC10880512 DOI: 10.1080/19490976.2024.2310215] [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: 05/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Human colorectal cancers (CRCs) are readily colonized by colibactin-producing E. coli (CoPEC). CoPEC induces DNA double-strand breaks, DNA mutations, genomic instability, and cellular senescence. Infected cells produce a senescence-associated secretory phenotype (SASP), which is involved in the increase in tumorigenesis observed in CRC mouse models infected with CoPEC. This study investigated whether CoPEC, and the SASP derived from CoPEC-infected cells, impacted chemotherapeutic resistance. Human intestinal epithelial cells were infected with the CoPEC clinical 11G5 strain or with its isogenic mutant, which is unable to produce colibactin. Chemotherapeutic resistance was assessed in vitro and in a xenograft mouse model. Expressions of cancer stem cell (CSC) markers in infected cells were investigated. Data were validated using a CRC mouse model and human clinical samples. Both 11G5-infected cells, and uninfected cells incubated with the SASP produced by 11G5-infected cells exhibited an increased resistance to chemotherapeutic drugs in vitro and in vivo. This finding correlated with the induction of the epithelial to mesenchymal transition (EMT), which led to the emergence of cells exhibiting CSC features. They grew on ultra-low attachment plates, formed colonies in soft agar, and overexpressed several CSC markers (e.g. CD133, OCT-3/4, and NANOG). In agreement with these results, murine and human CRC biopsies colonized with CoPEC exhibited higher expression levels of OCT-3/4 and NANOG than biopsies devoid of CoPEC. Conclusion: CoPEC might aggravate CRCs by inducing the emergence of cancer stem cells that are highly resistant to chemotherapy.
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Affiliation(s)
- Guillaume Dalmasso
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Antony Cougnoux
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Tiphanie Faïs
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Virginie Bonnin
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benoit Mottet-Auselo
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Hang Tt Nguyen
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre Sauvanet
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Centre de référence de la résistance aux antibiotiques, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Nicolas Barnich
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marine Jary
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Denis Pezet
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Julien Delmas
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Richard Bonnet
- Inserm U1071, USC-INRAe INRAE USC 1382, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Centre de Recherche en Nutrition Humaine Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
- Centre de référence de la résistance aux antibiotiques, Centre Hospitalier Universitaire, Clermont-Ferrand, France
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Maraud J, Bedhomme S, Pereira B, Trévis S, Jary M, Balayssac D. Self-Medication during and after Cancer: A French Nation-Wide Cross-Sectional Study. Cancers (Basel) 2023; 15:3190. [PMID: 37370800 DOI: 10.3390/cancers15123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Little data are available in Western countries regarding self-medication practices in the context of cancer. The aim of this study was to describe the prevalence of self-medication practices during (cancer patients) and after cancer (cancer survivors). (2) Methods: This multicenter, cross-sectional, and online study was designed to assess self-medication prevalence. Other objectives were explored, notably the medication types, the perceived risks, and the relation with symptoms and quality of life. (3) Results: Among the 518 patients analyzed, 56.4% declared they practiced self-medication. Dietary supplements and pain medications were used by more than half of the patients. Self-medication was practiced in order to manage the adverse effects of anticancer therapies (63.8%), for which pain was the leading indication (39%), and to improve the efficacy of anticancer therapies (43.8%, cancer patients). Patients believed that self-medication could not lead to drug interactions with anticancer therapies (84.9%, cancer patients), or to adverse effects (84.6%, cancer patients and survivors). Self-medication practices were associated with altered social functioning, pain, insomnia, and financial difficulties. (4) Conclusions: Self-medication was performed by more than half of the responders (ongoing or past cancer) and could be a marker of the undermanagement of cancer and treatment-related adverse effects.
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Affiliation(s)
- Julie Maraud
- UFR de Pharmacie, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Sabrina Bedhomme
- UR ACCePPT, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Sophie Trévis
- Pharmacie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marine Jary
- Chirurgie et Oncologie Digestive, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - David Balayssac
- UMR1107, NEURO-DOL, INSERM, Direction de la Recherche Clinique et de l'Innovation, Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
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Gronnier C, Mariette C, Lepage C, Monterymard C, Jary M, Ferru A, Baconnier M, Adhoute X, Tavan D, Perrier H, Guerin-Meyer V, Lecaille C, Bonichon-Lamichhane N, Pillon D, Cojocarasu O, Egreteau J, D'journo XB, Dahan L, Locher C, Texereau P, Collet D, Michel P, Ben Abdelghani M, Guimbaud R, Muller M, Bouché O, Piessen G. Perioperative Cetuximab with Cisplatin and 5-Fluorouracil in Esogastric Adenocarcinoma: A Phase II Study. Cancers (Basel) 2023; 15:cancers15072188. [PMID: 37046849 PMCID: PMC10093434 DOI: 10.3390/cancers15072188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE While perioperative chemotherapy provides a survival benefit over surgery alone in gastric and gastroesophageal junction (G/GEJ) adenocarcinomas, the results need to be improved. This study aimed to evaluate the efficacy and safety of perioperative cetuximab combined with 5-fluorouracil and cisplatin. PATIENTS AND METHODS Patients received six cycles of cetuximab, cisplatin, and simplified LV5FU2 before and after surgery. The primary objective was a combined evaluation of the tumor objective response (TOR), assessed by computed tomography, and the absence of major toxicities resulting in discontinuation of neoadjuvant chemotherapy (NCT) (45% and 90%, respectively). RESULTS From 2011 to 2013, 65 patients were enrolled. From 64 patients evaluable for the primary endpoint, 19 (29.7%) had a morphological TOR and 61 (95.3%) did not stop NCT prematurely due to major toxicity. Sixty patients (92.3%) underwent resection. Sixteen patients (/56 available, 28.5%) had histological responses (Mandard tumor regression grade ≤3). After a median follow-up of 44.5 months, median disease-free and overall survival were 24.4 [95% CI: 16.4-39.4] and 40.3 months [95% CI: 27.5-NA], respectively. CONCLUSION Adding cetuximab to the NCT regimen in operable G/GEJ adenocarcinomas is safe, but did not show enough efficacy in the present study to meet the primary endpoint (NCT01360086).
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Affiliation(s)
- Caroline Gronnier
- Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, CHU Lille, Claude Huriez University Hospital, 59000 Lille, France
- UMR-S 1172-CANTHER Laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies", University Lille, 59045 Lille, France
| | - Come Lepage
- FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, 21000 Dijon, France
- Department of Digestive Oncology University Hospital Dijon, University of Burgundy and Franche Comté, 21000 Dijon, France
| | - Carole Monterymard
- Federation Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, 21000 Dijon, France
| | - Marine Jary
- Department of Digestive Oncology, University Hospital, 63100 Clermont-Ferrand, France
| | - Aurélie Ferru
- Department of Oncology, University Hospital, 86000 Poitiers, France
| | - Mathieu Baconnier
- Department of Gastroenterology, General Hospital, 74960 Annecy, France
| | - Xavier Adhoute
- Department of Gastroenterology, St Joseph General Hospital, 13000 Marseille, France
| | - David Tavan
- Department of Gastroenterology, Lyon Protestant Infirmary Clinic, 69300 Lyon, France
| | - Hervé Perrier
- Department of Hepato-Gastroenterology, Saint Joseph Hospital, 13000 Marseille, France
| | | | - Cédric Lecaille
- Department of Hepato-Gastroenterology, Polyclinic Bordeaux Nord, 33000 Bordeaux, France
| | | | - Didier Pillon
- Department of Hepato-Gastroenterology, Centre Hospitalier de Bourg en Bresse, 01053 Bourg-en-Bresse, France
| | - Oana Cojocarasu
- Onco-Hematology Department, Centre Hospitalier du Mans, 72000 Le Mans, France
| | - Joëlle Egreteau
- Radiotherapy and Oncology Department, Centre Hospitalier Bretagne Sud, 56100 Lorient, France
| | - Xavier Benoit D'journo
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, 13000 Marseille, France
| | - Laétitia Dahan
- Service d'Oncologie Digestive, CHU Timone, 13000 Marseille, France
| | | | - Patrick Texereau
- Gastroenterology, Centre Hospitalier de Mont-de-Marsan, 40000 Mont-de-Marsan, France
| | - Denis Collet
- Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
| | - Pierre Michel
- Iron Group, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen University Hospital, Normandie University, 76000 Rouen, France
| | | | - Rosine Guimbaud
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Marie Muller
- Department of Gastroenterology, CHU Nancy, 54500 Vandoeuvre-les-Nancy, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, 51100 Reims, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Claude Huriez University Hospital, 59000 Lille, France
- UMR-S 1172-CANTHER Laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies", University Lille, 59045 Lille, France
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André T, Tougeron D, Piessen G, de la Fouchardière C, Louvet C, Adenis A, Jary M, Tournigand C, Aparicio T, Desrame J, Lièvre A, Garcia-Larnicol ML, Pudlarz T, Cohen R, Memmi S, Vernerey D, Henriques J, Lefevre JH, Svrcek M. Neoadjuvant Nivolumab Plus Ipilimumab and Adjuvant Nivolumab in Localized Deficient Mismatch Repair/Microsatellite Instability-High Gastric or Esophagogastric Junction Adenocarcinoma: The GERCOR NEONIPIGA Phase II Study. J Clin Oncol 2023; 41:255-265. [PMID: 35969830 PMCID: PMC9839243 DOI: 10.1200/jco.22.00686] [Citation(s) in RCA: 101] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE In patients with resectable gastric/gastroesophageal junction (GEJ) adenocarcinoma, surgery plus perioperative platinum-based chemotherapy is the standard of care. Perioperative chemotherapy remains debatable for gastric/GEJ adenocarcinoma with deficient mismatch repair (dMMR)/microsatellite instability-high (MSI-H). PATIENTS AND METHODS NEONIPIGA (ClinicalTrials.gov identifier: NCT04006262) phase II study evaluated neoadjuvant nivolumab 240 mg once every two weeks ×6 and ipilimumab 1 mg/kg once every six weeks ×2, followed by surgery and adjuvant nivolumab 480 mg once every four weeks (nine injections) in patients with locally advanced resectable dMMR/MSI-H, clinical (c) tumor (T)2-T4 node (N)x metastasis (M)0 gastric/GEJ adenocarcinoma. The primary end point was a pathological complete response (pCR) rate. RESULTS Between October 2019 and June 2021, 32 patients with dMMR/MSI-H gastric/GEJ adenocarcinoma were enrolled. The median age was 65.5 years (range, 40-80). Clinical stages were cT2-T3N0 (n = 9), cT2-T3N1 (n = 22), and cT3N1M1 (n = 1, wrongly included). With a median follow-up of 14.9 months (95% CI, 10.6 to 17.6), 32 patients received neoadjuvant immunotherapy (27 patients completed all cycles). Neoadjuvant therapy-related grade 3/4 adverse events occurred in six patients (19%). Twenty-nine patients underwent surgery; three did not have surgery and had complete endoscopic response with tumor-free biopsies and a normal computed tomography scan (two refused surgery and one had metastasis at inclusion). The rate of surgical morbidity (Clavien-Dindo classification) was 55% (one postoperative death occurred). All 29 patients had an R0 resection, and 17 (58.6%; 90% CI, 41.8 to 74.1) had pCR (pathological T0N0). Becker tumor regression grades 1a, 1b, 2, and 3 were observed in 17 patients, three (including two pathological T0N1), two, and seven patients, respectively. Of the 29 patients with surgery, 23 received adjuvant nivolumab. At database lock, no patient had relapse and one died without relapse. CONCLUSION Nivolumab and ipilimumab-based neoadjuvant therapy is feasible and associated with no unexpected toxicity and a high pCR rate in patients with dMMR/MSI-H resectable gastric/GEJ adenocarcinoma.
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Affiliation(s)
- Thierry André
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France,Thierry André, MD, Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France; e-mail:
| | - David Tougeron
- Department of Hepatology and Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- University of Lille, CNRS, INSERM, CHU Lille, Department of Digestive and Oncological Surgery, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | | | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Antoine Adenis
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Marine Jary
- University Hospital of Besançon, Clinical Investigational Center, CIC-1431, Besançon, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor Hospital, AP-HP, Paris-East Créteil University, INSERM, IMRB, Creteil, France
| | - Thomas Aparicio
- Paris Cité University, Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Jérôme Desrame
- Cancerology Institute, Jean Mermoz Hospital, Lyon, France
| | - Astrid Lièvre
- Department of Gastroenterology, CHU Pontchaillou, INSERM U1242, "Chemistry, Oncogenesis Stress Signaling", Rennes 1 University, Rennes, France
| | | | - Thomas Pudlarz
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France
| | - Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France
| | - Salomé Memmi
- Sorbonne University, Department of Pathology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, University of Besançon, Besançon, France,Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, University of Besançon, Besançon, France,Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Jérémie H. Lefevre
- Sorbonne University, Department of Digestive Surgery, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Magali Svrcek
- Sorbonne University, Department of Pathology, Saint-Antoine Hospital, AP-HP, Paris, France
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Chaigneau L, Jary M, Nerich V, Hervieu A, Aubry S, Charon Barra C, Meynard G, Neumann F, Kalbacher E, Isambert N. Real-World Experience of efficacy and safety of trabectedin in patients with soft tissue sarcoma: a bicentric retrospective analysis. Oncology 2022; 100:633-644. [DOI: 10.1159/000527602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022]
Abstract
Introduction: Soft tissue sarcomas (STS) are a rare and heterogenous group of tumors, with poor prognostic, judging from their frequency to relapse. Few drugs are available after the conventional first line regimen. Since 2007, trabectedin got approval after failure of anthracyclines and ifosfamide, for advanced or metastatic STS. This led to a FDA approval in 2015, but real-world evidence are still required, complementary to the pivotal phase II and III trials.
Methods: One hundred twenty-six patients with STS, treated by trabectedin between 2002 and 2019 were analysed in this retrospective study, in two French centers. The effects of trabectedin on survival, response, and toxicity, were described. All patients were tested for toxicities, and efficacy was assessed in patients exposed to at least 2 cycles of trabectedin.
Results: Three median cycles were administered per patient (1-79). Among the 113 patients analysed for efficacy, the median progression free survival was 3.0 months [CI95%: 2.3 – 4.8], with an overall survival of 12.3 months [CI95%: 10.2 – 16.9]. The rate of disease control was 46% at the end of treatment. Myxoid liposarcoma (n = 11) was the histology subtype that benefited most from this chemotherapy with median progression free survival and overall survival of 13.3 months [CI95%: 2.3 – 18.7] and 27.8 months [CI95%: 3.2 – 64.7], respectively. Adverse events were manageable.
Discussion and Conclusion: Efficacy of trabectedin is confirmed in terms of clinical benefit and low toxicity, especially for myxoid liposarcoma. Combinatory regimen are under clinical trials to optimize the place of this chemotherapy.
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8
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Gallois C, Sroussi M, Mouillet-Richard S, Mulot C, Dourthe L, Mazard T, Jary M, de la Fouchardiere C, Lecaille C, Lahlou W, Tabernero J, van Laethem JL, Lepage C, Emile J, Taieb J, de Reynies A, Laurent-Puig P. 321P A comprehensive predicting model of recurrence in stage III colon cancer from PETACC-8 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.459] [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: 11/29/2022] Open
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9
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Orillard E, Henriques J, Vernerey D, Almotlak H, Calcagno F, Fein F, Fratté S, Jary M, Klajer E, Vienot A, Borg C, Kim S. Interest of the Addition of Taxanes to Standard Treatment in First-Line Advanced HER2 Positive Gastroesophageal Adenocarcinoma in Selective Patients. Front Oncol 2022; 12:763926. [PMID: 35340264 PMCID: PMC8948436 DOI: 10.3389/fonc.2022.763926] [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: 08/24/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Studies have reported a beneficial role of the addition of trastuzumab to platin-5-FU based chemotherapy in first-line advanced HER2 positive gastroesophageal adenocarcinoma (GEA). However, the effect of taxanes combined with platin-5FU + trastuzumab (PFT) is understudied. Methods We performed a retrospective cohort study to evaluate the interest of taxanes among HER2-positive advanced GEA patients treated with PFT. We enrolled HER2-positive advanced GEA patients who underwent treatment between January 2009 to March 2021 in seven hospitals centers in France, treated with PFT alone (S group) or with taxanes + PFT regimen (T group). The primary outcome was progression-free survival (PFS). Also, overall survival (OS), response rate, conversion surgery rate, and safety were evaluated. Results Overall, 65 patients received PFT-based therapy, 24 patients in the T group, and 41 patients in the S group. To avoid the selection bias, only those patients presenting an ECOG-PS of 0-1 and synchronous metastasis (21 patients in the T group and 19 patients in the S group) were included for analysis. The median PFS was 9.3 months (95%CI 7.0 to 17.2) in the T group and 5.9 months (95%CI 3.7 to 9.6) in the S group (log-rank p=0.038). Treatment by taxanes was significantly associated with a better PFS in univariate (HR 0.49; 95%CI 0.25 to 0.98, p=0.042) and multivariate Cox regression analysis (HR 0.44; 95%CI 0.21 to 0.94, p=0.033), and IPTW method (HR 0.56; 95% CI 0.34 to 0.91, p=0.019). OS was prolonged (19.0 months (95%CI 7.8 to 45.2) vs 13.0 months (95%CI 5.5 to 14.8), log-rank p=0.033) in favor of the T group. Treatment by taxanes was significantly associated with a better OS in univariate Cox regression analysis (HR 0.49; 95%CI 0.21 to 0.96, p=0.038) and IPTW method (HR 0.49; 95% CI 0.29 to 0.84, p=0.009). The response rate was higher in the T group, with conversion surgery in five patients. No treatment-related death was observed in both groups. Conclusions Given the improvement in PFS and OS, the addition of taxanes to standard chemotherapy could be considered as a promising treatment for selected HER2-positive advanced GEA patients, with PS 0-1 and synchronous metastasis (NCT04920747).
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Affiliation(s)
- Emeline Orillard
- Department of Oncology, University Hospital of Besançon, Besançon, France.,Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Julie Henriques
- Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Dewi Vernerey
- Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Hamadi Almotlak
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Fabien Calcagno
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Serge Fratté
- Department of Gastroenterology, Centre Hospitalier Régional, Belfort, France
| | - Marine Jary
- Department of Oncology, University Hospital of Besançon, Besançon, France.,Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Elodie Klajer
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Angelique Vienot
- Department of Oncology, University Hospital of Besançon, Besançon, France.,Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Christophe Borg
- Department of Oncology, University Hospital of Besançon, Besançon, France.,Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Stefano Kim
- Department of Oncology, University Hospital of Besançon, Besançon, France.,Bourgogne Franche-Comté University, INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Department of Oncology and Radiotherapy, Hôpital Nord-Franche Comté, Montbéliard, France
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10
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Andre T, Tougeron D, Piessen G, De La Fouchardiere C, Louvet C, Adenis A, Jary M, Tournigand C, Aparicio T, Desrame J, Lièvre A, Garcia-Larnicol ML, Pudlarz T, Henriques J, Cohen R, Lefevre J, Svrcek M. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in patients (pts) with localized microsatellite instability-high (MSI)/mismatch repair deficient (dMMR) oeso-gastric adenocarcinoma (OGA): The GERCOR NEONIPIGA phase II study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.244] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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
244 Background: In pts with resectable gastric adenocarcinoma or OGA, radical surgery is the only curative option and perioperative chemotherapy seems worthless for those with MSI/dMMR tumors. Methods: We conducted phase II study evaluating the efficacy of neo-adjuvant nivolumab and ipilimumab followed by adjuvant nivolumab in pts with resectable MSI/dMMR, T2-T4 NxM0 tumors. Treatment consisted of nivolumab 240 mg every 2 weeks (6 infusions) and ipilimumab 1 mg/kg every 6 weeks (2 infusions), followed by radical surgery 5 weeks (±1 week) after last injection of nivolumab. Pts with Becker tumor regression grade (TRG) < 3 were treated with adjuvant nivolumab 480 mg every 4 weeks (9 infusions). The primary objective was pathological complete response (pCR) rate. Results: From 10/2019 to 06/2021, a total of 32 pts were enrolled (all had dMMR±MSI-H status; 16 with gastric cancer and 16 with OGA). The median age was 65.5 years (range, 40-80). Initial stage was: usT3Nx = 22, usT2Nx = 4, and usTxNx = 6 (not evaluable by ultrasound endoscopy). At data lock, 32 pts had terminated neo-adjuvant period and 27 (84%) completed all 6 neo-adjuvant cycles. 8 pts (32%) experienced G3/4 adverse events (AEs) during neo-adjuvant treatment. 29 pts underwent surgery; 2 refused surgery and had complete endoscopic response with tumor-free biopsies, 1 had surgery not performed in relation with a metastatic progression. The median delay between last injection and surgery was 35 days (extreme, 25-170). Overall surgical morbidity (54%, n = 14) was related to: anastomotic leakage = 4, pancreatitis = 2, pneumonia = 2, and other = 6. The incidence of post-operative mortality was 3.8% (n = 1) due to cardiovascular AE at post-operative day 3. All the 29 pts who underwent surgery had R0 resection: 17 (59%) had pCR (i.e., TRG 1a as per Becker grade, ypT0N0) and 4 (14%) had TRG 1b as per Beker grade (< 10% residual tumor per tumor bed). 1 pt had TRG 2 (10-50% of residual tumor) and 7 pts had TRG 3 (˃50% of residual tumor) as per Becker grade, per local pathological assessment (central pathological review is awaited). With a median follow-up of 10.9 months, 1 pt had metastatic relapse, 1 pt died without relapse and 30 pts were recurrence/progression-free. Conclusions: Neo-adjuvant therapy with nivolumab and ipilimumab is feasible and is associated with a high pCR rate in pts with MSI/dMMR resectable OGA. Data will be updated for the congress. Clinical trial information: NCT04006262.
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Affiliation(s)
- Thierry Andre
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | | | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Antoine Adenis
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Marine Jary
- University Hospital of Besançon, Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor Hospital, AP-HP, Paris-East Créteil University, INSERM, IMRB, Créteil, France
| | - Thomas Aparicio
- Paris University, Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | - Astrid Lièvre
- Department of Gastroenterology, CHU Pontchaillou, INSERM U1242, "Chemistry, Oncogenesis Stress Signaling", Rennes 1 University, Rennes, France
| | | | - Thomas Pudlarz
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life in Oncology Unit, Department of Oncology University Hospital, Besançon, France
| | - Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Jérémie Lefevre
- Sorbonne University, Department of Digestive Surgery, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Magali Svrcek
- Sorbonne University, Department of Pathology, Saint-Antoine Hospital, AP-HP, Paris, France
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11
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Jary M, Liu W, Yan D, Bai I, Muranyi A, Colle E, Brocheriou I, Turpin A, Radosevic‐Robin N, Bourgoin P, Penault‐Llorca F, Cohen R, Vernerey D, André T, Borg C, Shanmugam K, Svrcek M. The immune microenvironment in patients with mismatch‐repair‐proficient oligometastatic colorectal cancer exposed to chemotherapy: the randomized MIROX GERCOR cohort study. Mol Oncol 2021; 16:2260-2273. [PMID: 34954864 PMCID: PMC9168761 DOI: 10.1002/1878-0261.13173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/26/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
In the era of immune checkpoint inhibitors, understanding the metastatic microenvironment of proficient mismatch repair/microsatellite stable (pMMR/MSS) colorectal cancer (CRC) is of paramount importance to both prognostication and the development of more effective novel therapies. In this study, primary and paired metastasis tissue samples were collected from patients with resectable metastatic CRC treated with adjuvant FOLFOX or peri‐operative chemotherapy in the MIROX phase III prospective study. In total, 74 cancer tissues were stained for CD3, CD8, Forkhead box protein 3 (FOXP3), programmed cell death protein‐1 (PD‐1, invasive front, stromal, intra‐epithelial compartments), and programmed death‐ligand 1 (PD‐L1, tumor, immune cells). The immune profiling of primary CRC had a limited value to predict the immune context of paired metastases for all markers but CD3+. The expression of CD8 and PD‐L1 was higher in metastases after neoadjuvant FOLFOX. In metastases, both CD3 T cells at the invasive front and PD‐L1 expressions on immune cells were predictive of better disease‐free survival. These results show that the effect of FOLFOX on modifying the immune microenvironment in resected CRC metastases and measurement of PD‐L1 expression and tumor‐infiltrating CD8 T cells in pMMR/MSS metastatic tissue samples could improve treatment strategies of metastatic CRC patients.
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Affiliation(s)
- Marine Jary
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Department of Surgical and Medical Oncology University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - Wen‐Wei Liu
- Ventana Medical Systems Inc Tucson Arizona USA
| | - Dongyao Yan
- Ventana Medical Systems Inc Tucson Arizona USA
| | - Isaac Bai
- Ventana Medical Systems Inc Tucson Arizona USA
| | | | - Elise Colle
- Department of Medical Oncology University Hospital of Beaujon Clichy France
| | - Isabelle Brocheriou
- Sorbonne University Department of Pathology Assistance Publique‐Hôpitaux de Paris Pitié‐Salpêtrière Hospital Paris France
| | - Anthony Turpin
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Department of Medical Oncology University Hospital of Lille Lille France
| | | | - Pierre Bourgoin
- Sorbonne University Department of Pathology Assistance Publique‐Hôpitaux de Paris Saint‐Antoine Hospital Paris France
| | | | - Romain Cohen
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Sorbonne University Department of Medical Oncology Saint‐Antoine Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Dewi Vernerey
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Methodology and Quality of Life in Oncology Unit Besançon University Hospital Besançon France
- INSERM EFS BFC UMR1098, RIGHT University of Bourgogne Franche‐Comté Interactions hôte‐greffon‐tumeur/Ingénierie Cellulaire et Génique Besançon France
| | - Thierry André
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Sorbonne University Department of Medical Oncology Saint‐Antoine Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Christophe Borg
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- INSERM EFS BFC UMR1098, RIGHT University of Bourgogne Franche‐Comté Interactions hôte‐greffon‐tumeur/Ingénierie Cellulaire et Génique Besançon France
- Department of Medical Oncology University Hospital of Besançon Besançon France
| | | | - Magali Svrcek
- Multidisciplinary Group in Oncology (GERCOR) Paris France
- Sorbonne University Department of Pathology Assistance Publique‐Hôpitaux de Paris Saint‐Antoine Hospital Paris France
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12
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Klajer E, Jary M, Borg C, Kim S, Vernerey D, Henriques J, N'Guyen T, Nasri M, Almotlak H, Babre J, Meurisse A, Fratte S, Fein F, Calcagno F, Chanut L, Spehner L, Rebucci-Peixoto M, Vienot A. 509TiP REPROGRAM-01, a phase II study of regorafenib in combination with a multimodal metronomic chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1028] [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: 10/20/2022] Open
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13
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Pastor B, André T, Henriques J, Trouilloud I, Tournigand C, Jary M, Mazard T, Louvet C, Azan S, Bauer A, Roch B, Sanchez C, Vernerey D, Thierry AR, Adenis A. Monitoring levels of circulating cell-free DNA in patients with metastatic colorectal cancer as a potential biomarker of responses to regorafenib treatment. Mol Oncol 2021; 15:2401-2411. [PMID: 33934494 PMCID: PMC8410523 DOI: 10.1002/1878-0261.12972] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Circulating cell‐free DNA (cfDNA) contains circulating tumor DNA (ctDNA), which can be obtained from serial liquid biopsies to enable tumor genome analysis throughout the course of treatment. We investigated cfDNA and mutant ctDNA as potential biomarkers to predict the best outcomes of regorafenib‐treated metastatic colorectal cancer (mCRC) patients. We analyzed longitudinally collected plasma cfDNA of 43 mCRC patients prospectively enrolled in the phase II TEXCAN trial by IntPlex qPCR. Qualitative (KRAS, NRAS, BRAFV600E mutations) and quantitative (total cfDNA concentration, mutant ctDNA concentration, mutant ctDNA fraction) parameters were correlated with overall survival (OS) and progression‐free survival (PFS). When examined as classes or continuous variables, the concentrations of total cfDNA, mutant ctDNA, and, partly, mutant ctDNA fraction prior to regorafenib treatment correlated with OS. Patients with baseline cfDNA > 26 ng·mL−1 had shorter OS than those with cfDNA value below this threshold (4.0 vs 6.9 months; log‐rank P = 0.0366). Patients with baseline mutant ctDNA > 2 ng·mL−1 had shorter OS than those with mutant ctDNA below this threshold (log‐rank P = 0.0154). We show that pretreatment cfDNA and mutant ctDNA levels may identify mCRC patients that may benefit from regorafenib treatment.
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Affiliation(s)
- Brice Pastor
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France
| | - Thierry André
- Department of Medical Oncology, Saint-Antoine University Hospital, Sorbonne University, Paris, France.,Oncology Multidisciplinary Research Group (GERCOR), Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, Besançon University Hospital, France
| | - Isabelle Trouilloud
- Department of Medical Oncology, Saint-Antoine University Hospital, Sorbonne University, Paris, France.,Oncology Multidisciplinary Research Group (GERCOR), Paris, France
| | - Christophe Tournigand
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France.,Medical Oncology Service, Henri Mondor Hospital, AP-HP, Université Paris Est Créteil Créteil, France
| | - Marine Jary
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France.,INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Bourgogne Franche-Comté University, Besançon, France.,Department of Medical Oncology, Besançon University Hospital, France
| | - Thibault Mazard
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France.,Department of Medical Oncology, Montpellier Cancer Institute (ICM), France
| | - Christophe Louvet
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France.,Department of Medical Oncology, Institut Monsouris, Paris, France
| | - Simon Azan
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France
| | - Audrey Bauer
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France
| | - Benoit Roch
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France.,Department of Thoracic Oncology, Montpellier University Hospital, Université de Montpellier, France
| | - Cynthia Sanchez
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France
| | - Dewi Vernerey
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France.,Methodology and Quality of Life Unit in Oncology, Besançon University Hospital, France
| | - Alain R Thierry
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France.,Department of Medical Oncology, Montpellier Cancer Institute (ICM), France
| | - Antoine Adenis
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, Université de Montpellier, Montpellier Cancer Institute (ICM), France.,Department of Medical Oncology, Montpellier Cancer Institute (ICM), France
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14
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Mansi L, Spehner L, Daguindau E, Bouiller K, Almotlak H, Stein U, Bouard A, Kim S, Klajer E, Jary M, Meynard G, Vienot A, Nardin C, Bazan F, Lepiller Q, Westeel V, Adotévi O, Borg C, Kroemer M. Study of the SARS-CoV-2-specific immune T-cell responses in COVID-19-positive cancer patients. Eur J Cancer 2021; 150:1-9. [PMID: 33882374 PMCID: PMC7997727 DOI: 10.1016/j.ejca.2021.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/10/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer patients are considered highly vulnerable to the COVID-19 pandemic. However, delaying cancer-specific therapies could have a deleterious effect on survival. The potential suppressive effects of chemotherapies or cancer-related microenvironment raised the question on how cancer patients' immune system responds to SARS-CoV-2 virus. METHODS We have started a prospective monocentric trial entitled COV-CREM (NCT04365322) in April 2020. The primary objective of the trial was to assess specific immune response's intensity and diversity to SARS-CoV-2 in infected patients. RESULTS In this study, we showed that cancer patients (28 solid tumours, 11 haematological malignancies) exposed to SARS-CoV-2 produced a high rate of specific antibodies, as observed in patients without a cancer history (n = 29). However, our results highlight a lack in the generation of T-cell responses against CoV-N, M and S proteins from the SARS-CoV-2 virus, suggesting that cancer patients failed to mount a protective T-cell immunity. Nevertheless, SARS-CoV-2 infection did not impair established immune memory since specific responses against common viruses were not hampered in cancer patients. CONCLUSION Given the severity and the unknown evolution of the ongoing COVID-19 pandemic, it is of fundamental importance to integrate cancer patients in vaccination programs.
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Affiliation(s)
- Laura Mansi
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France.
| | - Laurie Spehner
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France
| | - Etienne Daguindau
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Hematology, University Hospital of Besancon, France
| | - Kevin Bouiller
- Department of Infectious Disease, University Hospital of Besançon, France; UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, F-25000, Besançon, France
| | - Hamadi Almotlak
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Ulrich Stein
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Adeline Bouard
- Department of Hematology, University Hospital of Besancon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Elodie Klajer
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Medical Oncology, Biotechnology and Immune-oncology Platforme, University Hospital of Besançon, France
| | - Guillaume Meynard
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Angélique Vienot
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Medical Oncology, Biotechnology and Immune-oncology Platforme, University Hospital of Besançon, France
| | - Charlée Nardin
- Department of Dermatology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France
| | - Fernando Bazan
- Department of Medical Oncology, University Hospital of Besançon, France
| | - Quentin Lepiller
- Department of Virology, University Hospital of Besançon, France; Research Unit EA3181, Université de Franche Comté, F-25000 Besançon, France
| | - Virginie Westeel
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Pneumology, University Hospital of Besancon, France
| | - Olivier Adotévi
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, France; INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Medical Oncology, Biotechnology and Immune-oncology Platforme, University Hospital of Besançon, France
| | - Marie Kroemer
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, France; Department of Medical Oncology, Biotechnology and Immune-oncology Platforme, University Hospital of Besançon, France; Department of Pharmacy, University Hospital of Besançon, France
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15
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Mouillet G, Falcoz A, Fritzsch J, Almotlak H, Jacoulet P, Pivot X, Villanueva C, Mansi L, Kim S, Curtit E, Meneveau N, Adotevi O, Jary M, Eberst G, Vienot A, Calcagno F, Pozet A, Djoumakh O, Borg C, Westeel V, Anota A, Paget-Bailly S. Feasibility of health-related quality of life (HRQoL) assessment for cancer patients using electronic patient-reported outcome (ePRO) in daily clinical practice. Qual Life Res 2021; 30:3255-3266. [PMID: 33387291 DOI: 10.1007/s11136-020-02721-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Routine Electronic Monitoring of Health-Related Quality of Life (HRQoL) (REMOQOL) in clinical care with real-time feedback to physicians could help to enhance patient-centered care. We evaluated the feasibility of REMOQOL in the French context in the QOLIBRY study. The primary objective was to assess the patients' compliance with REMOQOL. METHODS The QOLIBRY study was a single-center, prospective study conducted in the University Hospital of Besançon (France). Eligible patients were those treated with systemic therapies for breast, lung or colorectal cancer at any stage. Patients were invited to complete the EORTC QLQ-C30 questionnaire and cancer-site-specific modules before each visit on tablets and/or computers in the hospital or at home. During the consultation, physicians had real-time access to visual summaries of HRQoL scores. Compliance was assessed as adequate if at least 66% of HRQoL assessments were completed during the 4 months of follow-up. RESULTS Between March 2016 and October 2018, 177 patients were included in the QOLIBRY study. Median age was 64 years (IQR 54-71). The proportion of patients with an adequate compliance rate was 95.5% (n = 63) in the breast cancer cohort, 98.2% (n = 55) in the colorectal cancer cohort, and 90.9% (n = 50) in the lung cancer cohort. The physicians checked the HRQoL results in 73.1% of visits and prescribed supportive care and adapted patient management in 8.3% and 5.2% of visits, respectively. CONCLUSION & PERSPECTIVES The results of QOLIBRY study suggest that REMOQOL is feasible in the French context. However, information about HRQoL monitoring, training of the physicians in the use of the software, and recommendations for using HRQoL results to guide care are essential and must be improved.
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Affiliation(s)
- Guillaume Mouillet
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France.
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France.
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France.
| | - Antoine Falcoz
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Joëlle Fritzsch
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Hamadi Almotlak
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Pascale Jacoulet
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Xavier Pivot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | | | - Laura Mansi
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Nathalie Meneveau
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Olivier Adotevi
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Guillaume Eberst
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Angelique Vienot
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Fabien Calcagno
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Astrid Pozet
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Oumelkheir Djoumakh
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Virginie Westeel
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Amélie Anota
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- French National Platform Quality of Life and Cancer, Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
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16
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Kim S, Meurisse A, Spehner L, Stouvenot M, François E, Buecher B, André T, Samalin E, Jary M, Nguyen T, El Hajbi F, Baba-Hamed N, Pernot S, Kaminsky MC, Bouché O, Desrame J, Zoubir M, Ghiringhelli F, Parzy A, de la Fouchardiere C, Boulbair F, Lakkis Z, Klajer E, Jacquin M, Taieb J, Vendrely V, Vernerey D, Borg C. Pooled analysis of 115 patients from updated data of Epitopes-HPV01 and Epitopes-HPV02 studies in first-line advanced anal squamous cell carcinoma. Ther Adv Med Oncol 2020; 12:1758835920975356. [PMID: 33329760 PMCID: PMC7720302 DOI: 10.1177/1758835920975356] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/28/2020] [Indexed: 01/25/2023] Open
Abstract
AIMS The addition of docetaxel to cisplatin and 5-fluorouracil (DCF) has shown promising efficacy in advanced squamous cell carcinoma of the anus (SCCA). Preliminary results of Epitopes-HPV01 study showed a high rate of long-lasting complete response to DCF. The prospective, multicenter, Epitopes-HPV02 trial then confirmed the high efficacy of the modified DCF (mDCF) regimen in terms of complete response rate and long-term survival in metastatic or non-resectable locally advanced recurrent SCCA. Here, we present updated results of the Epitopes-HPV01 and Epitopes-HPV02 studies. PATIENTS & METHODS Epitopes-HPV01 is a prospective study performed by the regional cancer network of Franche-Comté, France. Epitopes-HPV02 is a phase II study supported by two French collaborative oncological groups, performed in 25 centers. Both studies included patients with metastatic, or with unresectable local recurrent SCCA, treated with DCF regimen. RESULTS In Epitopes-HPV01, 51 patients were enrolled between September 2012 and January 2019, and 49 patients were included for analysis; while 69 patients were included between September 2014 and December 2016 in Epitopes-HPV02, and 66 patients for analysis. Pooled analysis of 115 patients showed a median progression-free survival of 12.2 months [95% confidence interval (CI) 10.6-16.1] [11.0 months (9.3-16.0) in -HPV02, and 15.6 months (11.2-34.5) in -HPV01, (p = 0.06)]. The median overall survival was 39.2 months (26.0-109.1) [36.3 in -HPV02 (25.2-NR), and 61.1 months (21.4-120.0) in -HPV01 (p = 0.62)]. Objective response rate was 87.7% (90.9% in -HPV02 and 83.3% in -HPV01) with 40.3% of complete response (45.5% in -HPV02 and 33.3% in -HPV01). No differences were observed between standard DCF (n = 54) and mDCF (n = 58) in terms of OS (p = 0.57) and PFS (p = 0.99). 5-years PFS and OS rates were 24.5% and 44.4%, respectively, in the whole population. No treatment-related death was observed. CONCLUSION Updated results of Epitopes-HPV01 and 02 studies, as well as the pooled analysis, confirm mDCF as a standard treatment in patients with advanced SCCA.
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Affiliation(s)
- Stefano Kim
- Department of Oncology, Jean Minjoz University Teaching Hospital, 3 Boulevard Alexander Fleming, Besancon, 25030, France
- Centre Hospitalier Universitaire de Besançon, Besançon, France
- Hôpital Nord Franche Comté, Montbéliard, France
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group
- Fédération Francophone de Cancérologie Digestive (FFCD)
| | - Aurélia Meurisse
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Laurie Spehner
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
| | | | | | | | - Thierry André
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group Sorbonne Université and Hôpital Saint Antoine, Paris, France
| | | | - Marine Jary
- Centre Hospitalier Universitaire de Besançon, Besançon, France
- Hôpital Nord Franche Comté, Montbéliard, France
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group
| | - Thierry Nguyen
- Centre Hospitalier Universitaire de Besançon, Besançon, France
- Polyclinique Franche-Comté, Besançon, France
| | | | | | - Simon Pernot
- Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Olivier Bouché
- Centre Hospitalier Universitaire de Reims, Reims, France
| | | | | | | | | | | | | | - Zaher Lakkis
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Elodie Klajer
- Centre Hospitalier Universitaire de Besançon, Besançon, France
- Groupe Hospitalier de la Haute-Saône, Vesoul, France
| | - Marion Jacquin
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France
- Cancéropôle Grand-Est, Strasbourg, France
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Paris, France
| | - Véronique Vendrely
- Fédération Francophone de Cancérologie Digestive (FFCD) Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Dewi Vernerey
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Centre Hospitalier Universitaire de Besançon, Besançon, France
- Hôpital Nord Franche Comté, Montbéliard, France
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group
- Fédération Francophone de Cancérologie Digestive (FFCD)
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17
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Kroemer M, Turco C, Spehner L, Viot J, Idirène I, Bouard A, Renaude E, Deschamps M, Godet Y, Adotévi O, Limat S, Heyd B, Jary M, Loyon R, Borg C. Investigation of the prognostic value of CD4 T cell subsets expanded from tumor-infiltrating lymphocytes of colorectal cancer liver metastases. J Immunother Cancer 2020; 8:jitc-2020-001478. [PMID: 33229508 PMCID: PMC7684804 DOI: 10.1136/jitc-2020-001478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The positive role of CD8+ tumor-infiltrating lymphocytes (TIL) in patients with colorectal cancer (CRC) has been well described but the prognostic value of CD4 T cell subsets remained to be investigated. In this study, we expanded TIL from surgically resected liver metastases of patients with CRC and characterized the phenotype and the prognostic value of expanded-CD4 T cells. METHODS Liver metastases were surgically resected from 23 patients with CRC. Tumors were enzymatically digested and cultured in high dose of interleukin-2 for up to 5 weeks. T cell phenotype and reactivity of cultured-T cells were measured by flow cytometry and correlated with patients' clinical outcomes. RESULTS We successfully expanded 21 over 23 TIL from liver metastases of patients with CRC. Interestingly, we distinguished two subsets of expanded T cells based on T cell immunoglobulin mucin domain-containing protein 3 (TIM-3) expression. Medians fold expansion of expanded T cells after rapid expansion protocol was higher in CD3+TIM-3low cultures. In an attempt to investigate the correlation between the phenotype of expanded CD4 T cells and clinical outcomes, we observed on one hand that the level of Tregs in culture as well as the expression of both PD1 and TIM-3 by expanded T cells was not correlated to the clinical outcomes. Interestingly, on the other hand, cultures containing high levels of Th17 cells were associated with a poor prognosis (p=0.0007). CONCLUSIONS Our data confirmed the presence of Th17 cells in expanded T cells from liver metastases. Among CD4 T cell characteristics investigated, TIM-3 but not programmed cell death protein 1 predicted the expansion capacity of TIL while only the Th17 phenotype showed correlation with patients' survival, suggesting a particular role of this T cell subset in CRC immune contexture. TRIAL REGISTRATION NUMBER NCT02817178.
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Affiliation(s)
- Marie Kroemer
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France .,Department of Pharmacy, University hospital of Besançon, F-25000 Besançon, France
| | - Celia Turco
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University hospital of Besançon, F-25000 Besançon, France
| | - Laurie Spehner
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Julien Viot
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Medical Oncology, University hospital of Besançon, F-25000 Besançon, France
| | - Idir Idirène
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Adeline Bouard
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,ITAC platform, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Elodie Renaude
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Marina Deschamps
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Yann Godet
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Olivier Adotévi
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Medical Oncology, University hospital of Besançon, F-25000 Besançon, France
| | - Samuel Limat
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Pharmacy, University hospital of Besançon, F-25000 Besançon, France
| | - Bruno Heyd
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University hospital of Besançon, F-25000 Besançon, France
| | - Marine Jary
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Medical Oncology, University hospital of Besançon, F-25000 Besançon, France
| | - Romain Loyon
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Christophe Borg
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, F-25000 Besançon, France.,Department of Medical Oncology, University hospital of Besançon, F-25000 Besançon, France.,ITAC platform, University of Bourgogne Franche-Comté, F-25000 Besançon, France
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18
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Garnier L, Charton E, Falcoz A, Paget-Bailly S, Vernerey D, Jary M, Ducray F, Curtit E. Quality of patient-reported outcome reporting according to the CONSORT statement in randomized controlled trials with glioblastoma patients. Neurooncol Pract 2020; 8:148-159. [PMID: 33898048 DOI: 10.1093/nop/npaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Randomized controlled trials (RCTs) represent the best evidence in oncology research. Glioblastoma is the most frequent and deadly primary brain tumor, affecting health-related quality of life. An important end point is patient-reported outcomes (PROs). There are no data regarding how well publications of glioblastoma RCTs report PROs. A specific PRO extension of the Consolidated Standards of Reporting Trials (CONSORT) statement was created to improve the quality of reporting. The aim of this study was to evaluate adherence to the CONSORT-PRO statement in reporting RCTs addressing the treatment of patients with glioblastoma. PRO analysis methodology was explored and criteria associated with higher quality of reporting were investigated. Methods From PubMed/MEDLINE and the Cochrane Library databases, all phase 2 and 3 RCTs related to glioblastoma published between 1995 and 2018 were reviewed according to the CONSORT-PRO statements. An overall quality score on a 0 to 100 scale was defined based on these criteria and factors associated with this score were identified. Results Forty-four RCTs were identified as relevant according to predefined criteria. The median overall quality score was 26. No difference was observed regarding reporting quality over the years. CONSORT-PRO items concerning data collection and analysis were poorly reported. Thirty-four trials (77%) used longitudinal data. The most frequent statistical method for PROs analysis was the mean change from baseline (63%). Factors associated with improved overall quality score were the presence of a secondary publication dedicated to PROs results, the statement of any targeted dimensions, and when trials reported results using multiple methods. Conclusion Despite the importance of measuring PROs in patients with glioblastoma, employment of the CONSORT-PRO statement is poor in RCTs.
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Affiliation(s)
- Louis Garnier
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France.,Department of Neuro-Oncology, Hospices Civils de Lyon, Lyon, France
| | - Emilie Charton
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France.,French National Platform Quality of Life and Cancer, Besançon, France
| | - Antoine Falcoz
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Sophie Paget-Bailly
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Dewi Vernerey
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France.,Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France
| | - François Ducray
- Department of Neuro-Oncology, Hospices Civils de Lyon, Lyon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Tumor Interaction, Besançon, France
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19
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Wespiser M, Henriques J, Kroemer M, Mougey V, Borg C, Loyon R, Jary M. 8P STC1, a baseline predictive biomarker for overall survival in metastatic colorectal cancer (mCRC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2167] [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] Open
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20
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Royer B, Schmitt A, Nguyen T, Paillard MJ, Jary M, Demarchi M, Vernerey D, Henriques J, Jacquin M, Borg C, Kim S. Exposure-response analysis of Raltitrexed assessing liver toxicity. Br J Clin Pharmacol 2020; 87:1327-1337. [PMID: 32789966 DOI: 10.1111/bcp.14519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Raltitrexed (RTX) is a thymidylate synthase inhibitor with large pharmacokinetics (PK) variability that can be administered in case of 5-fluorouracil (5FU) intolerance or dihydropyrimidine dehydrogenase deficiency. While it is a more potent thymidylate synthase inhibitor than 5FU, RTX failed to replace this drug for colorectal cancer patients, mainly due to its toxicity at the recommended dose of 3 mg/m2 every 3 weeks. However, every 2 weeks administration at 2 mg/m2 demonstrated a favourable toxicity profile. METHOD We performed a randomized crossover comparative population PK study between every 2 weeks TOMOX (RTX 2 mg/m2 ) and every 3 weeks TOMOX (RTX 3 mg/m2 ). RESULTS A three-compartment model and a proportional error model best describe the data. Creatinine clearance and sex, but not body surface area (BSA), were covariates of RTX clearance leading to decrease of its interindividual variability of 28%. Weight and body surface area were covariates of central and peripheral volumes of distribution, respectively, leading to decreases of interindividual variability of 34.6% and 100%, respectively. In contrast to the dose, AUC was a good predictor of liver toxicity (P = 0.006, OR = 3.91, 95%CI = [1.48-10.34]). Using covariates to compute individual clearance and a threshold AUC (1.639, determined in this study), a covariates-based dose was calculated, leading to less variability in AUC than observed with the actual BSA-based or fixed doses. CONCLUSION These results advocate for the use of creatinine clearance and sex to determine the RTX dose instead of BSA.
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Affiliation(s)
- Bernard Royer
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU Besançon, Besançon, F-25000, France.,INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France
| | - Antonin Schmitt
- Service Pharmacie, Centre Georges-François Leclerc, Dijon, F-21000, France.,Université Bourgogne Franche-Comté, INSERM U1231, Dijon, F-21000, France
| | - Thierry Nguyen
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France
| | - Marie-Justine Paillard
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Marine Jary
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
| | - Martin Demarchi
- Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France
| | - Dewi Vernerey
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Julie Henriques
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Unité de méthodologie et de qualité de vie en cancérologie, CHU Besançon, Besançon, F-25000, France
| | - Marion Jacquin
- INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France.,Cancéropôle Grand Est, France
| | - Christophe Borg
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
| | - Stefano Kim
- INSERM, EFS BFC, Université Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, F-25000, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, F-25000, France.,INSERM CIC-1431, , CHU Besançon, Besançon, F-25000, France
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21
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de la Fouchardiere C, Hammel P, Launay S, Vienot A, Raimbourg J, Perrier H, Evesque L, Ghiringhelli F, Jary M, Aparicio T, Hociné F, Neuzillet C, Botsen D, Phelip J, Peytier A, Michel P, Cropet C, Lachaux N, Chabaud S, Dahan L. 1566TiP PRODIGE 65 - UCGI 36 - GEMPAX : A unicancer phase III randomized study evaluating gemcitabine and paclitaxel versus gemcitabine alone after FOLFIRINOX failure or intolerance in metastatic pancreatic ductal adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2049] [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: 10/23/2022] Open
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22
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Jary M, Hasanova R, Vienot A, Asgarov K, Loyon R, Tirole C, Bouard A, Orillard E, Klajer E, Kim S, Viot J, Colle E, Adotevi O, Bouché O, Lecomte T, Borg C, Feugeas JP. Molecular description of ANGPT2 associated colorectal carcinoma. Int J Cancer 2020; 147:2007-2018. [PMID: 32222972 DOI: 10.1002/ijc.32993] [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] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
Angiopoietin-2 (ANGPT2) is a prognostic factor in metastatic colorectal cancer (CRC). Nevertheless, it remains to be elucidated which molecular characteristics make up the ANGPT2-related poor-prognosis CRC subset. Public transcriptomic datasets were collected from Gene Expression Omnibus GEO and with the TCGAbiolinks R-package for the TCGA. After appropriate normalization, differential expression analysis was performed using Benjamini and Hochberg method for false discovery rate. Plasma from two prospective clinical trials were used to investigate the clinical impact of ANGPT2-related biomarkers. In the 935 samples included in four annotated platforms (GPL) and derived from localized CRC, ANGPT2hi expression conferred a worst overall survival (HR = 1.20; p = 0.02). CRC stage, ANGPT2hi expression but not Consortium Molecular Subtype (CMS) predict overall survival in multivariate analysis. ANGPT2 expression was not correlated with a specific CMS nor to RAS, RAF, MSI, p53, CIN, CIMP genomic alterations. Gene expression analysis revealed that ANGPT2hi CRC subset is characterized by angiogenesis-related gene expression, presence of myeloid cells, stromal organization and resistance to chemotherapy. A prognostic model was proposed using seric levels of ANGPT2, STC1 and CD138 in 97 mCRC patients. Our results provide evidence that ANGPT2 is a prognostic factor in localized CRC and defined a specific CRC subset with potential clinical implementation.
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Affiliation(s)
- Marine Jary
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Clinical Investigation Center in Biotherapy, INSERM CIC-BT1431, University Hospital of Besançon, Besançon, France
| | - Reyhan Hasanova
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France
| | - Angélique Vienot
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Kamal Asgarov
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France
| | - Romain Loyon
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Charline Tirole
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Adeline Bouard
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France
| | - Emeline Orillard
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Elodie Klajer
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Clinical Investigation Center in Biotherapy, INSERM CIC-BT1431, University Hospital of Besançon, Besançon, France
| | - Julien Viot
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Elise Colle
- University Hospital St-Antoine, Paris, France
| | - Olivier Adotevi
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Olivier Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Robert Debré, Reims, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, CHRU de Tours, Tours Cedex 09, France.,University of Tours, Tours Cedex 01, France
| | - Christophe Borg
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Clinical Investigation Center in Biotherapy, INSERM CIC-BT1431, University Hospital of Besançon, Besançon, France
| | - Jean P Feugeas
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaireet Génique, Besançon, France
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Vienot A, Chevalier H, Bolognini C, Gherga E, Klajer E, Meurisse A, Jary M, Kim S, d’Engremont C, Nguyen T, Calcagno F, Almotlak H, Fein F, Nasri M, Abdeljaoued S, Turpin A, Borg C, Vernerey D. FOLFOXIRI vs FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: A population-based cohort study. World J Gastrointest Oncol 2020; 12:332-346. [PMID: 32206183 PMCID: PMC7081111 DOI: 10.4251/wjgo.v12.i3.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/26/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy (L1) in advanced pancreatic ductal adenocarcinoma (aPDAC). FOLFOXIRI, a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil, has demonstrated efficacy and feasibility in colorectal cancer.
AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.
METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions, with either FOLFOXIRI (n = 165) or FOLFIRINOX (n = 124) regimens. FOLFOXIRI consisted of irinotecan (165 mg/m2), oxaliplatin (85 mg/m2), leucovorin (200 mg/m2) and 5-fluorouracil (3200 mg/m2 as a 48-h continuous infusion) every 2 wk. Ninety-six pairs of patients were selected through propensity score matching, and clinical outcomes of the two treatment regimens were compared.
RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts, respectively. After propensity score matching, survival rates remained similar between the two regimens in terms of overall survival (hazard ratio = 1.22; P = 0.219) and progression-free survival (hazard ratio = 1.27; P = 0.120). The objective response rate was 37.1% in the FOLFOXIRI group vs 47.8% in the FOLFIRINOX group (P = 0.187). Grade 3/4 toxicities occurred in 28.7% of patients in the FOLFOXIRI cohort vs 19.5% in the FOLFIRINOX cohort (P = 0.079). FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events. Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5% with both regimens.
CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX. The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.
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Affiliation(s)
- Angélique Vienot
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Hortense Chevalier
- Department of Medical Oncology, Lille University Hospital, Lille F-59000, France
| | - Clément Bolognini
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Elisabeta Gherga
- Department of Medical Oncology, Nord Franche-Comté Hospital, Montbéliard F-25020, France
| | - Elodie Klajer
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Aurélia Meurisse
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- Methodological and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon F-25030, France
| | - Marine Jary
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Stefano Kim
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | | | - Thierry Nguyen
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Fabien Calcagno
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Hamadi Almotlak
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Francine Fein
- Department of Gastroenterology, Besançon University Hospital, Besançon F-25030, France
| | - Meher Nasri
- Department of Medical Oncology, Nord Franche-Comté Hospital, Montbéliard F-25020, France
| | - Syrine Abdeljaoued
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
| | - Anthony Turpin
- Department of Medical Oncology, Lille University Hospital, Lille F-59000, France
| | - Christophe Borg
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Dewi Vernerey
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- Methodological and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon F-25030, France
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Cohen R, Pudlarz T, Garcia-Larnicol ML, Vernerey D, Dray X, Clavel L, Jary M, Piessen G, Zaanan A, Aparicio T, Louvet C, Tournigand C, Chibaudel B, Tougeron D, Guimbaud R, Benouna J, Adenis A, Sokol H, Borg C, Duval A, Svrcek M, André T. [Localized MSI/dMMR gastric cancer patients, perioperative immunotherapy instead of chemotherapy: The GERCOR NEONIPIGA phase II study is opened to recruitment]. Bull Cancer 2020; 107:438-446. [PMID: 32057467 DOI: 10.1016/j.bulcan.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Perioperative chemotherapy is the standard strategy for localized gastric cancers. Nevertheless, this strategy seems to be inefficient, if not deleterious, for patients with tumors harboring microsatellite instability (MSI) and/or mismatch repair deficiency (dMMR), a tumor phenotype predictive for the efficacy of immune checkpoint inhibitors (ICKi). AIM The GERCOR NEONIPIGA single-arm phase II study (NCT04006262; EUDRACT 2018-004712-22) aims at evaluating the efficacy of a peri-operative strategy with nivolumab and ipilimumab in neoadjuvant setting, then nivolumab alone after surgery for patients with resectable MSI/dMMR gastric cancer. MATERIAL AND METHODS Main inclusion criteria are: gastric and oesogastric junction adenocarcinoma (GOA), T2-T4, all N stage and M0, MSI/dMMR. Patients will be treated with nivolumab 240mg Q2W, 6 infusions, and ipilimumab 1mg/kg Q6W, 2 infusions in neoadjuvant setting. Following surgery, patients with TRG 1-2-3 (Mandard tumor regression grade), acceptable tolerance of neoadjuvant treatment and postoperative ECOG performance status 0-1, will be treated with adjuvant nivolumab 480mg Q4W, 9 infusions. RESULTS The primary endpoint is pathological complete response rate (pCR-R). Based on a Fleming design, with α=5% and β=20%, 27 patients have to be evaluated (H0=5%; H1=20%). Secondary endpoints include disease-free survival, overall survival and safety. CONCLUSION This study is planned to include 32 patients to evaluate the pCR-R with the combination of nivolumab and ipilimumab in neoadjuvant setting for MSI/dMMR localized GOA. The MSI/MMR status should be systematically assessed on diagnostic biopsies of all GOA. If it meets its primary endpoint, the GERCOR NEONIPIGA study might mark a turning point in the management of localized MSI/dMMR GOA patients.
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Affiliation(s)
- Romain Cohen
- AP-HP, Sorbonne Université, hôpital Saint-Antoine, department of medical oncology, 75012 Paris, France.
| | - Thomas Pudlarz
- AP-HP, hôpital Saint-Antoine, Department of medical oncology, 75012 Paris, France
| | | | - Dewi Vernerey
- University Hospital of Besançon, Methodology and Quality of Life Unit in Oncology, 25000 Besançon, France; University Bourgogne Franche-Comté, interactions Hôte-Greffon-Tumeur/Ingénierie cellulaire et génique, EFS BFC, UMR1098, Inserm, 25000 Besançon, France
| | - Xavier Dray
- AP-HP, Sorbonne Université, hôpital Saint-Antoine, department of endoscopy, 75012 Paris, France
| | - Léa Clavel
- Hôpital privé Jean-Mermoz, gastro-enterology and digestive oncology department, Lyon, France
| | - Marine Jary
- University Bourgogne Franche-Comté, interactions Hôte-Greffon-Tumeur/Ingénierie cellulaire et génique, EFS BFC, UMR1098, Inserm, 25000 Besançon, France; CHU de Jean-Minjoz, Medical oncology department, 3, boulevard Alexander-Fleming, 25000 Besançon, France
| | - Guillaume Piessen
- Hôpital Claude-Huriez, service de chirurgie digestive et oncologique, 59000 Lille, France
| | - Aziz Zaanan
- Paris Descartes University, Sorbonne Paris Cité, Georges-Pompidou European Hospital, Department of Digestive Oncology, Paris, France
| | - Thomas Aparicio
- AP-HP, université de Paris, Hôpital Saint-Louis, Gastro-enterology and digestive oncology department, Paris, France
| | - Christophe Louvet
- Institut mutualiste Montsouris, medical oncology department, 75014 Paris, France
| | | | - Benoist Chibaudel
- Hôpital Franco-Britannique, Fondation Cognacq-Jay, Medical Oncology, Levallois-Perret, France
| | - David Tougeron
- Poitiers University Hospital, Department of Gastroenterology, Poitiers, France
| | - Rosine Guimbaud
- CHU de Toulouse-IUCT Rangueil-Larrey, Digestive Medical Oncology department, Toulouse, France
| | - Jaafar Benouna
- University Hospital of Nantes, Digestive Oncology, Nantes, France
| | - Antoine Adenis
- ICM Val d'Aurelle, medical oncology department, Montpellier, France
| | - Harry Sokol
- AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine, CRSA, Hôpital Saint-Antoine, gastroenterology department, Inserm, 75012 Paris, France
| | - Christophe Borg
- University Bourgogne Franche-Comté, interactions Hôte-Greffon-Tumeur/Ingénierie cellulaire et génique, EFS BFC, UMR1098, Inserm, 25000 Besançon, France; Hôpital privé Jean-Mermoz, gastro-enterology and digestive oncology department, Lyon, France
| | - Alex Duval
- Sorbonne Université, centre de recherche Saint-Antoine, équipe Instabilité des microsatellites et cancer, équipe labellisée par la Ligue nationale contre le cancer et SIRIC CURAMUS, Inserm UMRS 938, 75012 Paris, France
| | - Magali Svrcek
- AP-HP, Sorbonne Université, hôpital Saint-Antoine, department of pathology, 75012 Paris, France
| | - Thierry André
- AP-HP, Sorbonne Université, hôpital Saint-Antoine, department of medical oncology, 75012 Paris, France
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25
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Lauret Marie Joseph E, Laheurte C, Jary M, Boullerot L, Asgarov K, Gravelin E, Bouard A, Rangan L, Dosset M, Borg C, Adotévi O. Immunoregulation and Clinical Implications of ANGPT2/TIE2 + M-MDSC Signature in Non-Small Cell Lung Cancer. Cancer Immunol Res 2019; 8:268-279. [PMID: 31871121 DOI: 10.1158/2326-6066.cir-19-0326] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/04/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022]
Abstract
Myeloid-derived suppressor cells (MDSC) promote immunosuppression and are a target in the field of immuno-oncology. Accumulation of MDSCs is associated with poor prognosis and resistance to immunotherapy for several cancers. Here, we describe an accumulation of a subset of circulating monocytic MDSCs (M-MDSC) overexpressing TIE2, the receptor for angiopoietin-2 (ANGPT2), in patients with non-small cell lung cancer (NSCLC). Greater numbers of circulating TIE2+ M-MDSCs were detected in patients with NSCLC compared with healthy subjects, and this accumulation correlated with ANGPT2 concentration in blood. The presence of an ANGPT2-rich environment was associated with impairment of preexisting T-cell responses against tumor-associated antigens (TAA) in patients with NSCLC. We demonstrated that ANGPT2 sensitizes TIE2+ M-MDSCs such that these cells suppress TAA-specific T cells. In patients with NSCLC, upregulation of the ANGPT2/TIE2+ M-MDSC signature in blood was associated with a poor prognosis. Our results identify the ANGPT2/TIE2+ M-MDSC axis as a participant in tumor immune evasion that should be taken into account in future cancer immunotherapy.
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Affiliation(s)
| | - Caroline Laheurte
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France.,Etablissement Français du Sang Bourgogne Franche-Comté, Plateforme de Biomonitoring, Besançon, France.,INSERM CIC-1431, CHU Besançon, Besançon, France
| | - Marine Jary
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, France
| | - Laura Boullerot
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France.,INSERM CIC-1431, CHU Besançon, Besançon, France
| | - Kamal Asgarov
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France
| | - Eléonore Gravelin
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France.,INSERM CIC-1431, CHU Besançon, Besançon, France
| | - Adeline Bouard
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France
| | - Laurie Rangan
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France
| | - Magalie Dosset
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France
| | - Christophe Borg
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France.,INSERM CIC-1431, CHU Besançon, Besançon, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, France
| | - Olivier Adotévi
- Université Bourgogne Franche-Comté, INSERM, EFS, BFC, UMR1098, RIGHT, Besançon, France. .,Etablissement Français du Sang Bourgogne Franche-Comté, Plateforme de Biomonitoring, Besançon, France.,INSERM CIC-1431, CHU Besançon, Besançon, France.,Service d'Oncologie médicale, CHU Besançon, Besançon, France
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26
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Fabre A, Badet N, Calame P, Delabrousse E, Wespiser M, Turco C, Borg C, Jary M. [Radiologic response assessment in metastatic colorectal cancers]. Bull Cancer 2019; 106:1029-1038. [PMID: 31570214 DOI: 10.1016/j.bulcan.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
The increasing indications of cytostatic biotherapies and the improvement in metastatic surgery have profoundly changed the management of metastatic colorectal cancer (mCRC) patients. Then the development of prognostic and predictive scores would be useful to stratify the treatments. Tumor radiological measurement is crucial to estimate treatment efficacy, and to predict pathological response and survival, and this parameter is included when a prognostic score is developed. But the standard size-based radiologic criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), was designed ten years ago to assess tumor volume reduction after cytotoxic chemotherapy only. Nowadays, this method may be insufficient for mCRC patients. The aim of this review is to describe the different radiological assessments evaluated in mCRC, and to underline their correlations with patient's survival and pathologic response. A better knowledge of these radiological measurements would help to better integrate them in prospective trials, and in the prognostic and predictive scores. The choice of radiological measurement could be discussed regarding patient's situation, combining different approaches, and assessing tumoral mass quantification.
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Affiliation(s)
- Achille Fabre
- Besançon University Hospital, Department of Radiology, 25000 Besançon, France
| | - Nicolas Badet
- Clinique Saint-Vincent, Department of Radiology, 25000 Besançon, France
| | - Paul Calame
- Besançon University Hospital, Department of Radiology, 25000 Besançon, France
| | - Eric Delabrousse
- Besançon University Hospital, Department of Radiology, 25000 Besançon, France
| | - Mylène Wespiser
- University Hospital, Department of Medical Oncology, 25000 Besançon, France
| | - Celia Turco
- Besançon University Hospital, Department of Digestive Surgery, 25000 Besançon, France
| | - Christophe Borg
- University Hospital, Department of Medical Oncology, 25000 Besançon, France; University of Franche-Comté, Unit 1098, Inserm, 25000 Besançon, France
| | - Marine Jary
- University Hospital, Department of Medical Oncology, 25000 Besançon, France; University of Franche-Comté, Unit 1098, Inserm, 25000 Besançon, France.
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27
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Kim S, Meurisse A, Stouvenot M, Jary M, Hon TNT, Francois E, Buecher B, Andre T, Samalin E, Boulbair F, De Bari B, Almotlak H, Klajer E, Calcagno F, Chatillon E, Spehner L, Jacquin M, Vendrely V, Vernerey D, Borg C. Updated data of epitopes-HPV02 trial and external validation of efficacy of DCF in prospective epitopes-HPV01 study in advanced anal squamous cell carcinoma. Pooled analysis of 115 patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Mouillet G, Fritzsch J, Thiery-Vuillemin A, Meneveau N, Almotlak H, Mansi L, Curtit E, Kim S, Jary M, Maurina T, Eberst G, Barthelemy P, Eymard JC, Geoffrois L, Djoumakh O, Anota A, Adotevi O, Westeel V, Paget-Bailly S. Physicians’ satisfaction with health-related quality of life (HRQoL) assessment in daily clinical practice using electronic patient-reported outcome (ePRO) for cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Loyon R, Jary M, Salomé B, Gomez-Cadena A, Galaine J, Kroemer M, Romero P, Trabanelli S, Adotévi O, Borg C, Jandus C. Peripheral Innate Lymphoid Cells Are Increased in First Line Metastatic Colorectal Carcinoma Patients: A Negative Correlation With Th1 Immune Responses. Front Immunol 2019; 10:2121. [PMID: 31555301 PMCID: PMC6742701 DOI: 10.3389/fimmu.2019.02121] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/23/2019] [Indexed: 01/26/2023] Open
Abstract
Several distinct innate lymphoid cell (ILC) populations have been recently identified and shown to play a critical role in the immediate immune defense. In the context of tumors, there is evidence to support a dual role for ILCs with pro- or antitumor effects, depending on the ILC subset and the type of cancer. This ambivalent role has been particularly well-described in colorectal cancer models (CRC), but the presence and the evolution of ILCs in the peripheral blood of metastatic CRC (mCRC) patients have not yet been explored. Here, we investigated the distribution of ILC subsets in 96 mCRC patients who were prospectively included in the “Epitopes-CRC02” trial. Peripheral blood mononuclear cells (PBMCs) were analyzed by flow cytometry at metastatic diagnosis and after 3-months of treatment. The treatments consisted of Oxaliplatin-based chemotherapies for 76% of the patients or Folfiri (5FU, Irinotecan) chemotherapies for 14% of patients. Compared to healthy donors, the frequency of total ILCs was dramatically increased at metastatic diagnosis. CD56+ ILC1-like cells were expanded, whereas ILC2, NCR− ILCP and NCR+ ILCP subsets were decreased. Combined analysis with the systemic anti-telomerase hTERT Th1 CD4 response revealed that patients with low anti-TERT Th1 CD4 responses had the highest frequencies of total ILCs at diagnosis. Of those, 91% had synchronous metastases, and their median progression-free survival was 7.43 months (vs. 9.17 months for the other patients). In these patients, ILC1 and ILC2 were significantly decreased, whereas CD56+ ILC1-like cells were significantly increased compared to patients with low frequency of total ILCs and high anti-TERT responses. After treatment, the NCR+ ILCP were further decreased irrespective of the chemotherapy regimen, whereas the balance between ILC1 and CD56+ ILC1-like cells was modulated mainly by the Folfiri regimen in favor of ILC1. Altogether our results describe the effects of different chemotherapies on ILCs in mCRC patients. We also establish for the first time a link between frequency of ILCs and anti-tumor CD4 T cell responses in cancer patients. Thus, our study supports an interest in monitoring ILCs during cancer therapy to possibly identify predictive biomarkers in mCRC.
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Affiliation(s)
- Romain Loyon
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
| | - Marine Jary
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,INSERM CIC-1431, Clinical Investigation Center in Biotherapy, University Hospital of Besançon, Besançon, France
| | - Bérengère Salomé
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
| | - Alejandra Gomez-Cadena
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
| | - Jeanne Galaine
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Marie Kroemer
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | - Pedro Romero
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
| | - Sara Trabanelli
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
| | - Olivier Adotévi
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Camilla Jandus
- Department of Oncology UNIL CHUV, Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne, Switzerland
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30
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Galaine J, Turco C, Vauchy C, Royer B, Mercier-Letondal P, Queiroz L, Loyon R, Mouget V, Boidot R, Laheurte C, Lakkis Z, Jary M, Adotévi O, Borg C, Godet Y. CD4 T cells target colorectal cancer antigens upregulated by oxaliplatin. Int J Cancer 2019; 145:3112-3125. [PMID: 31396953 DOI: 10.1002/ijc.32620] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
Immune checkpoint blockade has proven its efficacy in hypermutated subtypes of metastatic colorectal cancers (mCRC). Immunogenic potential can also be observed with conventional chemotherapies, but this property has never been explored thoroughly in CRC patients. The CRC therapeutic arsenal includes oxaliplatin, a well-characterized platinum drug already described as immunogenic. Here, we investigated the impact of the oxaliplatin-based treatment on mCRC immunopeptidome. We demonstrated that oxaliplatin-resistant CRC cell lines overexpressed telomerase reverse transcriptase (TERT), colorectal-associated-tumor antigen-1 (COA-1) and mesothelin tumor-associated antigens. We identified new HLA class-II-restricted and promiscuous peptides derived from COA-1 and mesothelin. The two naturally processed peptides COA-1331-345 and Meso366-380 appear to be the most immunogenic in mCRC patients. A prospective cohort of 162 mCRC patients enabled us to explore the impact of oxaliplatin exposure on the antitumor-specific immune response. Interestingly, chemotherapy-naive mCRC patients present high immune CD4 T-cell responses directed against TERT, COA-1 and mesothelin-derived peptides. These antitumor T-cell responses were maintained after 3 months of oxaliplatin-based treatment. Altogether, these findings highlight the interest of immunostimulatory agents to improve the management of chemoresistant mCRC patients. Finally, the high frequency of immune responses targeting the new immunogenic peptides derived from COA-1 and mesothelin support their use in immunomonitoring strategies.
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Affiliation(s)
- Jeanne Galaine
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Célia Turco
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of Gastrointestinal Surgery, Besançon, France
| | - Charline Vauchy
- INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center un Biotherapy, Fédération Hospitalo-Universitaire INCREASE, LabEx LipSTIC, Besançon, France
| | - Bernard Royer
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of pharmacotoxicology, Besançon, France
| | - Patricia Mercier-Letondal
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Lise Queiroz
- INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center un Biotherapy, Fédération Hospitalo-Universitaire INCREASE, LabEx LipSTIC, Besançon, France
| | - Romain Loyon
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Virginie Mouget
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Romain Boidot
- Centre Georges-François Leclerc, Platform for Transfer to Cancer Biology, Dijon, France
| | - Caroline Laheurte
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,EFS Bourgogne Franche-Comté, INSERM CIC-1431, CHRU Besançon, Plateforme de BioMonitoring, Besançon, France
| | - Zaher Lakkis
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of Gastrointestinal Surgery, Besançon, France
| | - Marine Jary
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, Besançon, France
| | - Olivier Adotévi
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, Besançon, France
| | - Christophe Borg
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, Besançon, France
| | - Yann Godet
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
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31
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Bernard-Tessier A, Jeannot E, Guenat D, Debernardi A, Michel M, Proudhon C, Vincent-Salomon A, Bièche I, Pierga JY, Buecher B, Meurisse A, François É, Cohen R, Jary M, Vendrely V, Samalin E, El Hajbi F, Baba-Hamed N, Borg C, Bidard FC, Kim S. Clinical Validity of HPV Circulating Tumor DNA in Advanced Anal Carcinoma: An Ancillary Study to the Epitopes-HPV02 Trial. Clin Cancer Res 2018; 25:2109-2115. [DOI: 10.1158/1078-0432.ccr-18-2984] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 11/16/2022]
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32
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Vrecko S, Guenat D, Mercier-Letondal P, Faucheu H, Dosset M, Royer B, Galaine J, Boidot R, Kim S, Jary M, Adotévi O, Borg C, Godet Y. Personalized identification of tumor-associated immunogenic neoepitopes in hepatocellular carcinoma in complete remission after sorafenib treatment. Oncotarget 2018; 9:35394-35407. [PMID: 30459932 PMCID: PMC6226040 DOI: 10.18632/oncotarget.26247] [Citation(s) in RCA: 6] [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: 06/23/2018] [Accepted: 10/08/2018] [Indexed: 12/11/2022] Open
Abstract
Sorafenib, a multi-targeted kinase inhibitor, is the current standard systemic treatment for advanced hepatocellular carcinoma. Sorafenib has anti-angiogenic and anti-proliferative properties and is also known to favor anti-tumor T cell responses by reducing the population of immunosuppressive cells such as Treg and MDSC. Anti-tumor immune responses, especially mediated by CD4+ T-cells, are critical for tumor cells eradication and therapies modulating those responses are appealing in a growing number of cancers. Here, we report and investigate the case of a patient diagnosed with an advanced HCC treated by sorafenib who experienced a complete histological response. We aimed to identify immunogenic peptides derived from tumor mutated proteins that stimulated CD4+ T cells responses thus favoring the exceptional recovery process of this patient. Tumor neoantigens were identified using whole exome sequencing of normal and tumor tissue and peptide MHC binding prediction algorithms. Among 442 tumor-specific somatic variants, 50 missense mutations and 20 neoepitopes predicted to bind MHC-II were identified. Candidate neoepitopes immunogenicity was assessed by IFN-γ ELISpot after culture of patient's PBMCs in presence of synthetic neopeptides. CD4+ memory T cell responses were detected against a mutated IL-1βS230F peptide and two additional neoepitopes from HELZ2V241M and MLL2A4458V suggesting that efficient anti-tumor immune response occurred in this patient. These results showed that T cells can recognize neoantigens and may lead to the cancer elimination after immunomodulation in the tumor-microenvironment induced by sorafenib. This observation indicates that other immunotherapies in combination with sorafenib could potentially increase the response rate in HCC at advanced stage.
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Affiliation(s)
- Sindy Vrecko
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
| | - David Guenat
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon F-25000, France
- University Hospital of Besançon, Department of Molecular and Cell Biology, Besançon F-25000, France
- Stanford Cancer Institute, Department of Medicine, Division of Oncology, Stanford University, Stanford, CA 94305, USA
| | - Patricia Mercier-Letondal
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
| | - Hugues Faucheu
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Hospital of Besançon, Department of Molecular and Cell Biology, Besançon F-25000, France
| | - Magalie Dosset
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon F-25000, France
| | - Bernard Royer
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Hospital of Besançon, Department of Pharmacology, Besançon F-25000, France
| | - Jeanne Galaine
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
| | - Romain Boidot
- Centre Georges-François Leclerc, Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre de Recherche INSERM LNC-UMR123, Dijon F-21000, France
| | - Stefano Kim
- University Hospital of Besançon, Department of Medical Oncology, Besançon F-25000, France
| | - Marine Jary
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Hospital of Besançon, Department of Medical Oncology, Besançon F-25000, France
| | - Olivier Adotévi
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Hospital of Besançon, Department of Medical Oncology, Besançon F-25000, France
| | - Christophe Borg
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- University Hospital of Besançon, Department of Medical Oncology, Besançon F-25000, France
| | - Yann Godet
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
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Bernard-Tessier A, Jeannot E, Guenat D, Michel M, Proudhon C, Vincent-Salomon A, Bièche I, Pierga JY, Buecher B, Francois E, Kim S, André T, Jary M, Vendrely V, Samalin E, El Hajbi F, Baba-Hamed N, Meurisse A, Bidard FC, Borg C. HPV circulating tumor DNA as predictive biomarker of sustained response to chemotherapy in advanced anal carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.092] [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: 11/14/2022] Open
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Kim S, François E, André T, Samalin E, Jary M, El Hajbi F, Baba-Hamed N, Pernot S, Kaminsky MC, Bouché O, Desrame J, Zoubir M, Ghiringhelli F, Parzy A, De La Fouchardiere C, Smith D, Deberne M, Spehner L, Badet N, Adotevi O, Anota A, Meurisse A, Vernerey D, Taieb J, Vendrely V, Buecher B, Borg C. Docetaxel, cisplatin, and fluorouracil chemotherapy for metastatic or unresectable locally recurrent anal squamous cell carcinoma (Epitopes-HPV02): a multicentre, single-arm, phase 2 study. Lancet Oncol 2018; 19:1094-1106. [PMID: 30042063 DOI: 10.1016/s1470-2045(18)30321-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of anal squamous cell carcinoma has been increasing markedly in the past few decades. Currently, there is no validated treatment for advanced-stage anal squamous cell carcinoma. Therefore, we aimed to validate the clinical activity and safety of docetaxel, cisplatin, and fluorouracil (DCF) chemotherapy in patients with metastatic or unresectable locally recurrent anal squamous cell carcinoma. METHODS We did a multicentre, single-arm, phase 2 study. We recruited patients from 25 academic hospitals, cancer research centres, and community hospitals in France who were aged 18 years or older with histologically confirmed anal squamous cell carcinoma, with metastatic disease or with unresectable local recurrence; an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; and with at least one evaluable lesion according to the Response Evaluation Criteria in Solid Tumors (version 1.1). Chemotherapy-naive patients received either six cycles of standard DCF (75 mg/m2 docetaxel and 75 mg/m2 cisplatin on day 1 and 750 mg/m2 per day of fluorouracil for 5 days, every 3 weeks) or eight cycles of modified DCF (40 mg/m2 docetaxel and 40 mg/m2 cisplatin on day 1 and 1200 mg/m2 per day of fluorouracil for 2 days, every 2 weeks), which were administered intravenously. The choice between the standard versus modified regimens was recommended based on, but not limited to, age (≤75 years vs >75 years) and ECOG performance status (0 vs 1). The primary endpoint was investigator-assessed progression-free survival at 12 months from the first DCF cycle; for the primary endpoint to be met, at least 11 (17%) of 66 enrolled patients had to be alive without disease progression at 12 months. Efficacy and safety analyses were done in a modified intention-to-treat population, defined as all patients who were evaluable for progression at 12 months who received at least one cycle of DCF. This trial is registered at ClinicalTrials.gov, number NCT02402842, and the final results are presented here. FINDINGS Between Sept 17, 2014, and Dec 7, 2016, we enrolled 69 patients. Of these patients, three did not receive DCF. Of the 66 patients who received treatment, 36 received the standard DCF regimen and 30 received modified DCF. The primary endpoint was met: 31 (47%) of 66 patients were alive and progression free at 12 months. 22 (61%) of 36 patients who received the standard DCF regimen and 18 (60%) of 30 patients who received the modified DCF regimen had disease progression at data cutoff. 46 (70%) of 66 patients had at least one grade 3-4 adverse event (30 [83%] of 36 in the standard DCF regimen and 16 [53%] of 30 in the modified DCF regimen). The most common grade 3-4 adverse events were neutropenia (15 [23%]; eight [22%] for standard DCF vs seven [23%] for modified DCF), diarrhoea (12 [18%]; nine [25%] vs three [10%]), asthenia (ten [15%]; eight [22%] vs two [7%]), anaemia (ten [15%]; six [17%] vs four [13%]), lymphopenia (eight [12%]; three [8%] vs five [17%]), mucositis (seven [11%]; seven [19%] vs none), and vomiting (seven [11%]; five [14%] vs two [7%]). No grade 4 non-haematological adverse events and febrile neutropenia were observed with modified DCF, whereas three (8%) grade 4 non-haematological adverse events and five (14%) cases of febrile neutropenia were reported with standard DCF. 97 serious adverse events were reported (69 in patients who received the standard DCF regimen [61 drug-related] and 28 in those given the modified DCF regimen [14 drug-related]). No treatment-related deaths were recorded. INTERPRETATION Compared with standard DCF, modified DCF provided long-lasting response with good tolerability in patients with metastatic or unresectable locally recurrent anal squamous cell carcinoma with ECOG performance status of 0-1 in the first-line setting, and therefore could be considered as a new standard of care for these patients. Regarding the elevated risk of high-grade and serious adverse events and febrile neutropenia, standard DCF cannot be recommended in this situation. FUNDING Besançon University Hospital and Ligue contre le cancer Grand-Est.
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Affiliation(s)
- Stefano Kim
- Department of Oncology, University Hospital of Besancon, Centre Hospitalier Universitaire de Besançon, Besançon, France; Department of Oncology and Radiotherapy, Hôpital Nord Franche Comté, Montbéliard, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France; Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.
| | - Eric François
- Medical Oncology Department, Centre Antoine-Lacassagne, Nice, France
| | - Thierry André
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France; Department of Medical Oncology, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris and Sorbonne Universités, Paris, France
| | - Emmanuelle Samalin
- Department of Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Marine Jary
- Department of Oncology, University Hospital of Besancon, Centre Hospitalier Universitaire de Besançon, Besançon, France; Department of Oncology and Radiotherapy, Hôpital Nord Franche Comté, Montbéliard, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France; Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France
| | - Farid El Hajbi
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - Nabil Baba-Hamed
- Department of Oncology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Simon Pernot
- Department of Oncology, Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Olivier Bouché
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France; Department of Oncology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Jérôme Desrame
- Department of Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mustapha Zoubir
- Department of Oncology, Hôpital Privé des Peupliers, Paris, France
| | | | - Aurélie Parzy
- Department of Oncology, Centre François Baclesse, Caen, France
| | | | - Denis Smith
- Department of Oncology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Mélanie Deberne
- Department of Oncology, Centre Hospitalier Lyon Sud, Lyon, France
| | - Laurie Spehner
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
| | - Nicolas Badet
- Department of Oncology, Clinique Saint Vincent, Besançon, France
| | - Olivier Adotevi
- Department of Oncology, University Hospital of Besancon, Centre Hospitalier Universitaire de Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France; French National Platform Quality of Life and Cancer, Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France; Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France
| | - Julien Taieb
- Department of Oncology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Véronique Vendrely
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France; Department of Oncology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Bruno Buecher
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France; Department of Oncology, Institut Curie, Paris, France
| | - Christophe Borg
- Department of Oncology, University Hospital of Besancon, Centre Hospitalier Universitaire de Besançon, Besançon, France; Department of Oncology and Radiotherapy, Hôpital Nord Franche Comté, Montbéliard, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France; Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France
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Adotevi O, Godet Y, Galaine J, Lakkis Z, Idirene I, Certoux JM, Jary M, Loyon R, Laheurte C, Kim S, Dormoy A, Pouthier F, Barisien C, Fein F, Tiberghien P, Pivot X, Valmary-Degano S, Ferrand C, Morel P, Delabrousse E, Borg C. In situ delivery of allogeneic natural killer cell (NK) combined with Cetuximab in liver metastases of gastrointestinal carcinoma: A phase I clinical trial. Oncoimmunology 2018; 7:e1424673. [PMID: 29721386 DOI: 10.1080/2162402x.2018.1424673] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 01/08/2023] Open
Abstract
Despite successful introduction of NK-based cellular therapy in the treatment of myeloid leukemia, the potential use of NK alloreactivity in solid malignancies is still elusive. We performed a phase I clinical trial to assess the safety and efficacy of in situ delivery of allogeneic NK cells combined with cetuximab in liver metastasis of gastrointestinal origin. The conditioning chemotherapy was administrated before the allogeneic NK cells injection via hepatic artery. Three escalating doses were tested (3.106, 8.106 and 12.106 NK cells/kg) following by a high-dose interleukin-2 (IL-2). Cetuximab was administered intravenously every week for 7 weeks. Nine patients with liver metastases of colorectal or pancreatic cancers were included, three per dose level. Hepatic artery injection was successfully performed in all patients with no report of dose-limiting toxicity. Two patients had febrile aplasia requiring a short-term antibiotherapy. Grade 3/4 anemia and thrombopenia were also observed related to the chemotherapy. Objective clinical responses were documented in 3 patients and among them 2 occurred in patients injected with cell products harboring two KIR ligand mismatches and one in a patient with one KIR ligand mismatch. Immune monitoring revealed that most patients presented an increase but transient of IL-15 and IL-7 cytokines levels one week after chemotherapy. Furthermore, a high expansion of FoxP3+regulatory T cells and PD-1+ T cells was observed in all patients, related to IL-2 administration. Our results demonstrated that combining allogeneic NK cells transfer via intra-hepatic artery, cetuximab and a high-dose IL-2 is feasible, well tolerated and may result in clinical responses.
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Affiliation(s)
- O Adotevi
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, F-25000 Besançon, France
| | - Y Godet
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - J Galaine
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - Z Lakkis
- University Hospital of Besançon, Department of Gastrointestinal and liver surgery, F-25000 Besançon, France
| | - I Idirene
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - J M Certoux
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - M Jary
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, F-25000 Besançon, France
| | - R Loyon
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - C Laheurte
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,Etablissement Français du Sang Bourgogne Franche-Comté, plateforme de BioMonitoring, F-25000 Besançon, France.,INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center in Biotherapy, F-25000, Besançon, France
| | - S Kim
- University Hospital of Besançon, Department of Medical Oncology, F-25000 Besançon, France
| | - A Dormoy
- Etablissement Français du Sang Bourgogne Franche-Comté, F-25000 Besançon, France
| | - F Pouthier
- Etablissement Français du Sang Bourgogne Franche-Comté, F-25000 Besançon, France
| | - C Barisien
- Etablissement Français du Sang Bourgogne Franche-Comté, F-25000 Besançon, France
| | - F Fein
- University Hospital of Besançon, Department of Gastroenterology, F-25000 Besançon, France
| | - P Tiberghien
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - X Pivot
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, F-25000 Besançon, France
| | - S Valmary-Degano
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,University Hospital of Besançon, Department of Pathology, F-25000 Besançon, France
| | - C Ferrand
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France
| | - P Morel
- Etablissement Français du Sang Bourgogne Franche-Comté, F-25000 Besançon, France
| | - E Delabrousse
- University Hospital of Besançon, Department of Radiology, F-25000, Besançon, France
| | - C Borg
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000 Besançon, France.,University Hospital of Besançon, Department of Medical Oncology, F-25000 Besançon, France
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Kroemer M, Spehner L, Mercier-Letondal P, Boullerot L, Kim S, Jary M, Galaine J, Picard E, Ferrand C, Nguyen T, Larosa F, Adotévi O, Godet Y, Borg C. SALL4 oncogene is an immunogenic antigen presented in various HLA-DR contexts. Oncoimmunology 2018; 7:e1412030. [PMID: 29632725 PMCID: PMC5889287 DOI: 10.1080/2162402x.2017.1412030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/11/2017] [Accepted: 11/26/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose: To investigate the immunoprevalence of SALL4-derived peptides in healthy volunteers and cancer patients. Experimental Design: A multistep approach including prediction algorithms was used to design in silico SALL4-derived peptides theoretically able to bind on common HLA-DR and HLA-A/B molecules. The presence of T-cell responses after a long term T-cell assay (28 days) against SALL4 was monitored in 14 healthy donors and the presence of T-cell responses after a short term T-cell assay (10 days) was monitored in 67 cancer patients using IFN-γ ELISPOT assay. A T-cell clone specific for the immunoprevalent A18 K-derived peptide was isolated, characterized and used as a tool to characterize the natural processing of A18 K. Results: A SALL4 specific T-cell repertoire was present in healthy donors (8/14) and cancer patients (29/67) after short term T-cell assay. We further identified two immunoprevalant SALL4-derived peptides, R18 A and A18 K, which bind MHC-class II. In parallel, an A18 K specific Th1 clone recognized monocyte derived Dendritic Cell (moDC) loaded with SALL4 containing cell lysate. The level of IFN-γ secreted by specific T-cell clone was greater in presence of moDC loaded with SALL4 containing cell lysate (49.23 ± 14.02%) than with moDC alone (18.03 ± 3.072%) (p = 0.0477) Conclusion: These results show for the first time immunogenicity of SALL4 oncogenic protein-derived peptides, especially A18 K and R18 A peptides and make them potential targets for personalized medicine. Thus, SALL4 possess major characteristics of a tumor antigen.
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Affiliation(s)
- Marie Kroemer
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
- Department of pharmacy, University hospital of Besançon, Besançon, France
| | - Laurie Spehner
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Patricia Mercier-Letondal
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Laura Boullerot
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Stefano Kim
- Department of medical oncology, University Hospital of Besançon, Besançon, France
| | - Marine Jary
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
- Department of medical oncology, University Hospital of Besançon, Besançon, France
| | - Jeanne Galaine
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Emilie Picard
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Christophe Ferrand
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Thierry Nguyen
- Department of medical oncology, University Hospital of Besançon, Besançon, France
| | - Fabrice Larosa
- Department of hematology, University Hospital of Besançon, Besançon, France
| | - Olivier Adotévi
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
- Department of medical oncology, University Hospital of Besançon, Besançon, France
| | - Yann Godet
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
| | - Christophe Borg
- University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France
- Department of medical oncology, University Hospital of Besançon, Besançon, France
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Asgarov K, Balland J, Tirole C, Bouard A, Mougey V, Ramos D, Barroso A, Zangiacomi V, Jary M, Kim S, Gonzalez-Pajuelo M, Royer B, de Haard H, Clark A, Wijdenes J, Borg C. A new anti-mesothelin antibody targets selectively the membrane-associated form. MAbs 2017; 9:567-577. [PMID: 28353419 DOI: 10.1080/19420862.2017.1288770] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Mesothelin is a glycosylphosphatidylinositol (GPI)-anchored membrane protein that shows promise as a target for antibody-directed cancer therapy. High levels of soluble forms of the antigen represent a barrier to directing therapy to cellular targets. The ability to develop antibodies that can selectively discriminate between membrane-bound and soluble conformations of a specific protein, and thus target only the membrane-associated antigen, is a substantive issue. We show that use of a tolerance protocol provides a route to such discrimination. Mice were tolerized with soluble mesothelin and a second round of immunizations was performed using mesothelin transfected P815 cells. RNA extracted from splenocytes was used in phage display to obtain mesothelin-specific antigen-binding fragments (Fabs) that were subsequently screened by flow cytometry and ELISA. This approach generated 147 different Fabs in 34 VH-CDR3 families. Utilizing competition assays with soluble protein and mesothelin-containing serum obtained from metastatic cancer patients, 10 of these 34 VH-CDR3 families were found to bind exclusively to the membrane-associated form of mesothelin. Epitope mapping performed for the 1H7 clone showed that it does not recognize GPI anchor. VH-CDR3 sequence analysis of all Fabs showed significant differences between Fabs selective for the membrane-associated form of the antigen and those that recognize both membrane bound and soluble forms. This work demonstrates the potential to generate an antibody specific to the membrane-bound form of mesothelin. 1H7 offers potential for therapeutic application against mesothelin-bearing tumors, which would be largely unaffected by the presence of the soluble antigen.
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Affiliation(s)
- Kamal Asgarov
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France
| | - Jeremy Balland
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France
| | - Charline Tirole
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France
| | - Adeline Bouard
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France
| | - Virginie Mougey
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,c Blood Bank Bourgogne-Franche-comté , Porto , Portugal
| | | | | | - Vincent Zangiacomi
- b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France
| | - Marine Jary
- e J.Minjoz University Hospital , Besançon Cedex , France
| | - Stefano Kim
- e J.Minjoz University Hospital , Besançon Cedex , France
| | | | - Bernard Royer
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France.,e J.Minjoz University Hospital , Besançon Cedex , France
| | | | | | | | - Christophe Borg
- a University of Bourgogne-Franche-Comte , Besançon Cedex , France.,b ITAC Platform of Clinical Investigation Center-Biotherapy , Besançon Cedex , France.,c Blood Bank Bourgogne-Franche-comté , Porto , Portugal.,e J.Minjoz University Hospital , Besançon Cedex , France
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Gérard C, Fagnoni P, Vienot A, Borg C, Limat S, Daval F, Calais F, Vardanega J, Jary M, Nerich V. A systematic review of economic evaluation in pancreatic ductal adenocarcinoma. Eur J Cancer 2017; 86:207-216. [PMID: 29024890 DOI: 10.1016/j.ejca.2017.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/08/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The economic evaluation (EE) of healthcare interventions has become a necessity. However, high quality needs to be ensured in order to achieve validated results and help making informed decisions. Thus, the objective of the present study was to systematically identify and review published pancreatic ductal adenocarcinoma-related EEs and to assess their quality. METHODS Systematic literature research was conducted in PubMed and Cochrane to identify published EEs between 2000 and 2015. The quality of each selected EE was assessed by two independent reviewers, using the Drummond's checklist. RESULTS Our systematic review was based on 32 EEs and showed a wide variety of methodological approaches, including different perspectives, time horizon, and cost effectiveness analyses. Nearly two-thirds of EEs are full EEs (n = 21), and about one-third of EEs had a Drummond score ≥7, synonymous with 'high quality'. Close to 50% of full EEs had a Drummond score ≥7, whereas all of partial EEs had a Drummond score <7 (n = 11). CONCLUSIONS Over the past 15 years, a lot of interest has been evinced over the EE of pancreatic ductal adenocarcinoma (PDAC) and its direct impact on therapeutic advances in PDAC. To provide a framework for health care decision-making, to facilitate transferability and to lend credibility to health EEs, their quality must be improved. For the last 4 years, a tendency towards a quality improvement of these studies has been observed, probably coupled with a context of rational decision-making in health care, a better and wider spread of recommendations and thus, medical practitioners' full endorsement.
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Affiliation(s)
- Claire Gérard
- Department of Pharmacy, University Hospital of Besançon, Besançon, France; INSERM UMR 1098, University of Bourgogne - Franche-Comté, Besançon, France
| | - Philippe Fagnoni
- Department of Pharmacy, University Hospital of Dijon, Dijon, France; INSERM UMR 866, University of Bourgogne - Franche-Comté, Dijon, France; EPICAD LNC UMR 1231, University of Bourgogne - Franche-Comté, Dijon, France
| | - Angélique Vienot
- Department of Gastro-enterology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- INSERM UMR 1098, University of Bourgogne - Franche-Comté, Besançon, France; Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, Besançon, France; INSERM UMR 1098, University of Bourgogne - Franche-Comté, Besançon, France
| | - Franck Daval
- Universitary Library, University of Franche-Comté, Besançon, France
| | - François Calais
- Universitary Library, University of Franche-Comté, Besançon, France
| | - Julie Vardanega
- Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | - Marine Jary
- INSERM UMR 1098, University of Bourgogne - Franche-Comté, Besançon, France; Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, Besançon, France; INSERM UMR 1098, University of Bourgogne - Franche-Comté, Besançon, France.
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39
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Jary M, Hasanova R, Faucheu H, Borg C, Feugeas J. Molecular characteristics of Angiopoietin 2-associated Colorectal Carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx510.003] [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: 11/13/2022] Open
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Kim S, Jary M, André T, Vendrely V, Buecher B, François E, Bidard FC, Dumont S, Samalin E, Peiffert D, Pernot S, Baba-Hamed N, El Hajbi F, Bouché O, Desrame J, Parzy A, Zoubir M, Louvet C, Bachet JB, Nguyen T, Abdelghani MB, Smith D, De La Fouchardière C, Aparicio T, Bennouna J, Gornet JM, Jacquin M, Bonnetain F, Borg C. Docetaxel, Cisplatin, and 5-fluorouracil (DCF) chemotherapy in the treatment of metastatic or unresectable locally recurrent anal squamous cell carcinoma: a phase II study of French interdisciplinary GERCOR and FFCD groups (Epitopes-HPV02 study). BMC Cancer 2017; 17:574. [PMID: 28841909 PMCID: PMC5574110 DOI: 10.1186/s12885-017-3566-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
Background The squamous cell carcinoma of the anus (SCCA) is a rare disease, but its incidence is markedly increasing. About 15% of patients are diagnosed at metastatic stage, and more than 20% with a localized disease treated by chemoradiotherapy (CRT) will recur. In advanced SCCA, cisplatin and 5-fluorouracil (CF) combination is the standard option but complete response is a rare event and the prognosis remains poor with most disease progression occurring within the first 12 months. We have previously published the potential role of the addition of docetaxel (D). Among 8 consecutive patients with advanced recurrent SCCA after CRT, the DCF regimen induced a complete response in 4 patients, including 3 pathological complete responses. Then, the Epitopes-HPV02 study was designed to confirm the interest of DCF regimen in SCCA patients. Methods This multicentre phase II trial assesses the DCF regimen in advanced SCCA patients. Main eligibility criteria are: histologically proven SCCA, unresectable locally advanced recurrent or metastatic disease, Eastern Cooperative Oncology Group-performance status (ECOG-PS) <2, and being eligible for DCF. Patients receive either 6 cycles of standard DCF or 8 cycles of modified DCF depending on age (> vs. ≤ 75 years-old) and ECOG-PS (0 vs. 1). The trial was set up based on a Simon’s optimal two-stage design for phase II trials, allowing an early futility interim analysis. The primary endpoint is the observed progression-free survival (PFS) rate at 12 months from the first DCF cycle. A PFS rate below 10% is considered uninteresting, while a PFS rate above 25% is expected. With a unilateral alpha error of 5% and a statistical power of 90%, 66 evaluable patients should be included. Main secondary endpoints are overall survival, PFS, response rate, safety, health-related quality of life, and the correlation of biomarkers with treatment efficacy. Discussion Since the recommended CF regimen is based in a small retrospective analysis and generates a low rate of complete responses, the Epitopes-HPV02 study will establish a new standard in case of a positive result. Associated biomarker studies will contribute to understand the underlying mechanism of resistance and the role of immunity in SCCA. Trial registration NCT02402842, EudraCT: 2014–001789-81.
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Affiliation(s)
- Stefano Kim
- Centre Hospitalier Universitaire de Besançon, Besançon, France. .,Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France. .,INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France. .,Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Besançon, France. .,Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. .,Department of Oncology, Jean Minjoz University Teaching Hospital, 3 Boulevard Alexander Fleming, F-25030, Besancon, France.
| | - Marine Jary
- Centre Hospitalier Universitaire de Besançon, Besançon, France.,Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France.,INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France.,Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Besançon, France
| | - Thierry André
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Besançon, France.,Hôpital Saint Antoine, Paris, France
| | - Véronique Vendrely
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.,Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Bruno Buecher
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.,Institut Curie, Paris, France
| | | | - François-Clément Bidard
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Besançon, France.,Institut Curie, Paris, France
| | | | | | | | - Simon Pernot
- Hôpital européen Georges-Pompidou, Paris, France
| | | | | | - Olivier Bouché
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.,Centre Hospitalier Universitaire de Reims, Reims, France
| | | | | | | | | | | | - Thierry Nguyen
- Centre Hospitalier Universitaire de Besançon, Besançon, France.,Polyclique de Franche-Comté, Besançon, France
| | | | - Denis Smith
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | | | - Marion Jacquin
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France.,Cancéropôle Grand Est, Besançon, France
| | - Franck Bonnetain
- INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,French National Platform Quality of Life and Cancer, Besançon, France
| | - Christophe Borg
- Centre Hospitalier Universitaire de Besançon, Besançon, France.,Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France.,INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France.,Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Besançon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France
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Kim S, Paget-Bailly S, Messager M, Nguyen T, Mathieu P, Lamfichekh N, Fein F, Fratté S, Cléau D, Lakkis Z, Jary M, Sakek N, Jacquin M, Foubert A, Bonnetain F, Mariette C, Fiteni F, Borg C. Perioperative docetaxel, cisplatin, and 5-fluorouracil compared to standard chemotherapy for resectable gastroesophageal adenocarcinoma. Eur J Surg Oncol 2017; 43:218-225. [DOI: 10.1016/j.ejso.2016.06.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/20/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022] Open
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d'Engremont C, Vernerey D, Pointet AL, Simone G, Fein F, Heyd B, Koch S, Vuitton L, Kim S, Jary M, Lamfichek N, Turco C, Lakkis Z, Berger A, Bonnetain F, Taieb J, Bachellier P, Borg C. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer 2016; 16:823. [PMID: 27782813 PMCID: PMC5080693 DOI: 10.1186/s12885-016-2860-6] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background Pancreatic adenocarcinoma (PDAC) incidence is increasing worldwide. Several studies have shown that lymphopenia was correlated with a poor prognosis but the potential interest to measure lymphopenia in the pre and post-operative setting as well as its added value among conventional prognostic factors was never investigated. Methods Data from two independent cohorts in whom patients underwent resection for pancreatic carcinoma were retrospectively recorded. We examined the association between perioperative findings, pre and post-operative lymphocyte counts and overall survival (OS) in univariate and multivariate analyses. Performance assessment and internal validation of the final model were evaluated with Harrell’s C-index, calibration plot and bootstrap sample procedures. Results Three hundred ninety patients were included in the analysis between 2000 and 2011. Pre and post-operative lymphocyte counts were independent prognostic factors associated with OS in multivariate analysis (p = 0.0128 and p = 0.0764, respectively). The addition of lymphocyte count variable to the conventional parameters identified in multivariate analysis (metastatic lymph node ratio, veinous emboli and adjuvant chemotherapy) significantly improved the model discrimination capacity (bootstrap mean difference = 0.04; 95 % CI, 0.01–0.06). The use of a threshold and combining the categorical (≥1000; <1000) information in pre and post lymphocyte counts permitted the identification of 4 subgroups of patients with different prognosis (p < 0.0001). Finally, the description of patients in long-term remission showed that only 3 of 65 (4.6 %) patients with post-operative lymphocyte count under 1000/mm3 were alive 4 years after surgery contrary to 54 of 236 (22.8 %) patients with a post-operative lymphocyte count above 1000/mm3. Conclusion Pre and post-operative lymphopenia are independent prognostic factors for OS and they have an additive value regarding conventional prognostic factors for death-risk stratification and to predict long-term survival. Lymphopenia should be included as stratification factors in future clinical trial assessing overall survival in pancreatic cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2860-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Anne-Laure Pointet
- Department of Gastroenterology and GI oncology, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Gaël Simone
- Department of Digestive Surgery and Liver Transplantation, University hospital of Strasbourg, Strasbourg, France
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Bruno Heyd
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Stéphane Koch
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Najib Lamfichek
- Department of Digestive Surgery, Hospital of Belfort-Montbeliard, Montbeliard, France
| | - Celia Turco
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Anne Berger
- Department of GI Surgery, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Julien Taieb
- Department of Gastroenterology and GI oncology, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Philippe Bachellier
- Department of Digestive Surgery and Liver Transplantation, University hospital of Strasbourg, Strasbourg, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. .,Centre investigation Clinique en biothérapie, CIC-1431, Besançon, France. .,UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon, France. .,Department of Oncology, University Hospital of Besançon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France.
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Kim S, Cayre A, Jary M, Jacquin M, Arbez-Gindre F, Fein F, Lakkis Z, Nguyen T, Borg C. Complete Response to Aflibercept-FOLFIRI in One Patient With Colorectal Cancer Refractory to Bevacizumab-FOLFOX: A Possible Autocrine Vascular Endothelial Growth Factor Receptor 2-Related Mechanism. Clin Colorectal Cancer 2016; 15:e229-e234. [PMID: 27600470 DOI: 10.1016/j.clcc.2016.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/15/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France.
| | - Anne Cayre
- Department of Pathology, Jean Perrin Center, Clermont-Ferrand, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
| | - Marion Jacquin
- Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France
| | | | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Thierry Nguyen
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
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Jary M, Lecomte T, Bouché O, Kim S, Dobi E, Queiroz L, Ghiringhelli F, Etienne H, Léger J, Godet Y, Balland J, Lakkis Z, Adotevi O, Bonnetain F, Borg C, Vernerey D. Prognostic value of baseline seric Syndecan-1 in initially unresectable metastatic colorectal cancer patients: a simple biological score. Int J Cancer 2016; 139:2325-35. [PMID: 27472156 DOI: 10.1002/ijc.30367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 01/17/2023]
Abstract
In first-line metastatic colorectal cancer (mCRC), baseline prognostic factors allowing death risk and treatment strategy stratification are lacking. Syndecan-1 (CD138) soluble form was never described as a prognostic biomarker in mCRC. We investigated its additional prognostic value for overall survival (OS). mCRC patients with unresectable disease at diagnosis were treated with bevacizumab-based chemotherapy in two independent prospective clinical trials (development set: n = 126, validation set: n = 51, study NCT00489697 and study NCT00544011, respectively). Serums were collected at baseline for CD138 measurement. OS determinants were assessed and, based on the final multivariate model, a prognostic score was proposed. Two independent OS prognostic factors were identified: Lactate Dehydrogenase (LDH) high level (p = 0.0066) and log-CD138 high level (p = 0.0190). The determination of CD138 binary information (cutoff: 75 ng/mL) allowed the assessment of a biological prognostic score with CD138 and LDH values, identifying three risk groups for death (median OS= 38.9, 30.1 and 19.8 months for the low, intermediate and high risk groups, respectively; p < 0.0001). This score had a good discrimination ability (C-index = 0.63). These results were externally confirmed in the validation set. Our study provides robust evidence in favor of the additional baseline soluble CD138 prognostic value for OS, in mCRC patients. A simple biological scoring system is proposed including LDH and CD138 binary status values.
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Affiliation(s)
- Marine Jary
- Department of Medical Oncology, University Hospital, Besançon, France. .,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France. .,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.
| | - Thierry Lecomte
- CNRS, Unit 7292, University François-Rabelais, Tours, France.,Department of HepatoGastroenterology and Digestive Oncology, University Hospital, Tours, France
| | - Olivier Bouché
- Department of HepatoGastroenterology and Digestive Oncology, University Hospital Robert Debré, Reims, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France
| | - Erion Dobi
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Lise Queiroz
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | | | - Hélène Etienne
- Department of Medical Oncology, University Hospital, Besançon, France.,Department of Gastroenterology, University Hospital, Besançon, France
| | - Julie Léger
- INSERM, Clinical Investigational Center CIC 1415, Tours, France
| | - Yann Godet
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Jérémy Balland
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital, Besançon, France
| | - Olivier Adotevi
- Department of Medical Oncology, University Hospital, Besançon, France.,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France
| | - Franck Bonnetain
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital, Besançon, France.,INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France
| | - Dewi Vernerey
- INSERM, Unit 1098, University of Bourgogne- Franche Comté, Besançon, France.,Clinical Investigation Center 1431, EFS Bourgogne-Franche Comté, Besançon, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital, Besançon, France
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Galaine J, Kellermann G, Guillaume Y, Boidot R, Picard E, Loyon R, Queiroz L, Boullerot L, Beziaud L, Jary M, Mansi L, André C, Lethier L, Ségal-Bendirdjian E, Borg C, Godet Y, Adotévi O. Heparan Sulfate Proteoglycans Promote Telomerase Internalization and MHC Class II Presentation on Dendritic Cells. J I 2016; 197:1597-608. [DOI: 10.4049/jimmunol.1502633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/01/2016] [Indexed: 01/18/2023]
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Calcagno F, Lenoble S, Lakkis Z, Nguyen T, Limat S, Borg C, Jary M, Kim S, Nerich V. Efficacy, Safety and Cost of Regorafenib in Patients with Metastatic Colorectal Cancer in French Clinical Practice. Clin Med Insights Oncol 2016; 10:59-66. [PMID: 27398042 PMCID: PMC4933532 DOI: 10.4137/cmo.s38335] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/21/2016] [Accepted: 04/23/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regorafenib is an orally administered multikinase inhibitor that has been approved for patients with chemotherapy-refractory metastatic colorectal cancer (mCRC). Even though regorafenib significantly improved survival in two international phase 3 trials (CORRECT and CONCUR), a high rate of treatment-related toxic effects and dose modifications were observed with a modest benefit. The aim of this study was to provide information concerning the efficacy, safety, and cost of regorafenib in patients with mCRC in clinical practice. MATERIAL AND METHODS We retrospectively reviewed patients treated with regorafenib monotherapy for unresectable mCRC in five Franche-Comté cancer hospitals (France). The primary end point was overall survival. Secondary end points were safety and descriptive cost analyses of patients treated with regorafenib in clinical practice. Another aim of this study was to assess the impact of regorafenib prescription on the risk of hospitalization in real-life practice. RESULTS From January 2014 to August 2014, 29 consecutive patients were enrolled. Patients were heavily pretreated and were refractory to standard chemotherapies. The primary tumor sites were the colon and the rectum for 55% and 45% of patients, respectively. Fifteen patients (51%) harbored an RAS mutation. Eastern Cooperative Oncology Group – Performance Status (PS) was 0–1 for 86% of patients and 2 for 14% of patients. Nineteen patients (66%) initially received reduced doses of 120 or 80 mg/day. The median duration of treatment was 2.5 months (range, 0.13–11.4 months). Treatment-related adverse events occurred in 86% of patients. The most frequent adverse events of any grade were fatigue (35%), diarrhea (20%), and hand–foot skin reaction (20%). Grade 3 or 4 treatment-related adverse events occurred in 10 patients (35%). Three patients (10%) were admitted to hospital due to drug-related severe adverse events. The mean cost of patient management with regorafenib for the duration of treatment was 9908 ± 8191€, and median cost was 7917€ (Interquartile range (IQR) 4469-13,042). The median overall survival was six months (95% confidence interval, five to eight months). CONCLUSIONS The safety and efficacy of regorafenib in heavily pretreated mCRC patients was comparable, in our study, to prospective and retrospective trials. Toxic effects were mostly manageable in an outpatient setting. Regorafenib itself represented the most important (93%) part of supported costs. Even though most side effects were manageable in an outpatient setting, severe adverse events occurred from hospitalization in 10% of patients. These data should be confirmed in a larger real-life-based cohort. Identification of predictive biomarkers is needed for mCRC patient selection for regorafenib treatment.
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Affiliation(s)
- Fabien Calcagno
- Department of Medical Oncology, Besançon University Hospital, Besançon, France.; INSERM, UMR 1098, Besançon, France.; University of Bourgogne-Franche-Comté, UMR 1098, SFR IBCT, Besançon, France.; Clinical Investigation Center, Inserm CIC 1431, Besançon, France
| | - Sabrina Lenoble
- Pharmacy Department, Besançon University Hospital, Besançon, France
| | - Zaher Lakkis
- Liver Transplantation and Digestive Surgery Unit, Besançon University Hospital, Besançon, France
| | - Thierry Nguyen
- Department of Medical Oncology, Besançon University Hospital, Besançon, France
| | - Samuel Limat
- University of Bourgogne-Franche-Comté, UMR 1098, SFR IBCT, Besançon, France.; Pharmacy Department, Besançon University Hospital, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, Besançon University Hospital, Besançon, France.; INSERM, UMR 1098, Besançon, France.; University of Bourgogne-Franche-Comté, UMR 1098, SFR IBCT, Besançon, France.; Clinical Investigation Center, Inserm CIC 1431, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, Besançon University Hospital, Besançon, France.; INSERM, UMR 1098, Besançon, France.; University of Bourgogne-Franche-Comté, UMR 1098, SFR IBCT, Besançon, France.; Clinical Investigation Center, Inserm CIC 1431, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, Besançon University Hospital, Besançon, France.; Clinical Investigation Center, Inserm CIC 1431, Besançon, France
| | - Virginie Nerich
- INSERM, UMR 1098, Besançon, France.; University of Bourgogne-Franche-Comté, UMR 1098, SFR IBCT, Besançon, France.; Pharmacy Department, Besançon University Hospital, Besançon, France
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Turco C, Jary M, Kim S, Moltenis M, Degano B, Manzoni P, Nguyen T, Genet B, Rabier MBV, Heyd B, Borg C. Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease. Clin Med Insights Oncol 2015; 9:75-9. [PMID: 26380562 PMCID: PMC4559186 DOI: 10.4137/cmo.s26537] [Citation(s) in RCA: 15] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Gemcitabine is a chemotherapeutic agent frequently used by for the treatment of several malignancies both in the adjuvant and metastatic setting. Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities. We describe a case of pulmonary veno-occlusive disease (PVOD) related to gemcitabine. CASE PRESENTATION The patient was an 83-year-old man with a metastatic pancreatic cancer who was treated by gemcitabine as first-line therapy. He was in good health and received no other chemotherapy. A dose of 1000 mg/m(2) of gemcitabine was administered over a 30-minute intravenous infusion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed. Nevertheless, the patient developed a severe dyspnea, with arterial hypoxemia and very low lung diffusion for carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral pleural effusion, and lymph node enlargement. On echocardiography, there was a suspicion of pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed pulmonary hypertension and normal pulmonary artery occlusion pressure. Diagnosis of PVOD was made, and a gemcitabine-induced toxicity was suspected. A symptomatic treatment was started. At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood gases, and echocardiography. A gemcitabine-induced PVOD is the more likely diagnosis.
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Affiliation(s)
- Célia Turco
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Mélanie Moltenis
- Regional center of Pharmacovigilance, University Hospital of Besançon, Besançon, France
| | - Bruno Degano
- Functional Explorations, University Hospital of Besançon, Besançon, France
| | - Philippe Manzoni
- Radiology and Interventional Pain Management Unit, University Hospital of Besançon, Besançon, France
| | - Thierry Nguyen
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Bruno Genet
- Department of Cardiology, University Hospital of Besançon, Besançon, France
| | | | - Bruno Heyd
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
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Boustani J, Kim S, Lescut N, Lakkis Z, de Billy M, Arbez-Gindre F, Jary M, Borg C, Bosset JF. Primary Linitis Plastica of the Rectum: Focus on Magnetic Resonance Imaging Patterns and Treatment Options. Am J Case Rep 2015; 16:581-5. [PMID: 26322720 PMCID: PMC4559009 DOI: 10.12659/ajcr.893830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Case series Patient: Male, 59 • Male, 85 • Male, 27 Final Diagnosis: refractory metastatic rectal cancer Symptoms: — Medication: — Clinical Procedure: Chemotherapy Specialty: Oncology
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Affiliation(s)
- Jihane Boustani
- Department of Radiotherapy, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Nicolas Lescut
- Department of Radiotherapy, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | | | | | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
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Jary M, Borg C, Bouché O, Kim S, André T, Bennouna J. [Anti-angiogenic treatments in metastatic colorectal cancer: Does a continuous angiogenic blockade make sense?]. Bull Cancer 2015; 102:758-71. [PMID: 26232849 DOI: 10.1016/j.bulcan.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/10/2014] [Indexed: 01/07/2023]
Abstract
Ten years after the approval of bevacizumab in colorectal cancer patients, results from ML18147 and CORRECT studies have recently demonstrated the possibility to target angiogenesis in patients previously exposed to anti-VEGF. An increasing number of anti-angiogenic treatments are now available, however, no biomarker has yet succeeded in rationalizing our therapeutic strategies. Nevertheless, several lessons have been learned from preclinical and pivotal clinical studies. The first clinical trials demonstrated a survival benefit, adding VEGFA targeting monoclonal antibodies to chemotherapy in metastatic colorectal cancer patients (AVF2107, ECOG 3200). Many phase III clinical trials confirmed the interest of this strategy, in combination with chemotherapies containing irinotecan, oxaliplatin, or with 5-fluorouracil in monotherapy. To date, such results have not been reproduced with tyrosine kinase inhibitors targeting the angiogenesis pathways, with an increasing rate of chemotherapy related toxicities. Clinical trials performed in the adjuvant setting (AVANT, NSABPC08) failed to demonstrate any efficacy of the anti-VEGFA treatments on the micrometastatic disease, encouraging its prescription in the unresectable cases. On the other hand, a continuous inhibition of angiogenesis during the course of the metastatic disease was shown to be feasible and to extend colon cancer patient's survival in two recent randomized trials. For these patients, the continuation of bevacizumab beyond progression in first line improves overall survival. Lastly, results achieved by the CORRECT and CONCUR studies demonstrated that anti-angiogenics might be effective in colorectal cancers resistant to chemotherapy. This review presents the main results of preclinical and clinical studies sustaining the prescription of anti-angiogenics in metastatic colorectal cancers. The future challenge is to promote the development of biomarkers to enable the stratification of the different therapeutic strategies.
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Affiliation(s)
- Marine Jary
- CHRU de Besançon, IRFC, service d'oncologie médicale, 25000 Besançon, France.
| | - Christophe Borg
- CHRU de Besançon, IRFC, service d'oncologie médicale, 25000 Besançon, France; Unité Inserm 1098, université de Franche-Comté, 25000 Besançon, France
| | - Olivier Bouché
- CHU de Reims, services de gastroentérologie et d'oncologie médicale, 51100 Reims, France
| | - Stéfano Kim
- CHRU de Besançon, IRFC, service d'oncologie médicale, 25000 Besançon, France
| | - Thierry André
- Hôpital Saint-Antoine, service d'oncologie médicale, 75012 Paris, France
| | - Jaafar Bennouna
- Institut de cancérologie de l'Ouest, Nantes-Angers, 44805 Nantes, France
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Kim S, Fiteni F, Paget-Bailly S, Ghiringhelli F, Lakkis Z, Jary M, Fein F, Bonnetain F, Mariette C, Borg C. The impact of taxane-based preoperative chemotherapy in gastroesophageal signet ring cell adenocarcinomas. J Hematol Oncol 2015; 8:52. [PMID: 25976888 PMCID: PMC4440289 DOI: 10.1186/s13045-015-0148-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/22/2015] [Accepted: 05/06/2015] [Indexed: 12/13/2022] Open
Abstract
The benefit of preoperative chemotherapy in resectable gastroesophageal adenocarcinomas was not observed in signet ring cell subtype. However, the potential interest of taxane-based preoperative chemotherapy on this subtype is still an unresolved issue. Nineteen patients with localized signet ring cell adenocarcinomas received taxane-based regimens, and 17 patients underwent surgery. Complete resection was achieved in 80 %, and median overall survival was 40.8 months (95 % confidence interval (CI), 20.2—not reached). Even though one patient achieved a complete pathological response, seven patients had an upstaging of their tumors at surgery. The potential benefits of taxane-based chemotherapy seem to be limited to a reduced number of patients.
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Affiliation(s)
- Stefano Kim
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Clinical Investigational Centre, CIC-1431, University Hospital of Besançon, Besançon, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
| | - Frederic Fiteni
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
| | - Sophie Paget-Bailly
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
| | | | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France.
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France.
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. .,EA 3181 University of Franche-Comté, Besançon, Besançon, France.
| | | | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Clinical Investigational Centre, CIC-1431, University Hospital of Besançon, Besançon, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
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