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Storme S, Debieuvre D, Souquet PJ, Toffart AC, Couraud S. [Management of immunotherapy in patients with non-small cell lung cancer presenting durable oncological response]. Rev Mal Respir 2022; 39:578-586. [PMID: 35909007 DOI: 10.1016/j.rmr.2022.06.006] [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: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Concerns about the proper schedule for discontinuing immunotherapy have been raised by many clinicians, as well as the minimal check-up required to assess residual disease before stopping immunotherapy. In fact, there currently exist no recommendations concerning immunotherapy prescription and optimal assessment in the event of persistent oncological response in cases of metastatic non-small cell lung cancer (NSCLC). METHODS We conducted an online survey among board-certified French Thoracic Oncologists belonging to two professional associations. The survey included multiple-choice questions that either stood alone or were included in case reports. RESULTS The survey was sent to 490 physicians, of whom 88 responded. For minimal residual disease assessment after 2 years of immunotherapy, PET-scan is prescribed by 92% of respondents and cerebral MRI by 59%. In the event of complete response after 2 years of treatment, 83% of physicians stop prescribing pembrolizumab and 70% discontinue nivolumab. In the event of partial response, 88% of respondents continue immunotherapy. In this case, only 33% use a complementary locoregional treatment such as radiotherapy. CONCLUSION Our survey highlights a pronounced tendency to stop immunotherapy in the event of complete oncological response. In the event of partial morphologic response, on the other hand, there is a tendency to continue immunotherapy. However, the use of locoregional treatments remains more heterogeneous.
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Affiliation(s)
- S Storme
- Faculté de médecine Lyon-Est, Claude-Bernard, université Claude-Bernard, Lyon 1, France.
| | - D Debieuvre
- Service de pneumologie, hôpital Émile-Muller, Mulhouse, France
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France
| | - A-C Toffart
- Service hospitalo-universitaire de pneumologie et physiologie, CHU de Grenoble-Alpes, Grenoble, France
| | - S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France
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Molinier O, Besse B, Barlesi F, Audigier-Valette C, Friard S, Monnet I, Jeannin G, Mazières J, Cadranel J, Hureaux J, Hilgers W, Quoix E, Coudert B, Moro-Sibilot D, Fauchon E, Westeel V, Brun P, Langlais A, Morin F, Souquet PJ, Girard N. IFCT-1502 CLINIVO: real-world evidence of long-term survival with nivolumab in a nationwide cohort of patients with advanced non-small-cell lung cancer. ESMO Open 2021; 7:100353. [PMID: 34953398 PMCID: PMC8764511 DOI: 10.1016/j.esmoop.2021.100353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immunotherapy using inhibitors targeting immune checkpoint programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) is currently the standard of care in patients with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS We carried out a nationwide cohort retrospective study of consecutive patients with advanced, refractory NSCLC who received nivolumab as second to later lines of treatment as part of the expanded access program. Key objectives were to assess the efficacy and safety of nivolumab and the efficacy of first post-nivolumab treatment. RESULTS Nine hundred and two patients were enrolled: 317 (35%) with squamous cell carcinoma and 585 (65%) with non-squamous cell carcinoma. Median age was 64 years; there were 630 (70%) men, 795 (88%) smokers, 723 (81%) patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0/1, 197 (22%) patients with brain metastases, and 212 (27%) with liver metastases. Best response was partial response for 16.2% and stable disease (SD) for 30.5%. Progression-free survival and overall survival (OS) rates at 2, 3, and 5 years were 8% and 25%, 6% and 16%, and 4% and 10%, respectively. At multivariate analysis, ECOG PS ≥2 [hazard ratio (HR) = 2.13, 95% confidence interval (95% CI) 1.78-2.55, P < 0.001], squamous histology (HR = 1.17, 95% CI 1.01-1.36, P = 0.04), and presence of central nervous system metastases (HR = 1.29, 95% CI 1.08-1.54, P = 0.005) were significantly associated with lower OS. Four hundred and ninety-two patients received at least one treatment after discontinuation of nivolumab, consisting of systemic therapies in 450 (91%). Radiation therapy was delivered to 118 (24%) patients. CONCLUSION The CLINIVO cohort represents the largest real-world evidence cohort with the use of immune checkpoint inhibitor in advanced, metastatic NSCLC after failure of first-line chemotherapy, with long-term follow-up and analysis of subsequent therapies. Our data confirm the efficacy of nivolumab in a cohort larger than that reported in landmark clinical trials and identify prognostic factors, which reinforces the need for accurate selection of patients for treatment with immune checkpoint inhibitors. Our data indicate that oligoprogression is frequent after nivolumab exposure and provide a unique insight into the long-term survival.
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Affiliation(s)
- O Molinier
- Pneumology, Centre Hospitalier Du Mans, Le Mans, France
| | - B Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France; Paris-Saclay University, Orsay, France
| | - F Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - C Audigier-Valette
- Pneumology Department, Centre Hospitalier Toulon Sainte-Musse, Toulon, France
| | - S Friard
- Hopital Foch, Chest Department, Suresnes, France
| | - I Monnet
- Pneumology Service, CHI Créteil, Créteil, France
| | - G Jeannin
- Pneumology Service, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - J Mazières
- Pneumology Service, Centre Hospitalier Universitaire de Toulouse, Hôpital Larrey, Pôle Voies Respiratoires, Toulouse, France
| | - J Cadranel
- Pneumology Service, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, GRC n04, Theranoscan, Paris, France
| | - J Hureaux
- Pôle Hippocrate, CHU d'Angers, Angers, France
| | - W Hilgers
- Medical Oncology, Sainte Catherine Cancer Institute, Avignon Provence, France
| | - E Quoix
- Pneumology Service, Hôpitaux Universitaires de Strasbourg-Unistra, Strasbourg, France
| | - B Coudert
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - D Moro-Sibilot
- Pneumology and Thoracic Oncology Department, CHU Grenoble-Alpes, La Tronche, France
| | - E Fauchon
- Pneumology Service, CHI, Saint-Julien-en-Genevois, France
| | - V Westeel
- Pneumology Service, Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | - P Brun
- Pneumology Service, CH de Valence, Valence, France
| | - A Langlais
- Biostatistic Department, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - F Morin
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - P J Souquet
- Pneumology Service, Centre hospitalier Lyon-Sud, Pierre-Bénite, France
| | - N Girard
- Paris-Saclay University, Orsay, France; Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France.
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Reck M, Ciuleanu TE, Cobo M, Schenker M, Zurawski B, Menezes J, Richardet E, Bennouna J, Felip E, Juan-Vidal O, Alexandru A, Sakai H, Lingua A, Reyes F, Souquet PJ, De Marchi P, Martin C, Pérol M, Scherpereel A, Lu S, Paz-Ares L, Carbone DP, Memaj A, Marimuthu S, Zhang X, Tran P, John T. Corrigendum to 'First-line nivolumab plus ipilimumab with 2 cycles of chemotherapy versus chemotherapy alone (4 cycles) in advanced non-small cell lung cancer: CheckMate 9LA 2-year update': [ESMO Open Volume 6, Issue 5, October 2021, 100273]. ESMO Open 2021; 6:100345. [PMID: 34864501 PMCID: PMC8649668 DOI: 10.1016/j.esmoop.2021.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- M Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany.
| | - T-E Ciuleanu
- Department of Oncology, Institutul Oncologic Prof Dr Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - M Cobo
- Department of Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - M Schenker
- Department of Oncology, SF Nectarie Oncology Center, Craiova, Romania
| | - B Zurawski
- Department of Clinical Oncology, Ambulatorium Chemioterapii, Bydgoszcz, Poland
| | - J Menezes
- Department of Oncology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - E Richardet
- Department of Clinical Oncology, Instituto Oncológico de Córdoba, Córdoba, Argentina
| | - J Bennouna
- Department of Thoracic Oncology, University Hospital of Nantes and INSERM, CRCINA, Nantes, France
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - A Alexandru
- Department of Oncology, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania
| | - H Sakai
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
| | - A Lingua
- Department of Medical Oncology, Instituto Medico Rio Cuarto, SA, Córdoba, Argentina
| | - F Reyes
- Department of Medical Oncology, Fundación Arturo López Pérez, Santiago, Metropolitana, Chile
| | - P-J Souquet
- Department of Pneumology, Hôpital Lyon Sud, Lyon, Pierre Bénite, France
| | - P De Marchi
- Department of Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - C Martin
- Department of Thoracic Oncology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - M Pérol
- Department of Thoracic Oncology, Léon Bérard Cancer Center, Lyon, France
| | - A Scherpereel
- Department of Pulmonary and Thoracic Oncology, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | - S Lu
- Department of Medical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China
| | - L Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Clinical Research Unit, Universidad Complutense & CiberOnc, Madrid, Spain
| | - D P Carbone
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - A Memaj
- Bristol Myers Squibb, Princeton, USA
| | | | - X Zhang
- Bristol Myers Squibb, Princeton, USA
| | - P Tran
- Bristol Myers Squibb, Princeton, USA
| | - T John
- Department of Medical Oncology, Austin Hospital, Heidelberg, Australia
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Reck M, Ciuleanu TE, Cobo M, Schenker M, Zurawski B, Menezes J, Richardet E, Bennouna J, Felip E, Juan-Vidal O, Alexandru A, Sakai H, Lingua A, Reyes F, Souquet PJ, De Marchi P, Martin C, Pérol M, Scherpereel A, Lu S, Paz-Ares L, Carbone DP, Memaj A, Marimuthu S, Zhang X, Tran P, John T. First-line nivolumab plus ipilimumab with two cycles of chemotherapy versus chemotherapy alone (four cycles) in advanced non-small-cell lung cancer: CheckMate 9LA 2-year update. ESMO Open 2021; 6:100273. [PMID: 34607285 PMCID: PMC8493593 DOI: 10.1016/j.esmoop.2021.100273] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [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: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND To further characterize survival benefit with first-line nivolumab plus ipilimumab with two cycles of chemotherapy versus chemotherapy alone, we report updated data from the phase III CheckMate 9LA trial with a 2-year minimum follow-up. PATIENTS AND METHODS Adult patients were treatment naïve, with stage IV/recurrent non-small-cell lung cancer, no known sensitizing EGFR/ALK alterations, and an Eastern Cooperative Oncology Group performance status ≤1. Patients were randomized 1 : 1 to nivolumab 360 mg every 3 weeks plus ipilimumab 1 mg/kg every 6 weeks with two cycles of chemotherapy, or four cycles of chemotherapy. Updated efficacy and safety outcomes are reported, along with progression-free survival (PFS) after next line of treatment (PFS2), treatment-related adverse events (TRAEs) by treatment cycle, and efficacy outcomes in patients who discontinued all treatment components in the experimental arm due to TRAEs. RESULTS With a median follow-up of 30.7 months, nivolumab plus ipilimumab with chemotherapy continued to prolong overall survival (OS) versus chemotherapy. Median OS was 15.8 versus 11.0 months [hazard ratio 0.72 (95% confidence interval 0.61-0.86)]; 2-year OS rate was 38% versus 26%. Two-year PFS rate was 20% versus 8%. ORR was 38% versus 25%, respectively; 34% versus 12% of all responses were ongoing at 2 years. Median PFS2 was 13.9 versus 8.7 months. Improved efficacy outcomes in the experimental versus control arm were observed across most subgroups, including by programmed death-ligand 1 and histology. No new safety signals were observed; onset of grade 3/4 TRAEs was mostly observed during the first two treatment cycles in the experimental arm. In patients who discontinued all components of nivolumab plus ipilimumab with chemotherapy treatment due to TRAEs (n = 61) median OS was 27.5 months; 56% of responders had an ongoing response ≥1 year after discontinuation. CONCLUSIONS With a 2-year minimum follow-up, nivolumab plus ipilimumab with two cycles of chemotherapy provided durable efficacy benefits over chemotherapy with a manageable safety profile and remains an efficacious first-line treatment of advanced non-small-cell lung cancer.
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Affiliation(s)
- M Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany.
| | - T-E Ciuleanu
- Department of Oncology, Institutul Oncologic Prof Dr Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - M Cobo
- Department of Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - M Schenker
- Department of Oncology, SF Nectarie Oncology Center, Craiova, Romania
| | - B Zurawski
- Department of Clinical Oncology, Ambulatorium Chemioterapii, Bydgoszcz, Poland
| | - J Menezes
- Department of Oncology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - E Richardet
- Department of Clinical Oncology, Instituto Oncológico de Córdoba, Córdoba, Argentina
| | - J Bennouna
- Department of Thoracic Oncology, University Hospital of Nantes and INSERM, CRCINA, Nantes, France
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - A Alexandru
- Department of Oncology, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania
| | - H Sakai
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
| | - A Lingua
- Department of Medical Oncology, Instituto Medico Rio Cuarto, SA, Córdoba, Argentina
| | - F Reyes
- Department of Medical Oncology, Fundación Arturo López Pérez, Santiago, Metropolitana, Chile
| | - P-J Souquet
- Department of Pneumology, Hôpital Lyon Sud, Lyon, Pierre Bénite, France
| | - P De Marchi
- Department of Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - C Martin
- Department of Thoracic Oncology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - M Pérol
- Department of Thoracic Oncology, Léon Bérard Cancer Center, Lyon, France
| | - A Scherpereel
- Department of Pulmonary and Thoracic Oncology, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | - S Lu
- Department of Medical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China
| | - L Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Clinical Research Unit, Universidad Complutense & CiberOnc, Madrid, Spain
| | - D P Carbone
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - A Memaj
- Bristol Myers Squibb, Princeton, USA
| | | | - X Zhang
- Bristol Myers Squibb, Princeton, USA
| | - P Tran
- Bristol Myers Squibb, Princeton, USA
| | - T John
- Department of Medical Oncology, Austin Hospital, Heidelberg, Australia
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Espi M, Teuma C, Novel-Catin E, Maillet D, Souquet PJ, Dalle S, Koppe L, Fouque D. Renal adverse effects of immune checkpoints inhibitors in clinical practice: ImmuNoTox study. Eur J Cancer 2021; 147:29-39. [PMID: 33607383 DOI: 10.1016/j.ejca.2021.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 10/08/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Acute Kidney Injury (AKI), induced by Checkpoint Inhibitors therapies (CPI-induced AKI), is an uncommon but severe Immune-Related Adverse Event (IRAE). The aim was to describe the epidemiology, risks factors, clinical, and laboratory characteristics of these renal adverse events (AEs) in a real-life cohort treatment. DESIGN/PARTICIPANTS Consecutive patients undergoing a checkpoint inhibitor (CPI) therapy at the Hôpital Lyon Sud from January 2015 to July 2017 were included. A systematic retrospective analysis of medical files was performed, monthly serum creatinine levels, associated treatments, and occurrence of other IRAEs data were collected. AKI episodes explained by classic AKI aetiologies (prerenal, obstructive, septic) were excluded from the analysis. RESULTS CPI-induced AKI incidence was 3.7% (13/352) and appeared to be time-dependent (7.7% (11/143) for patients with >3 months of CPI exposure), ranging from 1 to 16 months. All cases with available histology were acute tubulointerstitial nephritis (ATIN), with poor urinary sediment. The severity of AKI was mild (stage 1 in 50% of cases), with no need for renal-replacement therapy. Although CPI-induced AKI patients had more frequently other IRAEs (77% versus 39%), this was not associated with a greater risk of AKI. Pre-existing chronic kidney disease (defined as an estimated glomerular filtration rate (eGFR) <60 ml/min) was not associated with a greater risk of CPI-induced AKI. Treatments of CPI-induced AKI were heterogeneous, with discontinuation of CPIs, and inconstant systemic corticosteroid therapy. CONCLUSION The monitoring of renal function and early identification of AKI during CPIs treatment is essential. The optimal management of CPI-induced AKI remains unclear and requires a close collaboration between the oncology and nephrology departments. CLINICAL RELEVANCY STATEMENT Immune checkpoint inhibitors (CPIs) have dramatically improved patient outcomes in different malignant contexts such as melanoma, non-small cell lung cancers (NSCLC) and urologic cancers. Usually well-tolerated, CPIs are however associated with immune-related adverse events (IRAEs). Among them, acute kidney injury (AKI) is uncommon, and not well-described. Following the exponential increase in the prescription of CPIs, previously uncommon cases of IRAEs (such as AKI) have become common occurrence in referral centres. Data regarding the epidemiology, risk factors, or management of CPI-induced AKI are currently lacking or can be discordant. Data regarding CPI-induced AKI, in a large real-life cohort were reported herein.
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Affiliation(s)
- M Espi
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France.
| | - C Teuma
- Service de Néphrologie, Hôpital Nord Ouest, 69400, Gleizé, France
| | - E Novel-Catin
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - D Maillet
- Service D'Oncologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - P J Souquet
- Service de Pneumologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - S Dalle
- Service de Dermatologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - L Koppe
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; Univ. Lyon, CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, F-69621, Villeurbanne, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - D Fouque
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
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Blons H, Oudart JB, Merlio JP, Debieuvre D, de Fraipont F, Audigier-Valette C, Escande F, Hominal S, Bringuier PP, Fraboulet-Moreau S, Ouafik L, Moro-Sibilot D, Lemoine A, Langlais A, Missy P, Morin F, Souquet PJ, Barlesi F, Cadranel J, Beau-Faller M. PTEN, ATM, IDH1 mutations and MAPK pathway activation as modulators of PFS and OS in patients treated by first line EGFR TKI, an ancillary study of the French Cooperative Thoracic Intergroup (IFCT) Biomarkers France project. Lung Cancer 2020; 151:69-75. [PMID: 33248711 DOI: 10.1016/j.lungcan.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Tumor mutation screening is standard of care for patients with stage IV NSCLC. Since a couple of years, widespread NGS approaches used in routine diagnostics to detect driver mutations such as EGFR, KRAS, BRAF or MET allows the identification of other alterations that could modulated the intensity or duration of response to targeted therapies. The prevalence of co-occurring alterations that could affect response or prognosis as not been largely analyzed in clinical settings and large cohorts of patients. Thanks to the IFCT program "Biomarkers France", a collection of samples and data at a nation-wide level was available to test the impact of co-mutations on first line EGFR TKI in patients with EGFR mutated cancers. MATERIALS AND METHODS Targeted NGS was assessed on available (n = 208) samples using the Ion AmpliSeq™ Cancer Hotspot Panel v2 to screen for mutations in 50 different cancer genes. RESULTS This study showed that PTEN inactivating mutations, ATM alterations, IDH1 mutations and complex EGFR mutations were predictors of short PFS in patients with a stage 4 lung adenocarcinoma receiving first line EGFR TKI and that PTEN, ATM, IDH1 and KRAS mutations as well as alterations in the MAPK pathway were related to shorter OS. CONCLUSION These findings may lead to new treatment options in patients with unfavorable genotypes to optimize first line responses.
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Affiliation(s)
- H Blons
- HEGP, Biochimie UF de Pharmacogénétique et Oncologie Moléculaire, Paris, France; Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, France
| | - J-B Oudart
- HEGP, Biochimie UF de Pharmacogénétique et Oncologie Moléculaire, Paris, France
| | - J-P Merlio
- Tumor Bank and Tumor Biology Department, CHU Bordeaux, Bordeaux France; INSERM U1053, Univ. Bordeaux, Bordeaux France
| | - D Debieuvre
- Service de pneumologie, GHRMSA-Hôpital Emile Muller, Mulhouse, France
| | - F de Fraipont
- Unité de Génétique Moléculaire, Maladies Héréditaires et Oncologie, CHU Grenoble Alpes, Grenoble, France
| | | | - F Escande
- Laboratoire de Biochimie et Biologie Moléculaire, CHU Lille, France
| | - S Hominal
- Centre Hospitalier Annecy-Genevois, Epagny-Metz Tessy, France
| | - P-P Bringuier
- Institut de Pathologie Multi-Sites des Hospices Civils de Lyon - Site Est, Plateforme de Pathologie Moléculaire, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | | | - L Ouafik
- Aix Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France; APHM, CHU Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - D Moro-Sibilot
- Unité d'Oncologie Thoracique, Service Hospitalier Universitaire Pneumologie Physiologie Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
| | - A Lemoine
- Biochimie et Oncogénétique INSERM UMR-S1193, Hôpital Paul Brousse, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | - A Langlais
- Department of Biostatistics, French Cooperative Thoracic Intergroup, Paris, France
| | - P Missy
- Clinical Research Unit, French Cooperative Thoracic Intergroup, Paris, France
| | - F Morin
- Clinical Research Unit, French Cooperative Thoracic Intergroup, Paris, France
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, Hospices Civils de Lyon, Centre hospitalier Lyon-Sud, Pierre-Bénite, France
| | - F Barlesi
- Aix Marseille University, INSERM, CNRS, CRCM, APHM, Multidisciplinary Oncology & Therapeutic Innovations Department, Marseille, France
| | - J Cadranel
- AP-HP, Hôpital Tenon, Service de Pneumogie, GRC 04 Theranoscan, Sorbonne Université, Paris, France
| | - M Beau-Faller
- Laboratory of Biochemistry and Molecular Biology, Centre Hospitalier Universitaire de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; IRFAC UMR-S1113, Inserm, Université de Strasbourg, Strasbourg, France.
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Moro-Sibilot D, Cozic N, Pérol M, Mazières J, Otto J, Souquet PJ, Bahleda R, Wislez M, Zalcman G, Guibert SD, Barlési F, Mennecier B, Monnet I, Sabatier R, Bota S, Dubos C, Verriele V, Haddad V, Ferretti G, Cortot A, De Fraipont F, Jimenez M, Hoog-Labouret N, Vassal G. Crizotinib in c-MET- or ROS1-positive NSCLC: results of the AcSé phase II trial. Ann Oncol 2019; 30:1985-1991. [PMID: 31584608 DOI: 10.1093/annonc/mdz407] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2013, the French National Cancer Institute initiated the AcSé program to provide patients with secure access to targeted therapies outside of their marketed approvals. Efficacy and safety was then assessed using a two-stage Simon phase II trial design. When the study design was designed, crizotinib was approved only as monotherapy for adults with anaplastic lymphoma kinase plus non-small-cell lung cancers (NSCLC). PATIENTS AND METHODS Advanced NSCLC patients with c-MET ≥6 copies, c-MET-mutated, or ROS-1-translocated tumours were enrolled in one of the three cohorts. Patients were treated with crizotinib 250 mg twice daily. Efficacy was assessed using the objective response rate (ORR) after two cycles of crizotinib as primary outcome. Secondary outcomes included disease control rate at four cycles, best ORR, progression-free survival, overall survival, and drug tolerance. RESULTS From August 2013 to March 2018, 5606 patients had their tumour tested for crizotinib targeted molecular alterations: 252 patients had c-MET ≥6 copies, 74 c-MET-mutation, and 78 ROS-1-translocated tumour. Finally, 25 patients in the c-MET ≥6 copies cohort, 28 in the c-MET-mutation cohort, and 37 in the ROS-1-translocation cohort were treated in the phase II trial. The ORR was 16% in the c-MET ≥6 copies cohort, 10.7% in the mutated, and 47.2% in the ROS-1 cohort. The best ORR during treatment was 32% in the c-MET-≥6 copies cohort, 36% in the c-MET-mutated, and 69.4% in the ROS-1-translocation cohort. Safety data were consistent with that previously reported. CONCLUSIONS Crizotinib activity in patients with ROS1-translocated tumours was confirmed. In the c-MET-mutation and c-MET ≥6 copies cohorts, despite insufficient ORR after two cycles of crizotinib, there are signs of late response not sufficient to justify the development of crizotinib in this indication. The continued targeting of c-MET with innovative therapies appears justified. CLINICAL TRIAL NUMBER NCT02034981.
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Affiliation(s)
- D Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris.
| | - N Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, ESP, Paris-Saclay and Paris-Sud Universities, Villejuif
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon
| | - J Mazières
- Pneumology Department, Toulouse University Hospital and Paul Sabatier University, Toulouse
| | - J Otto
- Department of Medicine, Antoine Lacassagne Cancer Centre, Nice
| | - P J Souquet
- Department of Pneumology and Thoracic Oncology, Lyon Sud Hospital Center, Hospices Civils de Lyon, Pierre Bénite
| | - R Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif
| | - M Wislez
- Pneumology Department, Tenon Hospital, AP-HP and "Pierre and Marie Curie" University, Paris
| | - G Zalcman
- Thoracic Oncology Department-CIC INSERM 1425, Bichat University Hospital, AP-HP, Paris; Paris-Diderot University, Paris
| | | | - F Barlési
- Multidisciplinary Oncology & Therapeutic Innovations Department, APHM and Aix Marseille University, INSERM, CNRS, CRCM, Marseille
| | - B Mennecier
- Pneumology Department, Strasbourg University Hospital, Strasbourg
| | - I Monnet
- Pneumology Department, CHIC Creteil, Créteil
| | - R Sabatier
- Department of Medical Oncology, Inserm 1068, CNRS UMR7258, CRCM, Paoli-Calmettes Institute and Aix-Marseille University, Marseille
| | - S Bota
- Pneumology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen
| | - C Dubos
- Pneumology Department, François Baclesse Cancer Centre, Caen
| | - V Verriele
- Anatomy and Pathological Cytologies Department, Paul Papin Cancer Centre, ICO, Angers
| | - V Haddad
- Department of Tumour Biology, Léon Bérard Cancer Centre, Lyon
| | - G Ferretti
- Radiology and Medical Imaging Department, Grenoble-Alpes University Hospital, Grenoble
| | - A Cortot
- Department of Thoracic Oncology, Lille University Hospital and University of Lille, Lille
| | - F De Fraipont
- Molecular Genetic Unit: Hereditary Diseases and Oncology, Grenoble-Alpes University Hospital, Grenoble
| | - M Jimenez
- Research and Development UNICANCER, Paris
| | | | - G Vassal
- Clinical Research Division, Gustave Roussy Cancer Campus, Villejuif, France
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Amini-Adle M, Balme B, Locatelli-Sanchez M, Souquet PJ, Dalle S. [Oral and mucosal lichenoid drug eruption under anti-PD-1]. Ann Dermatol Venereol 2018; 145:725-727. [PMID: 30126642 DOI: 10.1016/j.annder.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Amini-Adle
- Immucare, service de dermatologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - B Balme
- Service d'anatomo pathologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - M Locatelli-Sanchez
- Service de pneumologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P-J Souquet
- Service de pneumologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - S Dalle
- Immucare, service de dermatologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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9
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Fontaine-Delaruelle C, Souquet PJ, Gamondes D, Pradat E, de Leusse A, Ferretti GR, Couraud S. [Predictive factors of complications during CT-guided transthoracic biopsy]. Rev Pneumol Clin 2017; 73:61-67. [PMID: 28063634 DOI: 10.1016/j.pneumo.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 11/11/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION CT-guided transthoracic core-needle biopsy (TTNB) is frequently used for the diagnosis of lung nodules. The aim of this study is to describe TTNBs' complications and to investigate predictive factors of complications. METHODS All consecutive TTNBs performed in three centers between 2006 and 2012 were included. Binary logistic regression was used for multivariate analysis. RESULTS Overall, 970 TTNBs were performed in 929 patients. The complication rate was 34% (life-threatening complication in 6%). The most frequent complications were pneumothorax (29% included 4% which required chest-tube) and hemoptysis (5%). The mortality rate was 0.1% (n=1). In multivariate analysis, predictive factor for a complication was small target size (AOR=0.984; 95% CI [0.976-0.992]; P<0.001). This predictive factor was also found for occurrence of life-threatening complication (AOR=0.982; [0.965-0.999]; P=0.037), of pneumothorax (AOR=0.987; [0.978-0.995]; P=0.002) and of hemoptysis (AOR=0.973; [0.951-0.997]; P=0.024). CONCLUSION One complication occurred in one-third of TTNBs. The proportion of life-threatening complication was 6%. A small lesion size was predictive of complication occurrence.
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Affiliation(s)
- C Fontaine-Delaruelle
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France.
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; EMR 3738, ciblage thérapeutique en oncologie, faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France
| | - D Gamondes
- Service d'imagerie, hospices civils de Lyon, centre hospitalier Louis-Pradel, 69500 Bron, France
| | - E Pradat
- DiM, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - A de Leusse
- Service d'imagerie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale, centre hospitalier universitaire Grenoble, 38043 Grenoble, France; Université Grenoble Alpes, 38000 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38700 la Tronche, France
| | - S Couraud
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; EMR 3738, ciblage thérapeutique en oncologie, faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France
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10
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Bouledrak K, Walter T, Souquet PJ, Lombard-Bohas C. [Metastatic bronchial carcinoid tumors]. Rev Pneumol Clin 2016; 72:41-48. [PMID: 26831129 DOI: 10.1016/j.pneumo.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/27/2015] [Accepted: 12/29/2015] [Indexed: 06/05/2023]
Abstract
Bronchial carcinoids are uncommon pulmonary neoplasms and represent 1 to 2 % of all lung tumors. In early stage of disease, the mainstay and only curative treatment is surgery. Bronchial carcinoids are generally regarded as low-grade carcinomas and metastatic dissemination is unusual. The management of the metastatic stage is not currently standardized due to a lack of relevant studies. As bronchial carcinoids and in particular their metastatic forms are rare, we apply treatment strategies that have been evaluated in gastrointestinal and pancreatic neuroendocrine tumors. However, bronchial carcinoids have their own characteristic. A specific therapeutic feature of these metastatic tumors is that they require a dual approach: both anti-secretory for the carcinoid syndrome, and anti-tumoral.
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Affiliation(s)
- K Bouledrak
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1, 69100 Villeurbanne, France.
| | - T Walter
- Université Lyon 1, 69100 Villeurbanne, France; Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69003 Lyon, France; Inserm, UMR 1052 CNRS UMR 5286, 69008 Lyon cedex, France
| | - P J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1, 69100 Villeurbanne, France
| | - C Lombard-Bohas
- Université Lyon 1, 69100 Villeurbanne, France; Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69003 Lyon, France; Inserm, UMR 1052 CNRS UMR 5286, 69008 Lyon cedex, France
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11
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Laffay L, Gérinière L, Couraud S, Souquet PJ. [Endobronchial ultrasound transbronchial needle aspiration initiation into the Lyon Sud hospital center: Experience of the first three years]. Rev Pneumol Clin 2016; 72:17-24. [PMID: 26305022 DOI: 10.1016/j.pneumo.2015.03.006] [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] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 02/23/2015] [Accepted: 03/01/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Endobronchial ultrasound is a recent technique for the diagnosis and the lymph node staging in lung cancer. It also showed interest in non tumoral mediastinal lymph nodes diagnosis. This work relates the CHLS first three years' experience in terms of EEB practical use as a new diagnostic tool in this field. METHODS Retrospective study of consecutive cases patients having undergone endobronchial ultrasound from November 2008 till June 2011 in the CHLS. RESULTS On 65 endobronchial ultrasound, general anesthesia was practiced in 89 % of the cases, with a good tolerance in 81 % of the cases. In 77 % cases, EEB allowed diagnosis and avoided mediastinoscopy in 60.5 % of the cases. The respective sensibility, specificity, positive and negative predictive values were 74 %, 100 %, 100 % and 48 %. CONCLUSION These data, reflect of a novice team experience, illustrate the results obtained in the current practice in terms of etiologic diagnosis. Endobronchial ultrasound seems destined to a bright future but requires the development of dedicated centers allowing pulmonologists training and specialized pathologists in this field.
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Affiliation(s)
- L Laffay
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine et de maïeutique Lyon-Sud Charles-Mérieux, université Lyon-1, 69600 Oullins, France.
| | - L Gérinière
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine et de maïeutique Lyon-Sud Charles-Mérieux, université Lyon-1, 69600 Oullins, France
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine et de maïeutique Lyon-Sud Charles-Mérieux, université Lyon-1, 69600 Oullins, France
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12
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Gardet E, Tabutin M, Couraud S, Maury JM, Guibert B, Nguyen Van M, Tchalla AE, Souquet PJ, Tronc F. [Long-term results of lung cancer surgery in octogenarians]. Rev Pneumol Clin 2016; 72:3-9. [PMID: 26725006 DOI: 10.1016/j.pneumo.2015.09.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This retrospective study was undertaken to evaluate late results of lung cancer surgery in octogenerians. METHODS All patients 80years old or more who underwent a lung resection for cancer from 2000 to 2010 at Lyon University Hospital were included. No patients were treated with video-assisted surgery. Wedge resections were excluded. RESULTS Sixty-three patients (42 men, 21 women) were operated. The median age was 82years. Operative mortality was 4.7%. The rate of perioperative complications was 49%. The late survival was 34% at 5years. Five-year survival by nodal involvement was N0, 36%; N1, 29%; N2 20%, P<0.05. Patients with a squamous cell carcinoma (24) had a better long-term survival than patients with an adenocarcinoma (30), 33% and 25% respectively at 5years, P<0.05. The rate of recurrence was 33.9%. CONCLUSIONS Surgical treatment of lung cancer in selected population of octogenerians is associated with satisfactory early and long-term results. Survival is influenced by nodal involvement and by the pathologic type of the cancer.
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Affiliation(s)
- E Gardet
- Service de chirurgie thoracique, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - M Tabutin
- Service de chirurgie thoracique, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - S Couraud
- Service de pneumologie, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - J-M Maury
- Service de chirurgie thoracique, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - B Guibert
- Service de chirurgie générale et thoracique, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - M Nguyen Van
- Service de chirurgie thoracique, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - A E Tchalla
- Unité fonctionnelle de recherche clinique et de biostatistiques, CHU Dupuytren, 87042 Limoges, France
| | - P-J Souquet
- Service de pneumologie, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - F Tronc
- Service de chirurgie thoracique, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France.
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13
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Couraud S, Girard P, Girard N, Souquet PJ, Coiffard B, Charlin B, Milleron B. [Script concordance test for knowledge assessment of lung cancer screening]. Rev Mal Respir 2015; 33:333-42. [PMID: 26603957 DOI: 10.1016/j.rmr.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Annual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education. METHOD We created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association. RESULTS One hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001). CONCLUSION SCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical.
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Affiliation(s)
- S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, institut du cancer des hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Faculté de médecine et de maïeutique Lyon Sud Charles-Mérieux, université Lyon 1, 69600 Oullins, France.
| | - P Girard
- Département thoracique, institut mutualiste Montsouris, 75014 Paris, France
| | - N Girard
- Service de pneumologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France; Faculté de médecine Lyon Est, université Lyon 1, 69100 Villeurbanne, France
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, institut du cancer des hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - B Coiffard
- Association des jeunes pneumologues (AJPO2), groupe de travail de la Société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France
| | - B Charlin
- Département recherche et développement, centre de pédagogie appliquée aux sciences de la santé, université de Montréal, Montréal, QC, Canada
| | - B Milleron
- Intergroupe francophone de cancérologie thoracique, 75010 Paris, France
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14
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Pujol JL, Lavole A, Quoix E, Molinier O, Souquet PJ, Barlesi F, Le Caer H, Moro-Sibilot D, Fournel P, Oster JP, Chatellain P, Barre P, Jeannin G, Mourlanette P, Derollez M, Herman D, Renault A, Dayen C, Lamy PJ, Langlais A, Morin F, Zalcman G. Randomized phase II-III study of bevacizumab in combination with chemotherapy in previously untreated extensive small-cell lung cancer: results from the IFCT-0802 trial†. Ann Oncol 2015; 26:908-914. [PMID: 25688059 DOI: 10.1093/annonc/mdv065] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/31/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This randomized phase II-III trial sought to evaluate the efficacy and safety of adding bevacizumab (Bev) following induction chemotherapy (CT) in extensive small-cell lung cancer (SCLC). PATIENTS AND METHODS Enrolled SCLC patients received two induction cycles of CT. Responders were randomly assigned 1:1 to receive four additional cycles of CT alone or CT plus Bev (7.5 mg/kg), followed by single-agent Bev until progression or unacceptable toxicity. The primary end point was the percentage of patients for whom disease remained controlled (still in response) at the fourth cycle. RESULTS In total, 147 patients were enrolled. Partial response was observed in 103 patients, 74 of whom were eligible for Bev and randomly assigned to the CT alone group (n = 37) or the CT plus Bev group (n = 37). Response assessment at the end of the fourth cycle showed that disease control did not differ between the two groups (89.2% versus 91.9% of patients remaining responders in CT alone versus CT plus Bev, respectively; Fisher's exact test: P = 1.00). Progression-free survival (PFS) since randomization did not significantly differ, with a median PFS of 5.5 months [95% confidence interval (CI) 4.9% to 6.0%] versus 5.3 months (95% CI 4.8% to 5.8%) in the CT alone and CT plus Bev groups, respectively [hazard ratio (HR) for CT alone: 1.1; 95% CI 0.7% to 1.7%; unadjusted P = 0.82]. Grade ≥2 hypertension and grade ≥3 thrombotic events were observed in 40% and 11% of patients, respectively, in the CT plus Bev group. Serum vascular endothelial growth factor (VEGF) and soluble VEGF receptor titrations failed to identify predictive biomarkers. CONCLUSION Administering 7.5 mg/kg Bev after induction did not improve outcome in extensive SCLC patients.
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Affiliation(s)
- J-L Pujol
- Pneumology Department, University Hospital, Montpellier.
| | - A Lavole
- Pneumology Department, AP-HP Hospital Tenon, Paris
| | - E Quoix
- Pneumology Department, University Hospital, Strasbourg
| | - O Molinier
- Respiratory Diseases Department, Le Mans Hospital, Le Mans
| | - P-J Souquet
- Pneumology Department, Pierre-Bénite Hospital, Lyon
| | - F Barlesi
- Oncology Department, Hopital Nord, Aix-Marseille University
| | - H Le Caer
- Pneumology Department, Draguignan Hospital, Draguignan
| | | | - P Fournel
- Oncology Department, Loire Cancer Institute, St-Priest-en-Jarez
| | - J P Oster
- Pneumology Department, Colmar Hospital, Colmar
| | - P Chatellain
- Pneumology Department, Alpes-Léman Hospital, Ambilly
| | - P Barre
- Pneumology Department, Jean Rougier Hospital, Cahors
| | - G Jeannin
- Pneumology Department, Gabriel Montpied University Hospital, Clermont-Ferrand
| | - P Mourlanette
- Pneumology Department, Private Hospital, Cornebarrieu
| | - M Derollez
- Pneumology Department, Private Hospital, Maubeuge
| | - D Herman
- Pneumology Department, Nevers Hospital, Nevers
| | - A Renault
- Pneumology Department, Pau Hospital, Pau
| | - C Dayen
- Pneumology Department, Saint-Quentin Hospital, Saint-Quentin
| | - P J Lamy
- Department of Biopathology and Oncogenetics, Regional Cancer Institute, Montpellier
| | - A Langlais
- French Cooperative Thoracic Intergroup (IFCT), Paris
| | - F Morin
- French Cooperative Thoracic Intergroup (IFCT), Paris
| | - G Zalcman
- Pneumology Department, University Hospital, Caen, France
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15
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Catho G, Couraud S, Grard S, Bouaziz A, Sénéchal A, Valour F, Perpoint T, Braun E, Biron F, Ferry T, Chidiac C, Freymond N, Perrot E, Souquet PJ, Maury JM, Tronc F, Veziris N, Lina G, Dumitrescu O, Ader F. Management of emerging multidrug-resistant tuberculosis in a low-prevalence setting. Clin Microbiol Infect 2015; 21:472.e7-10. [PMID: 25708551 DOI: 10.1016/j.cmi.2014.12.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 12/16/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
Multidrug-resistant (MDR) tuberculosis (TB) is an emerging concern in communities with a low TB prevalence and a high standard of public health. Twenty-three consecutive adult MDR TB patients who were treated at our institution between 2007 and 2013 were reviewed for demographic characteristics and anti-TB treatment management, which included surgical procedures and long-term patient follow-up. This report of our experience emphasizes the need for an individualized approach as MDR TB brings mycobacterial disease management to a higher level of expertise, and for a balance to be found between international current guidelines and patient-tailored treatment strategies.
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Affiliation(s)
- G Catho
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Service de Pneumologie et Allergologie Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - S Couraud
- Service de Pneumologie et Oncologie Thoracique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - S Grard
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - A Bouaziz
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - A Sénéchal
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - F Valour
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - T Perpoint
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - E Braun
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - F Biron
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - T Ferry
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Inserm U1111 CIRI, Université Claude Bernard Lyon I, Lyon, France
| | - C Chidiac
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - N Freymond
- Service de Pneumologie et Oncologie Thoracique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - E Perrot
- Service de Pneumologie et Oncologie Thoracique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - P-J Souquet
- Service de Pneumologie et Oncologie Thoracique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - J-M Maury
- Departement de Chirurgie Thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - F Tronc
- Departement de Chirurgie Thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - N Veziris
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France; UPMC, INSERM, Centre d'Immunologie et des Maladies Infectieuses, E13, Paris, France
| | - G Lina
- Inserm U1111 CIRI, Université Claude Bernard Lyon I, Lyon, France; Laboratoire de Microbiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - O Dumitrescu
- Inserm U1111 CIRI, Université Claude Bernard Lyon I, Lyon, France; Laboratoire de Microbiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - F Ader
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Inserm U1111 CIRI, Université Claude Bernard Lyon I, Lyon, France.
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Avrillon V, Ny C, Chan S, Souquet PJ, Couraud S. [First epidemiologic data on pneumonia in Cambodia]. Rev Pneumol Clin 2014; 70:133-141. [PMID: 24210153 DOI: 10.1016/j.pneumo.2013.09.003] [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] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/13/2013] [Accepted: 09/23/2013] [Indexed: 06/02/2023]
Abstract
About 15% of deaths in adults are related to lung infections in Cambodia. Some knowledge on microbial epidemiology is crucial for deciding first-line antibiotic treatment. However, to date, these data are not available in Cambodia. Consequently, antibiotic prescription relies on French or neighborhood's countries guidelines, which are possibly not suitable. This cases-series aimed to provide data on microbial ecology in pneumonia. Medical charts of patients newly admitted for lung infection in the pulmonology unit of Preah Kossamak Hospital were retrospectively reviewed. Ninety-four patients were included and 29% had a complete microbiological diagnosis. Main germs isolated were: Gram-negative bacilli (n=20; 70.4%) and M. tuberculosis infections (n=7; 25.9%). There was one case of myeloïdosis. No S. pneumonia was isolated, possibly due to sample shipping tropical conditions. Antibiograms showed high resistance profiles. Although this study bring new data in the field, it also showed that European guidelines for antibiotic are not relevant in such countries and stress the need for further dedicated and prospective studies.
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Affiliation(s)
- V Avrillon
- Centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; UER Lyon Est, université Lyon 1, avenue Rockfeller, 69373 Lyon cedex 08, France; Organisation Non Gouvernementale Prupet, BP 609, 03006 Moullins cedex, France.
| | - C Ny
- Centre hospitalier Preah Kossamak, Phnom Penh, Cambodge
| | - S Chan
- Centre hospitalier Preah Kossamak, Phnom Penh, Cambodge; Organisation Non Gouvernementale Prupet, BP 609, 03006 Moullins cedex, France
| | - P-J Souquet
- Centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; UER Lyon Sud, université Lyon 1, chemin du Petit-Revoyet, BP 12, 69921 Oullins cedex, France
| | - S Couraud
- Centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; UER Lyon Sud, université Lyon 1, chemin du Petit-Revoyet, BP 12, 69921 Oullins cedex, France; Organisation Non Gouvernementale Prupet, BP 609, 03006 Moullins cedex, France
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Carbonnaux M, Fossard G, Amzallag E, Piegay C, Perot E, Chossegros P, Souquet PJ, Couraud S. Earlier onset and poor prognosis of lung cancer in imprisoned patients. Oncology 2013; 85:370-7. [PMID: 24335502 DOI: 10.1159/000356877] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 10/23/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Prison inmates are known to be more exposed to various lung cancer risk factors, and some studies have shown that lung cancer is the most common cancer in prisoners. However, no study has particularly focused on lung cancer features in this population. METHOD Charts of patients with lung cancer hospitalized in one of the French secured hospital units between 1997 and 2012 were reviewed. Data from this cohort were then compared to those of two large observational studies conducted in 2000 and 2010 (KBP studies). RESULTS Thirty-two cases were included. All were men. The mean age was 52.2 ± 11.5 years, which was significantly lower than in the KBP-2000 (64.4 years) and KBP-2010 (65.5 years; both p < 0.0001) studies. The percentage of current smokers was much higher in prisoners (87.1 vs. 52.2 and 49.2%, respectively; both p < 0.001). Ninety percent of prisoners presented with at least one comorbidity. Lung cancer clinical presentation did not differ between prisoners and the reference populations. The median overall survival was 5.8 months (range 0-15.1) for all stages and 4.7 months (range 2.8-6.6) for stage IIIB/IV. CONCLUSION Although our study suffers from limitations, prisoners seem to develop lung cancer at a younger age and their prognosis is poor.
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Affiliation(s)
- M Carbonnaux
- Department of Pulmonary Medicine, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Bénite, France
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18
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Couraud S, Chan S, Avrillon V, Horn K, Try S, Gérinière L, Perrot É, Guichon C, Souquet PJ, Ny C. [How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia]. Rev Pneumol Clin 2013; 69:244-249. [PMID: 23796499 DOI: 10.1016/j.pneumo.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions.
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Affiliation(s)
- S Couraud
- Service de pneumologie, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine et de maïeutique Lyon Sud-Charles-Mérieux, université Lyon-1, 69600 Oullins, France; Association Prupet, 69007 Lyon, France.
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Couraud S, Chan S, Avrillon V, Souquet PJ, Ny C. [Monthly video-assisted web meeting between French and Cambodian team in order to improve management of difficult cases]. Rev Pneumol Clin 2013; 69:119-120. [PMID: 23474102 DOI: 10.1016/j.pneumo.2013.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/08/2013] [Indexed: 06/01/2023]
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20
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Le Treut J, Sault MC, Lena H, Souquet PJ, Vergnenegre A, Le Caer H, Berard H, Boffa S, Monnet I, Damotte D, Chouaid C. Multicentre phase II study of cisplatin-etoposide chemotherapy for advanced large-cell neuroendocrine lung carcinoma: the GFPC 0302 study. Ann Oncol 2013; 24:1548-52. [PMID: 23406729 DOI: 10.1093/annonc/mdt009] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment of large-cell neuroendocrine carcinoma (LCNEC) of the lung remains unclear. Here, our primary objective was to assess the efficacy of cisplatin-etoposide doublet chemotherapy in advanced LCNEC. Accuracy of the pathological diagnosis and treatment toxicity were assessed as secondary objectives. PATIENTS AND METHODS Prospective, multicentre, single-arm, phase II study with a centralised review of treatment-response and pathological data. Patients had untreated performance status (PS) 0/1 stage IV/IIIB LCNEC and received cisplatin (80 mg/m22 d1) and etoposide (100 mg/m22 d1-3) every 21 days. RESULTS Eighteen centres included 42 patients (mean age, 59 ± 9 years; 69% men; median of four cycles/patient). At least one grade-3/4 toxicity occurred in 59% of patients (neutropaenia, thrombocytopaenia, and anaemia in 32%, 17%, and 12%, respectively). The median progression-free survival (PFS) and overall survival (OS) were 5.2 months (95% confidence interval, CI, 3.1-6.6) and 7.7 months (95% CI, 6.0-9.6), respectively. The centralised pathologist review reclassified 11 of 40 (27.5%) patients: 9 as small-cell lung cancer, 1 as undifferentiated non-small-cell lung cancer, and 1 as atypical carcinoid. Survival data were not significantly changed by excluding the reclassified patients. CONCLUSIONS The pathological diagnosis of LCNEC is difficult. The outcomes of advanced LCNEC treated with cisplatin-etoposide doublets are poor, similar to those of patients with advanced small-cell lung carcinoma (SCLC).
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Affiliation(s)
- J Le Treut
- Department of Pneumology, Aix en Provence, France
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Couraud S, Cortot AB, Greillier L, Gounant V, Mennecier B, Girard N, Besse B, Brouchet L, Castelnau O, Frappé P, Ferretti GR, Guittet L, Khalil A, Lefebure P, Laurent F, Liebart S, Molinier O, Quoix E, Revel MP, Stach B, Souquet PJ, Thomas P, Trédaniel J, Lemarié E, Zalcman G, Barlési F, Milleron B. From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French intergroup (IFCT) and the groupe d'Oncologie de langue francaise (GOLF). Ann Oncol 2012; 24:586-97. [PMID: 23136229 PMCID: PMC3574545 DOI: 10.1093/annonc/mds476] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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] [Indexed: 12/26/2022] Open
Abstract
Background Despite advances in cancer therapy, mortality is still high except in early-stage tumors, and screening remains a challenge. The randomized National Lung Screening Trial (NLST), comparing annual low-dose computed tomography (LDCT) and chest X-rays, revealed a 20% decrease in lung-cancer-specific mortality. These results raised numerous questions. The French intergroup for thoracic oncology and the French-speaking oncology group convened an expert group to provide a coherent outlook on screening modalities in France. Methods A literature review was carried out and transmitted to the expert group, which was divided into three workshops to tackle specific questions, with responses presented in a plenary session. A writing committee drafted this article. Results The multidisciplinary group favored individual screening in France, when carried out as outlined in this article and after informing subjects of the benefits and risks. The target population involves subjects aged 55–74 years, who are smokers or have a 30 pack-year smoking history. Subjects should be informed about the benefits of quitting. Screening should involve LDCT scanning with specific modalities. Criteria for CT positivity and management algorithms for positive examinations are given. Conclusions Individual screening requires rigorous assessment and precise research in order to potentially develop a lung-cancer screening policy.
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Affiliation(s)
- S Couraud
- Respiratory Diseases Department, 'Hospices Civils de Lyon' Lyon University Hospital, Pierre-Bénite
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Gomez-Abreo D, Prost C, Couraud S, Parmeland L, Carret G, Boibieux A, Gagnieu MC, Gérinière L, Avrillon V, Souquet PJ. [Chronic necrotizing pulmonary aspergillosis following an infection by Mycobacterium malmoense]. Rev Mal Respir 2012; 29:435-9. [PMID: 22440310 DOI: 10.1016/j.rmr.2011.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
Abstract
Pneumonia due to Mycobacterium malmoense is rare and usually occurs in damaged lung as is the case with Aspergillus infections. We report the case of a patient who developed chronic necrotizing pulmonary aspergillosis following an infection by atypical mycobacteria. A 53-year-old woman was hospitalized because of weight loss and fever. Direct examination of sputum smear was positive for acid fast bacilli and PCR and culture led to the diagnosis of infection with M. malmoense. Treatment was begun with clarithromycin, rifampicin and ethambutol. Despite initial improvement and excellent adherence to treatment, fever and weight loss recurred 6 months later. Relapse of the mycobacterial infection was excluded and the final diagnosis was necrotizing pulmonary aspergillosis. Infection with A. fumigatus complicating the treatment of M. malmoense is unusual. The management is challenging because of strong interactions between voriconazole and rifampicin, and thus requires a multidisciplinary and specialized approach.
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Affiliation(s)
- D Gomez-Abreo
- Service de pneumologie et oncologie thoracique, hospices civils de Lyon, CH Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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Couraud S, Fournel P, Moro-Sibilot D, Pérol M, Souquet PJ. [Which organization for the management of thoracic cancer? Results from a French survey in Rhône-Alpes region]. Rev Pneumol Clin 2012; 68:1-9. [PMID: 22197158 DOI: 10.1016/j.pneumo.2011.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/03/2011] [Accepted: 04/28/2011] [Indexed: 05/31/2023]
Abstract
This survey, conducted in Rhône-Alpes region (France), aims to better understand the actual conditions of practice in thoracic oncology. A questionnaire was distributed to all oncologists, pulmonologists, radiotherapy physicians and thoracic surgeons in the region. Of 401 questionnaires, the response rate was 56%. Among the responders 46% reported exercising the Thoracic Oncology (TO). Most physicians practicing TO are pulmonologists (62%). The majority (45%) are engaged in secondary hospital or university hospital (27%). However, practitioners with the most important activity exerts in university hospitals and cancer centre (71% of physicians practicing in secondary hospitals and 75% of those in private practice reported to manage fewer than 80 new NSCLC cases per year in structure). Furthermore, 91% are regularly involved in a multidisciplinary team. Radiation oncologist, pulmonologists and thoracic surgeons are assiduous to these meeting; however radiologists and, to a lesser extent, pathologists are less attentive. Moreover, 92% of practitioners belong to cancer networks. Similarly, over one third of working together in a cooperative clinical research institution and nearly half are involved in clinical trials (with nearly half in secondary hospital). These results highlight the reality of practice in Rhône-Alpes and will serve as the basis for coordinating authorities to correct dysfunctions or monitor certain activities of interest (clinical trials).
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Affiliation(s)
- S Couraud
- Service de pneumologie et d'oncologie thoracique, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France.
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Bellière A, Girard N, Chapet O, Khodri M, Kubas A, Souquet PJ, Mornex F. Feasibility of high-dose three-dimensional radiation therapy in the treatment of localised non-small-cell lung cancer. Cancer Radiother 2009; 13:298-304. [PMID: 19525134 DOI: 10.1016/j.canrad.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/03/2009] [Accepted: 04/13/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC. PATIENTS AND METHODS We undertook a retrospective analysis of consecutive patients with non-resectable NSCLC treated with high-dose (74Gy) standard-fractionation 3D-CRT, with particular attention to the relationship between lung and heart radiation-induced toxicities. RESULTS Fifty patients (41 males, 9 females) were included. A total of 35 (70%) patients received the planned total dose of 74Gy. Patients irradiated to inferior doses interrupted the treatment because of limiting toxicities. Induction and concurrent chemotherapy was delivered to 39 (78%) and 14 (28%) patients, respectively. Eight (16%) patients experienced grade 3-4 acute lung toxicity, all of them having a history of pulmonary disease, a FEV1 below 1.6 L, and a lung V(20) of at least 25%. Three (6%) patients were deemed to experience radiation-induced cardiac toxicity. CONCLUSIONS This study assesses the feasibility of delivering a total dose of 74 Gy combined with chemotherapy in locally advanced NSCLC. High lung and heart V(20) increases the risk of radiation-induced lung and cardiac toxicity, the later being highly difficult to precisely assess, as late deaths are rarely documented, and responsibility of the treatment might be often underestimated. The precise evaluation of cardiac condition may be helpful to spare fragile patients from potentially toxic effects of high-dose radiation, especially in controlled trials.
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Affiliation(s)
- A Bellière
- Département de radiothérapie-oncologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165 chemin du Grand-Revoyet, Pierre-Bénite cedex, France
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Coudurier M, Houot R, Geriniere L, Blandin S, Salles G, Lamy T, Souquet PJ. [Thymic tumours, autoimmune neutropaenia and autoimmune haemolytic anaemia]. Rev Mal Respir 2008; 25:605-9. [PMID: 18535529 DOI: 10.1016/s0761-8425(08)71619-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although an association between thymic tumour and autoimmune disease (including autoimmune cytopenia) has been established, the association between thymic tumour and autoimmune neutropenia has rarely been reported, with only 13 cases described in the literature. OBSERVATION We report on a 30 year old man diagnosed with autoimmune neutropenia who had been treated for invasive thymic tumour one year previously. He successfully responded to cyclosporin and steroids therapy. A few months later, the patient presented with autoimmune haemolytic anaemia after prematurely halting his own immunosuppressive treatment. CONCLUSION This observation brings additional insights about the clinical features, biology and treatment of autoimmune neutropenia associated with thymic tumours and underlines the potential severity of such an association. Furthermore, the association of a thymic tumour with both autoimmune neutropaenia and autoimmune haemolytic anaemia has not been reported previously.
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Affiliation(s)
- M Coudurier
- Service de Pneumologie, Centre hospitalier, Lyon Sud, Hospices Civils de Lyon, Lyon, France.
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Moro-Sibilot D, Barlesi F, Timsit JF, Debieuvre D, Fournel P, Gervais R, Mazieres J, Milleron B, Morin F, Perol M, Soria JC, Souquet PJ, Vergnenègre A, Zalcman G. [How to treat the relapse of NSCLC after surgery and chemotherapy? IFTC 0702 randomized phase III study]. Rev Mal Respir 2008; 25:91-6. [PMID: 18288059 DOI: 10.1016/s0761-8425(08)70474-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND As chemotherapy gains wider acceptance for the treatment of earlier stages of NSCLC, particularly in the adjuvant and neoadjuvant setting, physicians face a growing population of high performance status patients who have relapsed after their first-line chemotherapy. The type of second-line chemotherapy after initial adjuvant or neoadjuvant treatment with a platinum-based regimen remains largely undefined. The current study has been designed to compare the classical mono chemotherapy docetaxel with a docetaxel cisplatin doublet. METHODS Patients will be randomized in 2 arms. Arm: docetaxel cisplatin (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. Arm B: docetaxel alone (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. EXPECTED RESULTS 300 patients will be randomized with a statistical hypothesis of a progression free survival of 3 months in the control arm and of 4.5 months in the experimental arm.
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Moro-Sibilot D, Pluquet E, Zalcman G, Bréchot JM, Souquet PJ, Debieuvre D, Morin F, Morère JF. [What treatment for a patient of PS 2-3 with stage IV non-small cell lung cancer?]. Rev Mal Respir 2007; 24:6S120-6S124. [PMID: 18235404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patients with poor performance status (PS) and advanced lung cancer have been underrepresented in clinical trials. As a consequence, the management of these patients in clinical practice is often empirical. Recent data indicate that patients with advanced non-small cell lung cancer (NSCLC) and a PS of 2 tend to benefit from first line chemotherapy with respect to symptom improvement and perhaps overall survival. Whether single-agent or combination chemotherapy is preferable remains debatable. In previously treated patients with NSCLC, EGFR tyrosine kinase inhibitors produced a substantial rate of clinical benefit and led to an improvement in survival compared with placebo in studies that included a significant percentage of patients with poor PS.
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Affiliation(s)
- D Moro-Sibilot
- PMAC pneumologie, CHU A. Michallon, BP217X, 38043 Grenoble cedex, France.
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Souquet PJ. [Non-small cell lung cancer - from treatment of relapse to treatments for relapses]. Rev Mal Respir 2007; 24:6S108-6S113. [PMID: 18235402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Second line treatments of non-small cell lung cancer are currently largely used because of their effectiveness in terms of survival and quality of life. Three drugs are currently licensed for this indication (docetaxel, pemetrexed and erlotinib), and possibly others will follow in the years to come. A true therapeutic strategy can thus be applied in advanced non-small cell lung cancer. The questions which need to be resolved are the optimum choice of treatments (mono-chemotherapy? Poly-chemotherapy? Therapeutic biological?) related to the still poorly understood "characteristics" of patients and tumours, as well as the specific question as to whether patients who have received adjuvant chemotherapy and then relapse should receive "first line" or "second line" therapy?
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Affiliation(s)
- P-J Souquet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Affiliation(s)
- M Coudurier
- Service de pneumologie, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, France.
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Abstract
INTRODUCTION Nocardial pneumonias are due to a genus of aerobic, filamentous, partly acid-alcohol fast, mainly Gram positive, actinomycetes. CASE REPORT We report here two cases of nocardial pneumonia. The first was a 62 year old man with a history of fludaribine treatment and bone marrow transplant for lymphocytic leukaemia. During the investigation of pyrexia evidence of N. farcinica infection was found in the bronchial secretions. The second case was a man of 61 receiving long term corticosteroids and cytotoxic chemotherapy. Investigation of a pneumonia with pleural effusion found evidence, on culture of blood and pleural fluid, of disseminated infection with N. nova (cerebral, pleural, pulmonary and splenic). CONCLUSION Nocardiosis is a rare cause of pneumonia mainly occurring in immuno-compromised adults (corticosteroid therapy, HIV infection, transplantation, cancer or leukaemia). It should be suspected in the presence of pleuro-pulmonary symptoms associated with neurological and cutaneous signs, general deterioration and weight loss. The microbiology laboratory should be advised of this eventuality as soon as possible in order to optimise the search for the organism.
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Affiliation(s)
- S Couraud
- Service de pneumologie, Centre Hospitalier Lyon Sud, CHU Lyon, Pierre Bénite, France.
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Souquet PJ, Gérinière L. [Evaluation criteria for bronchial carcinoma. How to assess quality of life in lung cancer?]. Rev Mal Respir 2006; 23:16S112-16S117. [PMID: 17268347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The aim of medical treatment in lung cancer is often to a large extent palliative, due to advanced stage at the time of diagnosis. Evaluation of such treatment has usually been based on objective responses, global survival, survival at 1 or 2 years and the occurrence of toxicities, but also more recently on assessment of quality of life. Two Quality of Life questionnaires have been validated (FACT and QLQ C30). The different criteria of 'quality of life' are presented and also their difficulties in application and interpretation, due to potential problems of bias. In routine clinical practice, only the visual symptom scales are of use, in association with the wishes and understanding of patients which must remain at the centre of medical care allowing the patient being a partner in therapeutic decisions.
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Affiliation(s)
- P-J Souquet
- Fédération Poumon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
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Vergnenegre A, Combescure C, Fournel P, Bayle S, Gimenez C, Souquet PJ, Lena H, Perol M, Delhoume JY. Cost-minimization analysis of a phase III trial comparing concurrent versus sequential radiochemotherapy for locally advanced non-small-cell lung cancer (GFPC-GLOT 95–01). Ann Oncol 2006; 17:1269-74. [PMID: 16728480 DOI: 10.1093/annonc/mdl100] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We conducted an economic analysis of a phase III clinical trial comparing sequential radiochemotherapy (RT-CT) with concurrent RT-CT in patients with locally advanced non-small-cell lung cancer. PATIENTS AND METHODS The trial was a randomized multicenter study comparing three cycles of chemotherapy (arm A) followed by radiotherapy against an RT-CT combination (two cycles of platinum etoposide) followed by two cycles of platinum-vinorelbine (arm B). The economic analysis adopted the payer's perspective and only included direct costs. Costs (euro, 1996-2003) were recorded until the cut-off date. A cost minimization analysis and a sensitivity analysis were carried out. RESULTS Data from 173 patients were used in the economic study. Protocol costs tended to be higher in arm B, while relapse costs were significantly higher in arm A. The total number of hospital days was higher in arm B. The average total cost per patient was euro16,074 in arm A and euro15,245 in arm B (P=0.15). The cost minimization analysis favored arm B. This advantage persisted in the sensitivity analysis. CONCLUSIONS Concurrent RT-CT was not the more costly strategy in this phase III trial, despite lengthier hospitalization for toxicity. Other studies of similar design are needed to confirm these results in future randomized trials.
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Abstract
INTRODUCTION Gastropleural fistula has only rarely been described in the literature, typically presenting with evidence of left-sided pleural infection. CASE REPORT The diagnosis may be suggested by the occurrence of chest pain and repeated vomiting with the diagnosis confirmed by microbiological examination of the pleural fluid and appropriate radiological investigations. The fistula occurs most frequently after abdominal or anterior thoracic surgery. Generally, surgical repair should be performed urgently but in the case that we describe occurring during pregnancy, surgery was delayed for 10 weeks until a caesarean section could be performed. CONCLUSION In the presence of left-sided basal pleuritic chest pain in the context of a possible gap in the diaphragm the diagnosis of gastropleural fistula should be considered. Treatment is usually a medico-surgical emergency.
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Affiliation(s)
- A Grouet
- Service de Pneumologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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Cortot AB, Gerinière L, Robinet G, Breton JL, Corre R, Falchero L, Berard H, Gimenez C, Chavaillon JM, Perol M, Bombaron P, Mercier C, Souquet PJ. Phase II trial of temozolomide and cisplatin followed by whole brain radiotherapy in non-small-cell lung cancer patients with brain metastases: a GLOT-GFPC study. Ann Oncol 2006; 17:1412-7. [PMID: 16790516 DOI: 10.1093/annonc/mdl146] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Brain metastases (BM) considerably worsen the prognosis of non-small-cell lung cancer (NSCLC) patients. The usefulness and choice of chemotherapy remain uncertain in this indication since these patients are excluded from most clinical trials. We conducted a phase II study to determine the efficacy and tolerability of up-front chemotherapy with association of temozolomide and cisplatin in NSCLC patients with BM. PATIENTS AND METHODS Fifty NSCLC patients with BM received temozolomide (200 mg/m(2)/day for 5 days every 28 days) and cisplatin (75 mg/m(2) at day 1 of each cycle), up to six cycles, followed by whole brain radiotherapy (WBRT). An evaluation was carried out every two cycles and after WBRT. WBRT was performed earlier in case of progressive disease at any time or stable disease after cycle 4. RESULTS Eight objective responses were achieved (16%). Overall median survival was 5 months. Median time to progression was 2.3 months. Ten patients (20%) presented a grade 3/4 neutropenia and 11 patients (22%) presented a grade 3/4 thrombopenia. CONCLUSION This study demonstrates a lack of efficacy of up-front chemotherapy with association of temozolomide and cisplatin in these patients. Nevertheless, it supports the feasibility of chemotherapy before brain radiotherapy in NSCLC patients with BM.
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Affiliation(s)
- A B Cortot
- Service de Pneumologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Pujol JL, Breton JL, Gervais R, Rebattu P, Depierre A, Morère JF, Milleron B, Debieuvre D, Castéra D, Souquet PJ, Moro-Sibilot D, Lemarié E, Kessler R, Janicot H, Braun D, Spaeth D, Quantin X, Clary C. Gemcitabine–docetaxel versus cisplatin–vinorelbine in advanced or metastatic non-small-cell lung cancer: a phase III study addressing the case for cisplatin. Ann Oncol 2005; 16:602-10. [PMID: 15741225 DOI: 10.1093/annonc/mdi126] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This multicenter, randomized, phase III study compared the efficacy, including progression-free survival (PFS), and safety of gemcitabine-docetaxel (GD) combination versus cisplatin-vinorelbine (CV) in the treatment of advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Chemonaive patients with stage IIIB or IV NSCLC were treated with GD (gemcitabine 1000 mg/m(2) days 1 and 8 plus docetaxel 85 mg/m(2) day 8, every 3 weeks for eight cycles) or CV (cisplatin 100 mg/m(2) day 1 plus vinorelbine 30 mg/m(2), days 1, 8, 15 and 22, every 4 weeks for six cycles). RESULTS A total of 311 patients were enrolled (155 GD and 156 CV). Neither PFS nor overall survival differed significantly between the two arms (median PFS 4.2 and 4 months; median survival 11.1 and 9.6 months; 1-year survival 46% and 42%, for GD and CV, respectively). For the GD arm compared with the CV arm, the hazard ratio for PFS was 1.04 [95% confidence interval (CI) 0.83-1.32], and for overall survival, it was 0.90 (95% CI 0.70-1.16). Objective response rates did not differ significantly (31% for GD, 35.9% for CV). Myelosupression, emesis and frequency of febrile neutropenia were less pronounced on the GD arm, whereas fluid retention and pulmonary events were more pronounced. The CV arm experienced a higher number of serious adverse events and a lower compliance with the protocol. There was no quality of life (QoL) difference between arms. Median time to definite impairment of health-related QoL was 153 and 168 days in GD and CV arms, respectively. CONCLUSIONS There was no advantage in PFS with GD compared with CV; however, the CV regimen had higher rate of toxic events, mainly myelosuppression. The herein, non-platinum-containing regimen could be considered as a rational alternative to the cisplatin-based doublet.
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Affiliation(s)
- J-L Pujol
- Montpellier University Hospital, Montpellier, France.
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Brechot JM, Roche N, Marichy C, Lebeau B, Debieuvre D, Darneau G, Coste E, Grivaux M, Falchero L, Vlastos F, Souquet PJ. [Treatment of anemia and bone metastasis in metastatic non-small-cell lung cancer. A French survey]. Rev Pneumol Clin 2005; 61:23-29. [PMID: 15772576 DOI: 10.1016/s0761-8417(05)84778-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Use of erythropoietin (EPO) for chemotherapy-induced anemia and biphosphonates (BP) for bone metastasis has increased steadily. However, there are no guidelines on their use in many situations such as non small cell lung carcinoma (NSCLC), which frequently alters quality of life markedly. Therefore, a multicentric survey was designed to assess the treatment of anemia and bone metastasis in chemotherapy-treated patients with non-small-cell lung carcinoma. Nine representative centers of the oncology working party of the French respiratory society (Groupe d'Oncologie de la Société de Pneumologie de Langue Française) participated. Inclusion criteria were stage IV NSCLC and at least one course of chemotherapy in the last 3 months. A total of 148 and 50 patients (pts) were included in the anemia and bone metastasis surveys, respectively. Anemia was present in 60.8% of patients, and was not treated in 75%; 15 patients received EPO (10.1%). Independent predictors of EPO use were presence of anemia-related symptoms, hemoglobin level, age and center: the rate of prescription in patients with anemia varied from 13 to 73% between centers. BP were administered in 38% of patients with bone metastasis. Independent predictors of BP use were calcium serum level, pain, and center with a rate of prescription ranging from 0 to 80% between centers. This study reveals that, in France, most patients with anemia are not treated, EPO being seldom prescribed. The use of both EPO and BP is highly variable between centers. Guidelines on the use of these supportive treatments could help improve the care for lung cancer patients receiving chemotherapy.
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Affiliation(s)
- J-M Brechot
- Service d'Oncologie Médicale, Hôpital Avicenne, AP-HP, 125, route de Stalingrad, 93009 Bobigny Cedex.
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Diab S, Geriniere L, Carrie C, Souquet PJ. [Treatment of lung cancer in the elderly]. Rev Mal Respir 2004; 21:8S59-69. [PMID: 15803539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Elderly patients form an increasing proportion of the lung cancer population. However, they are poorly represented in clinical trials. The published studies are generally phase II trials on highly selected small numbers of patients. Applying these trials to clinical practice is therefore difficult and this is compounded by the fear of increased treatment toxicity in elderly patients. In the event of organ failure (respiratory, cardiac or other organ failure), where conventional therapy is not possible, there are a number of alternative options: radiotherapy for inoperable limited non-small-cell-lung cancer, chemotherapy without platinum for those with more extensive disease or with analogues of platinum for small-cell-lung-cancer. Finally, adjunctive therapy with haematopoietic-cell growth factors or cytoprotectors may allow full doses of treatment to be delivered whilst limiting toxicity. More studies in elderly patients, with larger numbers, are needed to develop more rational therapeutic strategies. We present here some studies of reference and the most recent publications on this subject.
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Affiliation(s)
- S Diab
- Service de Pneumologie, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite
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Souquet PJ. [Biological therapy in non-small-cell lung cancer (NSCLC)]. Rev Pneumol Clin 2004; 60:4S53-4S56. [PMID: 15687996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- P-J Souquet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France
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Souquet PJ. [Second-line chemotherapy in non-small cell lung cancer]. Rev Pneumol Clin 2004; 60:3S57-3S59. [PMID: 15536355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The progress in first-line chemotherapy in non-small cell lung cancer with efficient and often well-tolerated combinations has progressively led to the proposal of second-line chemotherapy for the patients. Docetaxel provides significantly enhanced survival compared with palliative treatments. Various phase II studies with vinorelbine, gemcitabine and paclitaxel have been reported. Pemetrexed has demonstrated identical enhanced survival as docetaxel, but with improved tolerance. An epothilone B analog is under study in clinical trials.
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Affiliation(s)
- P-J Souquet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310 Pierre-Bénite.
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Abstract
INTRODUCTION Gefitinib (Iressa, ZD 1839; AstraZeneca) is a selective Epidermal Growth Factor receptor tyrosine kinase inhibitor. In two randomized phase II trials (IDEAL 1 and IDEAL 2), it has demonstrated an activity against NSCLC, showing partial response and symptoms improvement rates respectively in about 20% and 40% of patients. Multivariate analyses revealed that being a woman, a non-smoker and having an adenocarcinoma was associated with response rate. METHODS We describe a retrospective study of patients receiving Gefitinib as a third line compassionate treatment of NSCLC. RESULTS We enrolled 37 patients (29 men, 8 women). Tumors included 25 adenocarcinoma, 4 squamous cell carcinoma, 7 large cell carcinoma, and 1 neuroendocrine carcinoma. Partial response rate was 8.1%, and stable disease rate 27.0%. The 3 responders were all non-smoker women, with an histological type of adenocarcinoma. Symptoms improvement was observed in 59.5% of patients. Main toxicities were diarrhoea and skin reactions. We observed that responding patients had more adverse drugs-related reactions than stable or non-responding patients. CONCLUSIONS Gefitinib is a meaningful active therapy in NSCLC with a favorable toxicity profile. We suggest that being a woman, a never-smoker and having an adenocarcinoma may be clinical predictive factors of response to Gefitinib.
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Affiliation(s)
- N Girard
- Service de pneumologie, Hospices Civils de Lyon, Centre hospitalier Lyon-Sud, 165 chemin du Grand Revoyet, 69495 Pierre-Bénite Cedex, France
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Stahel R, Rossi A, Petruzelka L, Kosimidis P, de Braud F, Bernardo MM, Souquet PJ, Parra HS, Gridelli C. Lessons from the ("Iressa" Expanded Access Programme: gefitinib in special non-small-cell lung cancer patient populations. Br J Cancer 2004; 89 Suppl 2:S19-23. [PMID: 14661049 PMCID: PMC2750243 DOI: 10.1038/sj.bjc.6601479] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Some subgroups of patients with advanced/metastatic non-small-cell lung cancer (NSCLC) are frequently considered ineligible for the aggressive, platinum-based combination chemotherapy that is the recommended treatment. Elderly patients may have a poorer tolerance of chemotherapy due to impaired organ function and frequent comorbidities; patients with poor performance status (PS; ⩾2 due to NSCLC and/or coexisting illnesses) are often considered unfit for chemotherapy; other patients may be unable or unwilling to endure the toxicity or inconvenience of chemotherapy. These patient groups may benefit from novel, relatively nontoxic treatment modalities. Gefitinib (‘Iressa’, ZD1839) 250 mg day−1 is well tolerated and has proven antitumour and symptom improvement activity in patients with previously treated NSCLC. Phase II trials (IDEAL 1 and 2) of gefitinib in advanced/metastatic NSCLC included 70 out of 425 (16.5%) patients with PS ⩾2, and their response rate, clinical benefit rate and rates of adverse events were similar to those of the overall trial population. In addition, many patients with advanced/metastatic NSCLC with poor PS or advanced age have received gefitinib 250 mg day−1 in an Expanded Access Programme (EAP). Observations from the EAP support those of IDEAL 1 and 2, and indicate that gefitinib 250 mg day−1 warrants further investigation in these patient groups.
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Affiliation(s)
- R Stahel
- Klinik und Poliklinik für Onkologie, Universitätsspital, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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Depierre A, Lagrange JL, Theobald S, Astoul P, Baldeyrou P, Bardet E, Bazelly B, Bréchot JM, Breton JL, Douillard JY, Grivaux M, Jacoulet P, Khalil A, Lemarié E, Martinet Y, Massard G, Milleron B, Molina T, Moro-Sibilot D, Paesmans M, Pujol JL, Quoix E, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stoebner-Delbarre A, Thiberville L, Touboul E, Vaylet F, Vergnon JM, Westeel V. Summary report of the Standards, Options and Recommendations for the management of patients with non-small-cell lung carcinoma (2000). Br J Cancer 2003; 89 Suppl 1:S35-49. [PMID: 12915902 PMCID: PMC2753012 DOI: 10.1038/sj.bjc.6601083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Souquet PJ, Tan EH, Rodrigues Pereira J, Van Klaveren R, Price A, Gatzemeier U, Jaworski M, Burillon JP, Aubert D. GLOB-1: a prospective randomised clinical phase III trial comparing vinorelbine-cisplatin with vinorelbine-ifosfamide-cisplatin in metastatic non-small-cell lung cancer patients. Ann Oncol 2002; 13:1853-61. [PMID: 12453852 DOI: 10.1093/annonc/mdf316] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The standard doublet, vinorelbine-cisplatin, was compared with a triplet of vinorelbine-ifosfamide-cisplatin, in terms of survival, in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS From February 1998 to June 1999, 259 chemonaïve patients entered the study and were randomised to receive either vinorelbine-cisplatin (NP; vinorelbine 30 mg/m(2) on days 1, 8 and 15 with cisplatin 80 mg/m(2) on day 1) or vinorelbine-ifosfamide-cisplatin (NIP; vinorelbine 25 mg/m(2) on days 1 and 8, ifosfamide 3 g/m(2) on day 1 and cisplatin 75 mg/m(2) on day 1), with both regimens being repeated every 3 weeks. All patients had stage IV or relapsed disease and a performance score of 0 or 1. RESULTS The overall response rate was 34.6% for NP and 35.7% for NIP. Median and 1-year survival rates were 10.0 months and 38.4% for NP, and 8.2 months and 33.7% for NIP, respectively. A median of four cycles was administered in each arm. The major World Health Organization grade 3-4 toxicities for NP and NIP, respectively, were: neutropenia (20.3% compared with 9% of cycles), anaemia (4.1% compared with 5% of cycles), nausea and vomiting (22.2% compared with 19.4% of patients) and alopecia (5.6% compared with 29.8% of patients). Four toxic deaths occurred in the NP arm and eight in the NIP arm. CONCLUSIONS The different schedules of vinorelbine in the two arms led to a greater survival in the NP arm without impairing the tolerance profile, although this is not statistically significant. This confirms that the two-drug combination NP is a reference treatment for metastatic NSCLC. The role of three-drug combinations remains questionable in this subset of patients.
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Diab S, Geriniere L, Carrie C, Souquet PJ. [Treatment of bronchial carcinoma in the elderly]. Rev Mal Respir 2002; 19:616-26. [PMID: 12473948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Elderly patients form an increasing proportion of the lung cancer population. However, they are poorly represented in clinical trials. The published studies are generally phase II trials on highly selected small numbers of patients. Applying these trials to clinical practice is therefore difficult and this is compounded by the fear of increased treatment toxicity in elderly patients. In the event of organ failure (respiratory, cardiac or other organ failure), where conventional therapy is not possible, there are a number of alternative options: radiotherapy for inoperable limited non-small-cell-lung cancer, chemotherapy without platinum for those with more extensive disease or with analogues of platinum for small-cell-lung-cancer. Finally, adjunctive therapy with haematopoietic-cell growth factors or cytoprotectors may allow full doses of treatment to be delivered whilst limiting toxicity. More studies in elderly patients, with larger numbers, are needed to develop more rational therapeutic strategies. We present here some studies of reference and the most recent publications on this subject.
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Affiliation(s)
- S Diab
- Service de Pneumologie, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France
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Blandin S, Khouatra C, Geriniere L, Larive S, Arnaud I, Bied-Damon V, Souquet PJ. [Isolated pleurisy revealing ovarian hyperstimulation syndrome]. Rev Pneumol Clin 2002; 58:151-153. [PMID: 12486799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Ovarian hyperstimulation is a rare but serious iatrogenic complication following induction of ovulation cycles. Release of vasoactive substances by the stimulated ovaries leads to leakage of intravascular fluid into the extracellular and serous spaces due to enhanced capillary permeability. Pleural effusion is a classical finding in the most severe forms, often associated with ascitis and signs of hemoconcentration. We report the case of a women who presented pleural effusion as the sole inaugural sign of ovarian hyperstimulation.
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Affiliation(s)
- S Blandin
- Service de Pneumologie, Pavillon 1A, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite.
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Omezzine N, Khouatra C, Larivé S, Freyer G, Isaac-Pinet S, Gérinière L, Droz JP, Souquet PJ. Rhabdomyosarcoma arising in mediastinal teratoma in an adult man: a case report. Ann Oncol 2002; 13:323-6. [PMID: 11886012 DOI: 10.1093/annonc/mdf022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of rhabdomyosarcoma which occurred in a mediastinal teratoma in a 44-year-old man. Presentation symptoms were chest pain, hoarseness and a cough. Diagnosis was fortuitous, performed by the histological and immunohistochemical study of a mediastinal tumour biopsy specimen that showed embryonal carcinoma and yolk sac tumour components associated with the rhabdomyosarcoma. After cisplatin-based chemotherapy (bleomycin-etoposide-cisplatin), surgical resection of the residual mediastinal tumour was performed. Histological and immunohistochemical study of this tumour confirmed the presence of mature teratoma and embryonal rhabdomyosarcoma. Evolution was marked by a local extension of the mediastinal tumour, occurrence of multiple metastases and bone marrow involvement. The patient died 8 months after diagnosis despite chemotherapy and radiotherapy. A review of the literature reveals that the development of rhabdomyosarcoma in primary mediastinal teratomas is unusual in adults. The diagnostic, therapeutic and prognostic implications of such an association are reviewed.
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Affiliation(s)
- N Omezzine
- Department of Pneumology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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47
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Larive S, Bombaron P, Riou R, Fournel P, Perol M, Lena H, Dussopt C, Philip-Joet F, Touraine F, Lecaer H, Souquet PJ. Carboplatin-etoposide combination in small cell lung cancer patients older than 70 years: a phase II trial. Lung Cancer 2002; 35:1-7. [PMID: 11750705 DOI: 10.1016/s0169-5002(01)00288-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND No standard treatment is defined for elderly patients with small cell lung cancer (SCLC). Carboplatin and etoposide are highly active agents against SCLC. In this study, we evaluated the activity and toxicity of a combination of these two agents. PATIENTS AND METHODS Thirty-four untreated patients with limited or extensive SCLC and median age of 73.9 years entered the study. Chemotherapy consisted of carboplatin i.v. on day 1 (AUC 5 using Calvert's formula) and etoposide 100 mg/m(2) given orally on days 1-5, every 4 weeks, and thoracic irradiation was given to limited disease patients after chemotherapy. RESULTS The overall response rates was 59% (95% CI: 43-76). The median survival for all patients was 37 weeks (range 3-76 weeks). The toxicity was mainly haematological with grade 3-4 neutropenia in 59% of courses, febrile neutropenia in 15% of courses, and toxic death in 9% of patients. CONCLUSION The results of this regimen are disappointing with worse response and survival, and more haematological toxicity than expected and previously reported, despite the use of Calvert's formula. Possible explanations are the use of etoposide per os rather than i.v., the frequent comorbidities of older patients and the inclusion of patients with poor prognosis factors.
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Affiliation(s)
- S Larive
- Service de Pneumologie, Centre Hospitalier Lyon Sud, 69495 Cedex, Pierre Bénite, France
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Abstract
Despite surgery, resectable NSCLC (stage I, II, and IIIA N2) has a quite poor prognosis: about 50% of patients will die during the first 2 years by metastatic disease and only 36% are alive at 5 years after diagnosis. Postoperative radiotherapy is not effective in case of complete resection (PORT meta-analysis). The role of perioperative chemotherapy is still questionnable. Cambridge meta-analysis has shown a little benefit of cisplatin based postoperative chemotherapy. Several randomised trials are completed like Alpi Trial or ANITA or still in progress. Results would be available in 2 or 3 years. Several phase II trials of preoperative chemotherapy have demonstrated that preoperative chemotherapy is feasible, with high response rate, very few progression (mainly metastatic progression without local progression) and no increase of mortality and morbidity. Two small phase III trials have demonstrated that preoperative chemotherapy can dramatically increase survival compared with surgery alone, in case of N2 disease. The MIP trial of Depierre has studied two or four cycles of MIP regimen in perioperative setting in stage IB, II or IIIA, compared to surgery alone (TRT in case of N2 disease). After 3 years of survey there is a trend in favor of MIP in case of stage IB and II (23% increase of 3 years survival) but not in case of N2. The toxicity of MIP is a possible explanation of such poor results in N2 patients despite a high response rate (64%). Some other trials are in progress in the world. Surgery is also questionnable in case of resectable N2 disease. Several trials comparing chemo radiotherapy to chemo (+/- radiotherapy)+surgery are in progress in U.S. and Europe.
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Affiliation(s)
- P J Souquet
- Department of Pneumology and Thoracic Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Cedex, Pierre-Bénite, France.
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Touboul E, Lagrange JL, Theobald S, Astoul P, Baldeyrou P, Bardet E, Bazelly B, Bréchot J, Breton JL, Douillard JY, Grivaux M, Jacoulet P, Khalil A, Le Chevalier T, Lemarie E, Martinet Y, Massard G, Milleron B, Moro-Sibilot D, Paesmans M, Pujol JL, Quoix AE, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stoebner-Delbarre A, Thiberville L, Vaylet F, Vergnon JM, Westeel V, Depierre A. [Standards, Options and Recommendations for the management of stage I or II primary bronchial cancers treated exclusively with radiotherapy]. Cancer Radiother 2001; 5:452-63. [PMID: 11521393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
CONTEXT The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone. METHODS Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres. RESULTS The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.
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Bardet E, Moro-Sibilot D, Le Chevalier T, Massard G, Douillard JY, Theobald S, Astoul P, Baldeyrou P, Bazelly B, Bréchot J, Breton JL, Grivaux P, Jacoulet P, Khalil A, Lemarie E, Martinet Y, Milleron B, Paesmans M, Pujol JL, Quoix AE, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stcebner-Delbarre A, Thiberville L, Touboul E, Vaylet F, Vergnon JM, Westeel V, Depierre A, Lagrange JL. [Standards, options and recommendations for the management of locally advanced non small cell lung carcinoma]. Bull Cancer 2001; 88:369-87. [PMID: 11371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of locally advanced non small cell lung carcinoma. METHODS Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS The main recommendations are: 1) The management of the locally advanced non small cell lung carcinoma has two main goals: firstly to obtain local control of the disease (or to at least delay local progression in order to improve the survival or relapse free survival), and secondly to prevent the development of metastases. 2) There is a consensus that locally advanced non small cell lung carcinoma should be irradiated. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poor life expectancy, this can be delivered as a split-course or hypofractionated scheme. 3) Treatment for patients with a performance status of 0-1 should consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional radiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combined radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside clinical trials. Surgery is justified in stage N2 disease as good local control can be achieved. T4-N0 disease should be treated surgically with curative intent.
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Affiliation(s)
- E Bardet
- Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13
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