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Valter R, Paillaud E, Boudou-Rouquette P, Oubaya N, Arégui A, Lorisson E, Brain E, Rochette de Lempdes G, Histe A, Laurent M, Canouï-Poitrine F, Caillet P, Broussier A, Martinez-Tapia C. Comparison of the prognostic value of eight nutrition-related tools in older patients with cancer: A prospective study. J Nutr Health Aging 2024; 28:100188. [PMID: 38350302 DOI: 10.1016/j.jnha.2024.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES The primary objective of the present study was to evaluate and compare the ability of eight nutrition-related tools to predict 1-year mortality in older patients with cancer. DESIGN, SETTING AND PARTICIPANTS We studied older patients with cancer from the ELCAPA cohort and who had been referred for a geriatric assessment at one of 14 participating geriatric oncology clinics in the greater Paris area of France between 2007 and 2018. MEASUREMENTS The studied nutrition-related tools/markers were the body mass index (BMI), weight loss (WL) in the previous 6 months, the Mini Nutritional Assessment, the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index, the Glasgow Prognostic Score (GPS), the modified GPS, and the C-reactive protein/albumin ratio. RESULTS A total of 1361 patients (median age: 81; males: 51%; metastatic cancer: 49%) were included in the analysis. Most of the tools showed a progressively increase in the mortality risk as the nutrition-related risk category worsened (overall p-values <0.02 for all) after adjustment for age, outpatient status, functional status, severe comorbidities, cognition, mood, cancer treatment strategy, tumour site, and tumour metastasis. All the models were discriminant, with a C-index ranging from 0.748 (for the BMI) to 0.762 (for the GPS). The concordance probability estimate ranged from 0.764 (WL) to 0.773 (GNRI and GPS)). CONCLUSION After adjustment for relevant prognostic factors, all eight nutrition-related tools/markers were independently associated with 1-year mortality in older patients with cancer. Depending on the time or context of the GA, physicians do not always have the time or means to perform and assess all the tools/markers compared here. However, even when some information is missing, each nutritional tool/marker has prognostic value and can be used in the evaluation.
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Affiliation(s)
- Rémi Valter
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, hôpital Européen Georges Pompidou, département de gériatrie, F-75015 Paris, France
| | | | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Service de Santé Publique, F-94010 Creteil, France
| | - Amélie Arégui
- APHP, Hôpital St Louis, UCOG Paris Nord, F-75010 Paris, France
| | | | - Etienne Brain
- Institut Curie, 35 Rue Dailly, F-92210 Saint-Cloud, France
| | | | - Axelle Histe
- AP-HP, Hopital Henri-Mondor, Unité de Recherche Clinique, F-94010 Creteil, France
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Service de Santé Publique, F-94010 Creteil, France
| | - Philippe Caillet
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, hôpital Européen Georges Pompidou, département de gériatrie, F-75015 Paris, France
| | - Amaury Broussier
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopitaux Henri-Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Puszkiel A, Bianconi G, Pasquiers B, Balakirouchenane D, Arrondeau J, Boudou-Rouquette P, Bretagne MC, Salem JE, Declèves X, Vidal M, Kramkimel N, Guegan S, Aractingi S, Huillard O, Alexandre J, Wislez M, Goldwasser F, Blanchet B. Extending the dosing intervals of nivolumab: model-based simulations in unselected cancer patients. Br J Cancer 2024:10.1038/s41416-024-02659-x. [PMID: 38532102 DOI: 10.1038/s41416-024-02659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Reducing nivolumab dose intensity could increase patients' life quality and decrease the financial burden while maintaining efficacy. The aims of this study were to develop a population PK model of nivolumab based on data from unselected metastatic cancer patients and to simulate extended-interval regimens allowing to maintain minimal effective plasma concentrations (MEPC). METHODS Concentration-time data (992 plasma nivolumab concentrations, 364 patients) were modeled using a two-compartment model with linear elimination clearance in Monolix software. Extended-interval regimens allowing to maintain steady-state trough concentrations (Cmin,ss) above the MEPC of 2.5 mg/L or 1.5 mg/L in >90% of patients were simulated. RESULTS Increasing 3-times the dosing interval from 240 mg every two weeks (Q2W) to Q6W and 2-times from 480 mg Q4W to Q8W resulted in Cmin,ss above 2.5 mg/L in 95.8% and 95.4% of patients, respectively. 240 mg Q8W and 480 mg Q10W resulted in Cmin,ss above 1.5 mg/L in 91.0% and 91.8% of patients, respectively. Selection of a 240 mg Q6W regimen would decrease by 3-fold the annual treatment costs compared to standard regimen of 240 mg Q2W (from 78,744€ to 26,248€ in France). CONCLUSIONS Clinical trials are warranted to confirm the non-inferiority of extended-interval compared to standard regimen.
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Affiliation(s)
- Alicja Puszkiel
- Université Paris Cité, Faculté de Pharmacie de Paris, INSERM UMR-S1144, Paris, France.
- Biologie du Médicament - Toxicologie, Cochin University Hospital, AP-HP, Paris, France.
| | - Guillaume Bianconi
- Biologie du Médicament - Toxicologie, Cochin University Hospital, AP-HP, Paris, France
| | - Blaise Pasquiers
- Université Paris Cité, Faculté de Pharmacie de Paris, INSERM UMR-S1144, Paris, France
- PhinC Development, Massy, France
| | | | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin University Hospital, Institut du Cancer Paris CARPEM, AP-HP, Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin University Hospital, Institut du Cancer Paris CARPEM, AP-HP, Paris, France
| | - Marie-Claire Bretagne
- Department of Pharmacology, Pharmacovigilance Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, Pharmacovigilance Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
- INSERM, CIC-1901, Sorbonne Université, Paris, France
| | - Xavier Declèves
- Université Paris Cité, Faculté de Pharmacie de Paris, INSERM UMR-S1144, Paris, France
- Biologie du Médicament - Toxicologie, Cochin University Hospital, AP-HP, Paris, France
| | - Michel Vidal
- Biologie du Médicament - Toxicologie, Cochin University Hospital, AP-HP, Paris, France
- Université Paris Cité, Faculté de Pharmacie de Paris, UMR8038 CNRS CiTCoM, U1268 INSERM, CARPEM, Paris, France
| | - Nora Kramkimel
- Department of Dermatology, Cochin University Hospital, AP-HP, Paris, France
| | - Sarah Guegan
- Department of Dermatology, Cochin University Hospital, AP-HP, Paris, France
| | - Selim Aractingi
- Department of Dermatology, Cochin University Hospital, AP-HP, Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Cochin University Hospital, Institut du Cancer Paris CARPEM, AP-HP, Paris, France
| | - Jérôme Alexandre
- Department of Medical Oncology, Cochin University Hospital, Institut du Cancer Paris CARPEM, AP-HP, Paris, France
- Université Paris Cité, INSERM, Centre de Recherche des Cordeliers, Équipe labélisée Ligue Contre le Cancer, CNRS SNC 5096, Sorbonne Université, Paris, France
| | - Marie Wislez
- Department of Pneumology, Cochin University Hospital, AP-HP, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin University Hospital, Institut du Cancer Paris CARPEM, AP-HP, Paris, France
- Université Paris Cité, Faculté de Médecine, INSERM, U1016, Institut Cochin, Paris, France
| | - Benoit Blanchet
- Biologie du Médicament - Toxicologie, Cochin University Hospital, AP-HP, Paris, France
- Université Paris Cité, Faculté de Pharmacie de Paris, UMR8038 CNRS CiTCoM, U1268 INSERM, CARPEM, Paris, France
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Conti C, Paillaud E, Laurent M, Poisson J, Boudou-Rouquette P, Frelaut M, Gay P, Canovas J, Caillet P, Mebarki S, Broussier A, Canouï-Poitrine F. Prognostic impact of neurocognitive disorders in older patients with cancer: the ELCAPA prospective cohort study. J Nutr Health Aging 2024; 28:100215. [PMID: 38518539 DOI: 10.1016/j.jnha.2024.100215] [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: 01/29/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To assess the prognostic value of neurocognitive disorder (NCD) for 12 month-overall mortality in patients aged 70 or more with a solid cancer. DESIGN prospective, observational, multicenter cohort. SETTING AND PARTICIPANTS We analyzed data from the ELCAPA longitudinal multicenter observational cohort of patients aged 70 or over, referred for a geriatric assessment (GA) before a new cancer treatment modality between January 31st, 2007, and December 29th, 2017. We defined the baseline NCD in four classes: no NCD, mild NCD, moderate NCD, and major NCD, based on the Mini-Mental State Examination (MMSE) score, memory complaint, and the Instrumental Activities of Daily Living (IADL) score. STATISTICAL METHODS We compared the baseline characteristics of patients according to NCD classes, globally and by pairs (with Bonferroni' correction). Prognosis value of NCD classes were analysed by using univariable and then multivariable 12 month survival analysis with age as time-variable and with and without adjustement for the treatment strategy (curative, palliative or exclusive supportive care). RESULTS 2784 patients with solid-cancer were included, with a median [interquartile range] age of 82 [78;86]. 36% of the patients were free of NCD, 34% had a mild NCD, 17% had a moderate NCD, and 13% had a major NCD. We identified the following independent prognostic factors for 12 month-overall mortality: NCD (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for a major NCD = 1.54 [1.19-1.98] (p < 0.001), type of cancer, metastatic status, inpatient consultation, poor general health (assessed as the level of fatigue and Eastern Cooperative Oncology Group performance status [ECOG-PS]), greater weight loss, palliative treatment, and exclusive supportive care. Additional adjustment for the treatment strategy did not greatly change the strength of the association of a major NCD with 12 month-overall mortality (HR [95%CI] = 1.78 [1.39-2.29] (p < 0.001). CONCLUSION Our results suggest that the presence of a major NCD has direct prognostic value (independently of other geriatric factors, the type of cancer and the treatment strategy) in older patients with a solid cancer.
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Affiliation(s)
- Catherine Conti
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France.
| | - Elena Paillaud
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France
| | - Marie Laurent
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France
| | - Johanne Poisson
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Cité, Center for Research on Inflammation, Inserm U1149, F-75018 Paris, France
| | | | | | - Pierre Gay
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Johanna Canovas
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Philippe Caillet
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France
| | - Soraya Mebarki
- AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France
| | - Amaury Broussier
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hôpitaux Henri-Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, F-94000 Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Public Health Departement, F-94010 Creteil, France
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Tardy C, Puszkiel A, Boudou-Rouquette P, De Percin S, Alexandre J, Berge M, Ulmann G, Blanchet B, Batista R, Goldwasser F, Thomas Schoemann A. Pazopanib pharmacokinetically guided dose optimization in three cancer patients with gastrointestinal resection. Cancer Chemother Pharmacol 2024; 93:169-175. [PMID: 37620675 DOI: 10.1007/s00280-023-04574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Pazopanib is approved in advanced renal cell carcinoma (RCC) and soft-tissue sarcoma at a flat-fixed dose despite a large pharmacokinetics interindividual variability and a narrow therapeutic index. To our knowledge, pazopanib exposure in patients with gastrointestinal resections (GIR) has not been described. This report focuses on feasibility of pharmacokinetics-guided dose escalation in these patients and clinical implications for their management. METHOD A retrospective data collection was performed for three patients with GIR treated with pazopanib, including pazopanib plasma concentrations (high-performance liquid chromatography with UV detection) and treatment adherence (Girerd score). CASE PRESENTATION First patient (55-year-old man, RCC, gastric bypass surgery) pazopanib Cmin,ss at day 39 was 4.1 mg/L. Dose escalation to 1800 mg/day fractionated allowed to reach Cmin,ss of 18.5 mg/L (target threshold in RCC patients: 20.5 mg/L). Patient 2 (50-year-old woman, metastatic myxofibrosarcoma, gastric band) showed Cmin,ss of 4.0 mg/L at day 13. In patient 3 (49-year-old man, gastric malignant peripheral nerve sheath tumor, gastrectomy), Cmin,ss at day 13 was 2.7 mg/L. For these two patients, intake with food and dose fractioning only slightly increased pazopanib Cmin,ss to 12.0 mg/L and 6.5 mg/L, respectively (therapeutic threshold in sarcoma patients: 27 mg/L). Treatment adherence was good in all patients. CONCLUSION Optimal pazopanib exposure cannot be achieved in patients with GIR, and thus, other therapeutic strategies should be encouraged. Pretherapeutic assessment seems crucial to evaluate factors as bariatric surgery that may impact pazopanib concentrations. Therapeutic drug monitoring could be helpful to optimize pazopanib response in these patients.
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Affiliation(s)
- Cléa Tardy
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France.
| | - Alicja Puszkiel
- Biologie du Médicament-Toxicologie, Cochin Hospital (AP-HP), Paris, France
- INSERM UMR-S1144, Université Paris Cité, Paris, France
| | | | | | - Jérôme Alexandre
- Oncology Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Centre de Recherche des Cordeliers, Université Paris-Sorbonne, INSERM, 75005, Paris, France
| | - Marion Berge
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
| | | | - Benoit Blanchet
- Biologie du Médicament-Toxicologie, Cochin Hospital (AP-HP), Paris, France
| | - Rui Batista
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
| | | | - Audrey Thomas Schoemann
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Université Paris Cité, UMR 8038 CNRS, CiTCom, INSERM U1268, 75006, Paris, France
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6
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Baber A, Legendre P, Palmic P, Lupo-Mansuet A, Burroni B, Azoulay C, Szwebel TA, Costedoat-Chalumeau N, Leroy K, Blons H, Blay JY, Boudou-Rouquette P, Terrier B. EBV-Positive Inflammatory Follicular Dendritic Cell Sarcoma of the Spleen: Report of an Aggressive Form With Molecular Characterization. Int J Surg Pathol 2024; 32:150-154. [PMID: 37157817 DOI: 10.1177/10668969231168345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
EBV-positive inflammatory follicular dendritic cell sarcoma (EBV+ inflammatory FDCS) is a rare neoplasm almost exclusively located in the spleen or liver. It is characterized by a proliferation of EBV-positive spindle-shaped cells bearing follicular dendritic cell markers, associated with an abundant lymphoplasmacytic infiltrate. EBV+ inflammatory FDCS is often asymptomatic or responsible for mild symptoms. It usually displays an indolent course and its prognosis is excellent after tumor removal, although relapsing and metastatic forms exist. Herein, we describe an aggressive form of splenic EBV+ inflammatory FDCS in a 79-year-old woman presenting with abdominal pain, deterioration of general health status, major inflammatory syndrome, and symptomatic hypercalcemia. A splenectomy was performed leading to a rapid improvement in her clinical condition and normalization of laboratory abnormalities. Unfortunately, her symptoms and laboratory abnormalities reappeared 4 months later. Computed tomography showed a mass in the splenectomy site and multiple liver and peritoneal nodules. Further analyses were performed on tumor tissue and showed positive phospho-ERK staining of tumoral cells indicating activation of MAPK pathway. Inactivating mutations were found on CDKN2A and NF1 genes. Subsequently, the patient's condition deteriorated rapidly. Since interleukin-6 levels were dramatically increased, tocilizumab was used but only had a transient effect on the patient's symptoms and inflammatory syndrome. Antitumor agent gemcitabine was initiated but her clinical condition continued to deteriorate and the patient died 2 weeks later. The management of aggressive forms of EBV+ inflammatory FDCS remains challenging. However, since these tumors seem to display genetic alterations, better characterization could lead to molecular targeted therapies.
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Affiliation(s)
- Alistair Baber
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Patricia Palmic
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Audrey Lupo-Mansuet
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Barbara Burroni
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Célia Azoulay
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Karen Leroy
- Department of Medical Biology, Genomic Medicine and Physiology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Hélène Blons
- Department of Medical Biology, Genomic Medicine and Physiology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Jean-Yves Blay
- Léon Bérard Oncology Center, Claude Bernard Lyon 1 University, Lyon, France
| | - Pascaline Boudou-Rouquette
- Department of Oncology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, University of Paris, Paris, France
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7
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Duffaud F, Blay JY, Le Cesne A, Chevreau C, Boudou-Rouquette P, Kalbacher E, Penel N, Perrin C, Laurence V, Bompas E, Saada-Bouzid E, Delcambre C, Bertucci F, Cancel M, Schiffler C, Monard L, Bouvier C, Vidal V, Gaspar N, Chabaud S. Regorafenib in patients with advanced Ewing sarcoma: results of a non-comparative, randomised, double-blind, placebo-controlled, multicentre Phase II study. Br J Cancer 2023; 129:1940-1948. [PMID: 37914801 PMCID: PMC10703915 DOI: 10.1038/s41416-023-02413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/23/2023] [Accepted: 08/21/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The REGOBONE multi-cohort study explored the efficacy and safety of regorafenib for patients with advanced bone sarcomas; this report details the Ewing sarcoma (ES) cohort. METHODS Patients with relapsed ES progressing despite prior standard therapy, were randomised (2:1) to receive regorafenib or placebo. Patients on placebo could crossover to receive regorafenib after centrally confirmed progression. The primary endpoint was the progression-free rate at 8 weeks. With one-sided α of 0.05, and 80% power, at least 14/24 progression-free patients at 8 weeks were needed for success. RESULTS From September 2014 to November 2019, 41 patients were accrued. 36 patients were evaluable for efficacy: 23 on regorafenib and 13 on placebo. Thirteen patients (56%; one-sided 95% CI [37.5%-[)) were progression-free at 8 weeks on regorafenib vs. 1 (7.7%; 95% CI [0.4%-[) on placebo. Median PFS was 11.4 weeks on regorafenib, and 3.9 weeks on placebo. Ten placebo patients crossed over to receive regorafenib after progression. The most common grade ≥3 regorafenib-related adverse events were pain (22%), asthenia (17%), thrombocytopenia (13%) and diarrhoea (13%). CONCLUSION Although the primary endpoint was not met statistically in this randomised cohort, there is evidence to suggest that regorafenib might modestly delay tumour progression in relapsed ES after failure of prior chemotherapy.
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Affiliation(s)
- Florence Duffaud
- APHM Hopital La Timone, Medical Oncology Unit, and Aix-Marseille University (AMU), Marseille, France.
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Christine Chevreau
- Medical Oncology Department, Institut Universitaire de Cancérologie de Toulouse, Oncopole, Toulouse, France
| | | | - Elsa Kalbacher
- Medical Oncology Department, CHU J Minjoz, Besançon, France
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | - Emmanuelle Bompas
- Medical Oncology Department, Centre René Gauduchau, Saint Herblain, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | | | - François Bertucci
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Mathilde Cancel
- Medical Oncology Department, Centre Hospitalier Régional Universitaire Bretonneau, Tours, France
| | | | | | - Corinne Bouvier
- APHM Hopital La Timone, Pathology Department, and Aix-Marseille University, Marseille, France
| | - Vincent Vidal
- APHM Hopital La Timone, Radiology Department, and Aix-Marseille University Marseille, Marseille, France
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sylvie Chabaud
- Department of Statistics, Centre Léon Bérard, Lyon, France
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8
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van Ewijk R, Cleirec M, Herold N, le Deley MC, van Eijkelenburg N, Boudou-Rouquette P, Risbourg S, Strauss SJ, Palmerini E, Boye K, Kager L, Hecker-Nolting S, Marchais A, Gaspar N. A systematic review of recent phase-II trials in refractory or recurrent osteosarcoma: Can we inform future trial design? Cancer Treat Rev 2023; 120:102625. [PMID: 37738712 DOI: 10.1016/j.ctrv.2023.102625] [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: 07/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND/OBJECTIVE To analyze changes in recurrent/refractory osteosarcoma phase II trials over time to inform future trials in this population with poor prognosis. METHODS A systematic review of trials registered on trial registries between 01/01/2017-14/02/2022. Comparison of 98 trials identified between 2003 and 2016. Publication search/analysis for both periods, last update on 01/12/2022. RESULTS Between 2017 and 2022, 71 phase-II trials met our selection criteria (19 osteosarcoma-specific trials, 14 solid tumor trials with and 38 trials without an osteosarcoma-specific stratum). The trial number increased over time: 13.9 versus 7 trials/year (p = 0.06). Monotherapy remained the predominant treatment (62% vs. 62%, p = 1). Targeted therapies were increasingly evaluated (66% vs. 41%, P = 0.001). Heterogeneity persisted in the trial characteristics. The inclusion criteria were measurable disease (75%), evaluable disease (14%), and surgical remission (11%). 82% of the trials included pediatric or adolescent patients. Biomarker-driven trials accounted for 25% of the total trials. The survival endpoint use (rather than response) slightly increased (40% versus 31%), but the study H1/H0 hypotheses remained heterogeneous. Single-arm designs predominated over multiarm trials (n = 7). Available efficacy data on 1361 osteosarcoma patients in 58 trials remained disappointing, even though 21% of these trials were considered positive, predominantly those evaluating multi-targeted kinase inhibitors. CONCLUSION Despite observed changes in trial design and an increased number of trials investigating new therapies, high heterogeneity remained with respect to patient selection, study design, primary endpoints, and statistical hypotheses in recently registered phase II trials for osteosarcoma. Continued optimization of trial design informed by a deeper biological understanding should strengthen the development of new therapies.
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Affiliation(s)
- Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Morgane Cleirec
- Department of Pediatric Oncology, CHU Nantes, Nantes, France
| | - Nikolas Herold
- Paediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden, and Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Cécile le Deley
- Unité de Méthodologie et Biostatistiques, Centre Oscar Lambret, Lille, France; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, U1018 ONCOSTAT, F-94085 Villejuif, France
| | | | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Cochin Institute, INSERMU1016, Paris Cancer Institute, CARPEM, AP-HP, Paris, France
| | - Séverine Risbourg
- Unité de Méthodologie et Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Sandra J Strauss
- Department of Oncology, University College London Cancer Institute, London, UK
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Norway
| | - Leo Kager
- St. Anna Children's Hospital, Department of Pediatrics, Medical University Vienna, Vienna, Austria; St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | | | - Antonin Marchais
- Department of Oncology for Child and Adolescents, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France; National Institute for Health and Medical Research (INSERM) U1015, BiiOSTeam, Gustave Roussy Institute, Villejuif, France
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescents, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France; National Institute for Health and Medical Research (INSERM) U1015, BiiOSTeam, Gustave Roussy Institute, Villejuif, France.
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9
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Mogenet A, Finetti P, Denicolai E, Greillier L, Boudou-Rouquette P, Goldwasser F, Lumet G, Ceccarelli M, Birnbaum D, Bedognetti D, Mamessier E, Barlesi F, Bertucci F, Tomasini P. Immunologic constant of rejection as a predictive biomarker of immune checkpoint inhibitors efficacy in non-small cell lung cancer. J Transl Med 2023; 21:637. [PMID: 37726776 PMCID: PMC10507965 DOI: 10.1186/s12967-023-04463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Anti-PD1/PDL1 immune checkpoint inhibitors (ICI) transformed the prognosis of patients with advanced non-small cell lung cancer (NSCLC). However, the response rate remains disappointing and toxicity may be life-threatening, making urgent identification of biomarkers predictive for efficacy. Immunologic Constant of Rejection signature (ICR) is a 20-gene expression signature of cytotoxic immune response with prognostic value in some solid cancers. Our objective was to assess its predictive value for benefit from anti-PD1/PDL1 in patients with advanced NSCLC. METHODS We retrospectively profiled 44 primary tumors derived from NSCLC patients treated with ICI as single-agent in at least the second-line metastatic setting. Transcriptomic analysis was performed using the nCounter® analysis system and the PanCancer Immune Profiling Panel. We then pooled our data with clinico-biological data from four public gene expression data sets, leading to a total of 162 NSCLC patients treated with single-agent anti-PD1/PDL1. ICR was applied to all samples and correlation was searched between ICR classes and the Durable Clinical Benefit (DCB), defined as stable disease or objective response according to RECIST 1.1 for a minimum of 6 months after the start of ICI. RESULTS The DCB rate was 29%; 22% of samples were classified as ICR1, 30% ICR2, 22% ICR3, and 26% ICR4. These classes were not associated with the clinico-pathological variables, but showed enrichment from ICR1 to ICR4 in quantitative/qualitative markers of immune response. ICR2-4 class was associated with a 5.65-fold DCB rate when compared with ICR1 class. In multivariate analysis, ICR classification remained associated with DCB, independently from PDL1 expression and other predictive immune signatures. By contrast, it was not associated with disease-free survival in 556 NSCLC TCGA patients untreated with ICI. CONCLUSION The 20-gene ICR signature was independently associated with benefit from anti-PD1/PDL1 ICI in patients with advanced NSCLC. Validation in larger retrospective and prospective series is warranted.
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Affiliation(s)
- Alice Mogenet
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | - Pascal Finetti
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
| | - Emilie Denicolai
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France-University of Paris Descartes, ARIANE, CARPEM, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France-University of Paris Descartes, ARIANE, CARPEM, Paris, France
| | - Gwenael Lumet
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
| | - Michele Ceccarelli
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel Birnbaum
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
| | - Davide Bedognetti
- Division of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Emilie Mamessier
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
| | - Fabrice Barlesi
- Paris-Saclay University and Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - François Bertucci
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France.
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix Marseille Univ, 232, Bd de Sainte-Marguerite, 13009, Marseille, France.
| | - Pascale Tomasini
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR1068, CNRS UMR725, Laboratoire d'Oncologie Prédictive, Aix Marseille Univ, Marseille, France
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10
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Blay JY, Chevret S, Le Cesne A, Brahmi M, Penel N, Cousin S, Bertucci F, Bompas E, Ryckewaert T, Soibinet P, Boudou-Rouquette P, Saada Bouzid E, Soulie P, Valentin T, Lotz JP, Tosi D, Neviere Z, Cancel M, Ray-Coquard I, Gambotti L, Legrand F, Lamrani-Ghaouti A, Simon C, Even C, Massard C. Pembrolizumab in patients with rare and ultra-rare sarcomas (AcSé Pembrolizumab): analysis of a subgroup from a non-randomised, open-label, phase 2, basket trial. Lancet Oncol 2023; 24:892-902. [PMID: 37429302 DOI: 10.1016/s1470-2045(23)00282-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Sarcoma is a heterogeneous group of diseases with few treatment options. Immunotherapy has shown little activity in studies including unselected sarcomas, but immune checkpoint blockers have shown activity in specific histotypes. We evaluated the activity of pembrolizumab in rare and ultra-rare sarcomas. METHODS AcSé Pembrolizumab is an ongoing phase 2, basket, multitumour study investigating the activity of pembrolizumab monotherapy in rare cancers. Here, we report the results obtained in patients with selected histotypes of rare sarcomas (incidence of less than one case per 1 000 000 people per year) recruited at 24 French hospitals. Key inclusion criteria were age 15 years or older, Eastern Cooperative Oncology Group performance status of 0-1, and advanced disease that was untreated and resistant to treatment. Patients were given pembrolizumab 200 mg intravenously on day 1 of every 21-day cycle for a maximum of 24 months. The primary endpoint was objective response rate at week 12 using Response Evaluation Criteria in Solid Tumours version 1.1, assessed by local investigators. The primary endpoint and safety were analysed in the intention-to-treat population. The AcSé Pembrolizumab study is registered with ClinicalTrials.gov, NCT03012620. FINDINGS Between Sept 4, 2017, and Dec 29, 2020, 98 patients were enrolled, of whom 97 received treatment and were included in analyses (median age 51 years [IQR 35-65]; 53 [55%] were male; 44 [45%] were female; no data were collected on race or ethnicity). 34 (35%) patients had chordomas, 14 (14%) had alveolar soft part sarcomas, 12 (12%) had SMARCA4-deficient sarcomas or malignant rhabdoid tumours, eight (8%) had desmoplastic small round cell tumours, six (6%) had epithelioid sarcomas, four (4%) had dendritic cell sarcomas, three (3%) each had clear cell sarcomas, solitary fibrous tumours, and myxoid liposarcomas, and ten (10%) had other ultra-rare histotypes. As of data cutoff (April 11, 2022), median follow-up was 13·1 months (range 0·1-52·8; IQR 4·3-19·7). At week 12, objective response rate was 6·2% (95% CI 2·3-13·0), with no complete responses and six partial responses in the 97 patients. The most common grade 3-4 adverse events were anaemia (eight [8%] of 97), alanine aminotransferase and aspartate aminotransferase increase (six [6%]), and dyspnoea (five [5%]). 86 serious adverse events were reported in 37 patients. Five deaths due to adverse events were reported, none of which were determined to be related to treatment (two due to disease progression, two due to cancer, and one due to unknown cause). INTERPRETATION Our data show the activity and manageable toxicity of pembrolizumab in some rare and ultra-rare sarcoma histotypes, and support the PD-1/PD-L1 pathway as a potential therapeutic target in selected histotypes. The completion of the basket study will provide further evidence regarding the activity and toxicity of pembrolizumab in identified rare types of cancer. FUNDING The Ligue contre le cancer, INCa, MSD. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jean-Yves Blay
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France.
| | - Sylvie Chevret
- Service de Biostatistique, Hôpital Saint Louis (AP-HP), Université Paris Cité, Paris, France
| | - Axel Le Cesne
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Mehdi Brahmi
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Emmanuelle Bompas
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes, France
| | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | - Diego Tosi
- Institut Régional du Cancer de Montpellier, Centre Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | | | | | - Caroline Even
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
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11
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Ashton E, Arrondeau J, Jouinot A, Boudou-Rouquette P, Hirsch L, Huillard O, Ulmann G, Lupo-Mansuet A, Damotte D, Wislez M, Alifano M, Alexandre J, Goldwasser F. Impact of sarcopenia indexes on survival and severe immune acute toxicity in metastatic non-small cell lung cancer patients treated with PD-1 immune checkpoint inhibitors. Clin Nutr 2023; 42:944-953. [PMID: 37099986 DOI: 10.1016/j.clnu.2023.03.023] [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: 10/19/2022] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND & AIMS Sarcopenia has long been associated with higher toxicity induced by anti-cancer treatments and shorter survival in patients with solid tumors. The creatinine-to-cystatin ratio (CC ratio, serum creatinine/cystatin C × 100) and the sarcopenia index (SI, serum creatinine × cystatin C (CysC)-based glomerular filtration rate (eGFRCysC)) are have been reported to be correlated with skeletal muscle mass. The aim of this study is to assess primarily whether the CC ratio and the SI could predict mortality in metastatic non-small cell lung cancer (NSCLC) patients treated with PD-1 inhibitors, and secondarily their impact on severe immune-related adverse effects (irAEs). METHODS From the prospective CERTIM cohort, we analyzed retrospectively stage IV NSCLC patients, who received PD-1 inhibitors between June 2015 and November 2020 in Cochin Hospital (Paris, France). We assessed sarcopenia measuring skeletal muscle area (SMA) by computed tomography and handgrip strength (HGS) by a hand dynamometer. RESULTS In total, 200 patients were analyzed. The CC ratio and the IS were significantly correlated with SMA and HGS: rCC/SMA = 0.360, rSI/SMA = 0.407, rCC/HGS = 0.331, rSI/HGS = 0.370. In multivariate analysis of overall survival, a lower CC ratio (HR 1.73, P = 0.033) and a lower SI (HR 1.89, P = 0.019) were independent predictors of poor prognosis. In univariate analysis of severe irAEs, CC ratio (OR 1.01, P = 0.628) and SI (OR 0.99, P = 0.595) were not associated with a higher risk of severe irAEs. CONCLUSIONS In metastatic NSCLC patients treated with PD-1 inhibitors, a lower CC ratio and a lower SI are independent predictors of mortality. However, they are not associated with severe irAEs.
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Affiliation(s)
- Elisabeth Ashton
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France.
| | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France.
| | - Anne Jouinot
- Université Paris Cité, Institut Cochin, INSERM U-1016, CNRS UMR-8104, 75014 Paris, France; Department of Endocrinology, Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Laure Hirsch
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Guillaume Ulmann
- Department of Clinical Chemistry, Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Audrey Lupo-Mansuet
- Department of Pathology, Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Diane Damotte
- Department of Pathology, Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Marie Wislez
- Department of Respiratory Medicine and Thoracic Oncology, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Jérôme Alexandre
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, Université Paris Cité, APHP.Centre, 75014 Paris, France.
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12
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Bonnet M, Jouinot A, Boudou-Rouquette P, Seif V, Villeminey C, Arrondeau J, Vidal M, Batista R, Wislez M, Blanchet B, Goldwasser F, Thomas-Schoemann A. Predictive factors associated with pemetrexed acute toxicity. Eur J Clin Pharmacol 2023; 79:635-641. [PMID: 36951965 DOI: 10.1007/s00228-023-03478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Pemetrexed has shown efficacy as monotherapy or in combination with platinum salts in the treatment of non-small cell lung cancer and mesothelioma. However, severe hematological toxicities induced by pemetrexed-based chemotherapy have been observed. Some studies have suggested that drug interactions may be associated with pemetrexed toxicity. The objective of this study was to determine predictive factors, including drug interactions, associated with pemetrexed toxicity. METHODS This retrospective open monocentric study included patients consecutively treated with pemetrexed after a multidisciplinary risk assessment. Patients who experienced toxicity of grade 3 or 4 according to the Common Terminology Criteria for Adverse Events v5.0, or a grade 2 leading to a change in management, during the first four courses of pemetrexed, were assigned to the early limiting toxicities (ELT) group. Univariate and multivariable logistic regression models were used to test the association variables with the occurrence of ELT. RESULTS Seventy-four patients were included in this study (median age: 67 years, with non-small cell lung cancer adenocarcinoma (88%), mesothelioma (7%), or others (5%). Thirty-six patients (49%) were assigned to the ELT group (27 grades 3 and 4; 9 grade 2 with management modification). Three baseline factors were associated with pemetrexed ELT in univariate and multivariate analysis: cystatin clearance (p = 0.0135), albumin level (p = 0.0333), and proton pump inhibitors use (p = 0.035). CONCLUSION To conclude, ELT induced by pemetrexed-based treatments occur frequently in cancer patients in a real-world setting. A pretherapeutic assessment before pemetrexed initiation should include three major checkpoints: use of proton pump inhibitors, sarcopenia, and denutrition evaluation.
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Affiliation(s)
| | | | | | | | | | | | - Michel Vidal
- Pharmacocinétique et Pharmacochimie, Hôpital Cochin, Paris, France
- UMR8038, CNRS, U.1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | | | | | - Benoit Blanchet
- Pharmacocinétique et Pharmacochimie, Hôpital Cochin, Paris, France
| | | | - Audrey Thomas-Schoemann
- Pharmacie, Hôpital Cochin, Paris, France.
- Oncologie, Hôpital Cochin, Paris, France.
- UMR8038, CNRS, U.1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
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13
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Couderc AL, Liuu E, Boudou-Rouquette P, Poisson J, Frelaut M, Montégut C, Mebarki S, Geiss R, ap Thomas Z, Noret A, Pierro M, Baldini C, Paillaud E, Pamoukdjian F. Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment. Nutrients 2023; 15:nu15051193. [PMID: 36904192 PMCID: PMC10005339 DOI: 10.3390/nu15051193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I2: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I2 < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- CNRS, EFS, ADES, Aix-Marseille University, 13015 Marseille, France
| | - Evelyne Liuu
- Department of Geriatrics, CHU Poitiers, 86000 Poitiers, France
- CIC1402 INSERM Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - Pascaline Boudou-Rouquette
- Ariane Program, Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, APHP, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Paris Cité University, 75015 Paris, France
| | - Johanne Poisson
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- Faculty of Health, Paris Cité University, 75006 Paris, France
| | - Maxime Frelaut
- Department of Medical Oncology, Gustave Roussy Institute, 94805 Villejuif, France
| | - Coline Montégut
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
| | - Soraya Mebarki
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Romain Geiss
- Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France
| | - Zoé ap Thomas
- Department of Cancer Medicine, Gustave Roussy Institute, 94805 Villejuif, France
| | - Aurélien Noret
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Monica Pierro
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Capucine Baldini
- Drug Development Department, Gustave Roussy Institute, 94805 Villejuif, France
| | - Elena Paillaud
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- INSERM, IMRB, Clinical, Epidemiology and Ageing, Université Paris-Est Creteil, 94010 Creteil, France
| | - Frédéric Pamoukdjian
- Department of Geriatrics, Avicenne Hospital, APHP, 93000 Bobigny, France
- INSERM UMR_S942 Cardiovascular Markers in Stressed Conditions MASCOT, Sorbonne Paris Nord University, 93000 Bobigny, France
- Correspondence:
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14
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González Serrano A, Laurent M, Barnay T, Martínez-Tapia C, Audureau E, Boudou-Rouquette P, Aparicio T, Rollot-Trad F, Soubeyran P, Bellera C, Caillet P, Paillaud E, Canouï-Poitrine F. A Two-Step Frailty Assessment Strategy in Older Patients With Solid Tumors: A Decision Curve Analysis. J Clin Oncol 2023; 41:826-834. [PMID: 36306481 PMCID: PMC9901978 DOI: 10.1200/jco.22.01118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The intended clinical value of frailty screening is to identify unfit patients needing geriatric assessment (GA) and to prevent unnecessary GA in fit patients. These hypotheses rely on the sensitivity and specificity of screening tests, but they have not been verified. METHODS We performed a cross-sectional analysis of outpatients age ≥ 70 years with prostate, breast, colorectal, or lung cancer included in the ELCAPA cohort study (ClinicalTrials.gov identifier: NCT02884375) between February 2007 and December 2019. The diagnostic accuracy of the G8 Geriatric Screening Tool (G8) and modified G8 scores for identifying unfit patients was determined on the basis of GA results. We used decision curve analysis to calculate the benefit of frailty screening for detecting unfit patients and avoiding unnecessary GA in fit patients across different threshold probabilities. RESULTS We included 1,648 patients (median age, 81 years), and 1,428 (87%) were unfit. The sensitivity and specificity were, respectively, 85% (95% CI, 84 to 87) and 59% (95% CI, 57 to 61) for G8, and 86% (95% CI, 84 to 87) and 60% (95% CI, 58 to 63) for the modified G8 score. For decision curve analysis, the net benefit (NB) for identifying unfit patients were 0.72 for G8, 0.72 for the modified G8, and 0.82 for GA at a threshold probability of 0.25. At a threshold probability of 0.33, the NBs were 0.71, 0.72, and 0.80, respectively. At a threshold probability of 0.5, the NBs were 0.68, 0.69, and 0.73, respectively. No screening tool reduced unnecessary GA in fit patients at predefined threshold probabilities. CONCLUSION Although frailty screening tests showed good diagnostic accuracy, screening showed no clinical benefits over the GA-for-all strategy. NB approaches, in addition to diagnostic accuracy, are necessary to assess the clinical value of tests.
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Affiliation(s)
- Adolfo González Serrano
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Adolfo González Serrano, MD, MSc, Mondor Biomedical Research Institute, Faculty of Health, Université Paris-Est-Créteil, 8 rue du Général Sarrail, 94010 Créteil, France; Twitter: @AGonzalezUro; e-mail:
| | - Marie Laurent
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Department of Internal Medicine and Geriatrics, Henri Mondor Hospital, AP-HP, Creteil, France
| | - Thomas Barnay
- ERUDITE Research Unit, Université Paris-Est-Créteil, Créteil, France
| | | | - Etienne Audureau
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Department of Public Health, Henri Mondor Hospital, AP-HP, Creteil, France
| | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, AP-HP, Paris, France
| | - Florence Rollot-Trad
- Department of Supportive Care and Geriatric Oncology, Institut Curie, Paris, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Bergonie Institute Comprehensive Cancer Center, Bordeaux, France
| | - Carine Bellera
- Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Université de Bordeaux, Bordeaux, France,Inserm CIC1401, Clinical and Epidemiological Research Unit, Bergonié Institute Comprehensive Cancer Center, Bordeaux, France
| | - Philippe Caillet
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Department of Geriatrics, Georges Pompidou European Hospital, AP-HP, Paris, France,Paris Cancer Research for Personalized Medicine Institute, Paris, France
| | - Elena Paillaud
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Department of Geriatrics, Georges Pompidou European Hospital, AP-HP, Paris, France,Paris Cancer Research for Personalized Medicine Institute, Paris, France
| | - Florence Canouï-Poitrine
- Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France,Department of Public Health, Henri Mondor Hospital, AP-HP, Creteil, France
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15
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Kubicek P, Cesne AL, Lervat C, Toulmonde M, Chevreau C, Duffaud F, Le Nail LR, Morelle M, Gaspar N, Vérité C, Castex MP, Penel N, Saada E, Causeret S, Bertucci F, Perrin C, Bompas E, Orbach D, Laurence V, Piperno-Neumann S, Anract P, Rios M, Gentet JC, Mascard É, Pannier S, Blouin P, Carrère S, Chaigneau L, Soibinet-Oudot P, Corradini N, Boudou-Rouquette P, Ruzic JC, Lebrun-Ly V, Dubray-Longeras P, Varatharajah S, Lebbe C, Ropars M, Kurtz JE, Guillemet C, Lotz JP, Berchoud J, Cherrier G, Ducimetière F, Chemin C, Italiano A, Honoré C, Desandes E, Blay JY, Gouin F, Marec-Bérard P. Management and outcomes of adolescent and young adult sarcoma patients: results from the French nationwide database NETSARC. BMC Cancer 2023; 23:69. [PMID: 36670431 PMCID: PMC9854049 DOI: 10.1186/s12885-023-10556-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The initial management of patients with sarcoma is a critical issue. We used the nationwide French National Cancer Institute-funded prospective sarcoma database NETSARC to report the management and oncologic outcomes in adolescents and young adults (AYAs) patients with sarcoma at the national level. PATIENTS AND METHODS NETSARC database gathers regularly monitored and updated data from patients with sarcoma. NETSARC was queried for patients (15-30 years) with sarcoma diagnosed from 2010 to 2017 for whom tumor resection had been performed. We reported management, locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) in AYA treated in French reference sarcoma centers (RSC) and outside RSC (non-RSC) and conducted multivariable survival analyses adjusted for classical prognostic factors. RESULTS Among 3,227 patients aged 15-30 years with sarcoma diagnosed between 2010 and 2017, the study included 2,227 patients with surgery data available, among whom 1,290 AYAs had been operated in RSC, and 937 AYAs in non-RSC. Significant differences in compliance to guidelines were observed including pre-treatment biopsy (RSC: 85.9%; non-RSC 48.1%), pre-treatment imaging (RSC: 86.8%; non-RSC: 56.5%) and R0 margins (RSC 57.6%; non-RSC: 20.2%) (p < 0.001). 3y-OS rates were 81.1% (95%CI 78.3-83.6) in AYA in RSC and 82.7% (95%CI 79.4-85.5) in AYA in non-RSC, respectively. Whereas no significant differences in OS was observed in AYAs treated in RSC and in non-RSC, LRFS and PFS were improved in AYAs treated in RSC compared to AYAs treated in non-RSC (Hazard Ratios (HR): 0.58 and 0.83, respectively). CONCLUSIONS This study highlights the importance for AYA patients with sarcoma to be managed in national sarcoma reference centers involving multidisciplinary medical teams with paediatric and adult oncologists.
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Affiliation(s)
- Pierre Kubicek
- grid.418191.40000 0000 9437 3027Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Angers, France ,grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Cyril Lervat
- grid.452351.40000 0001 0131 6312Centre Oscar Lambret, Lille, France
| | - Maud Toulmonde
- grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | - Christine Chevreau
- grid.417829.10000 0000 9680 0846Institut Claudius Régaud IUCT Toulouse, Toulouse, France
| | | | | | - Magali Morelle
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Nathalie Gaspar
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Cécile Vérité
- grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | | | - Nicolas Penel
- grid.452351.40000 0001 0131 6312Centre Oscar Lambret, Lille, France
| | - Esma Saada
- grid.417812.90000 0004 0639 1794Centre Antoine Lacassagne, Nice, France
| | - Sylvain Causeret
- grid.418037.90000 0004 0641 1257Centre Georges François Leclerc, Dijon, France
| | - François Bertucci
- grid.418443.e0000 0004 0598 4440Institut Paoli-Calmettes, Marseille, France
| | - Christophe Perrin
- grid.417988.b0000 0000 9503 7068Centre Eugène Marquis, Rennes, France
| | - Emmanuelle Bompas
- grid.418191.40000 0000 9437 3027Institut de Cancérologie de l’Ouest, Nantes, France
| | - Daniel Orbach
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Valérie Laurence
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Sophie Piperno-Neumann
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Philippe Anract
- grid.411784.f0000 0001 0274 3893Hôpital Cochin, Paris, France
| | - Maria Rios
- grid.452436.20000 0000 8775 4825Institut de Cancérologie de Lorraine, Nancy, France
| | | | - Éric Mascard
- grid.412134.10000 0004 0593 9113Hôpital Necker, Paris, France
| | | | - Pascale Blouin
- grid.411777.30000 0004 1765 1563CHU Tours, Tours, France
| | - Sébastien Carrère
- grid.418189.d0000 0001 2175 1768Centre Val d’Aurelle ICM, Montpellier, France
| | - Loïc Chaigneau
- grid.411158.80000 0004 0638 9213CHU Besançon, Besançon, France
| | | | | | | | | | | | | | | | - Céleste Lebbe
- grid.413328.f0000 0001 2300 6614Hôpital Saint-Louis, Paris, France
| | - Mickaël Ropars
- grid.411154.40000 0001 2175 0984CHU Rennes, Rennes, France
| | - Jean-Emmanuel Kurtz
- grid.512000.6Institut de Cancérologie Strasbourg-Europe ICANS, Strasbourg, France
| | - Cécile Guillemet
- grid.418189.d0000 0001 2175 1768Centre Henri Becquerel, Rouen, France
| | | | | | | | | | - Claire Chemin
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Antoine Italiano
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France ,grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | - Charles Honoré
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Emmanuel Desandes
- CHRU Nancy, Centre de Recherche en Epidémiologie et en Statistique Sorbonne-Paris Cité (CRESS), UMR 1153, INSERM, Université de Paris-Descartes, Paris, France
| | - Jean-Yves Blay
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - François Gouin
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France ,grid.277151.70000 0004 0472 0371CHU Nantes, Nantes, France
| | - Perrine Marec-Bérard
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France ,Institute of Pediatric Hematology and Oncology, Lyon, France
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16
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Tlemsani C, Larousserie F, De Percin S, Audard V, Hadjadj D, Chen J, Biau D, Anract P, Terris B, Goldwasser F, Pasmant E, Boudou-Rouquette P. Biology and Management of High-Grade Chondrosarcoma: An Update on Targets and Treatment Options. Int J Mol Sci 2023; 24:ijms24021361. [PMID: 36674874 PMCID: PMC9862566 DOI: 10.3390/ijms24021361] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
This review provides an overview of histopathology, clinical presentation, molecular pathways, and potential new systemic treatments of high-grade chondrosarcomas (CS), including grade 2−3 conventional, dedifferentiated, and mesenchymal CS. The diagnosis of CS combines radiological and histological data in conjunction with patient clinical presentations. Conventional CS is the most frequent subtype of CS (85%) and represents about 25% of primary bone tumors in adults; they can be categorized according to their bone location into central, peripheral, and periosteal chondrosarcomas. Central and peripheral CS differ at the molecular level with either IDH1/2 mutations or EXT1/2 mutations, respectively. CDKN2A/B deletions are also frequent in conventional CS, as well as COL2A1 mutations. Dedifferentiated CS develops when low-grade conventional CS transforms into a high-grade sarcoma and most frequently exhibits features of osteosarcoma, fibrosarcoma, or undifferentiated pleomorphic sarcoma. Their molecular characteristics are similar to conventional CS. Mesenchymal CS is a totally different pathological entity exhibiting recurrent translocations. Their clinical presentation and management are different too. The standard treatment of CSs is wide en-bloc resection. CS are relatively radiotherapy resistant; therefore, doses >60 Gy are needed in an attempt to achieve local control in unresectable tumors. Chemotherapy is possibly effective in mesenchymal chondrosarcoma and is of uncertain value in dedifferentiated chondrosarcoma. Due to resistance to standard anticancer agents, the prognosis is poor in patients with metastatic or unresectable chondrosarcomas. Recently, the refined characterization of the molecular profile, as well as the development of new treatments, allow new therapeutic options for these rare tumors. The efficiency of IDH1 inhibitors in other malignancies suggests that these inhibitors will be part of IDH1/2 mutated conventional CS management soon. Other treatment approaches, such as PIK3-AKT-mTOR inhibitors, cell cycle inhibitors, and epigenetic or immune modulators based on improving our understanding of CS molecular biology, are emerging.
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Affiliation(s)
- Camille Tlemsani
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Frédérique Larousserie
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Sixtine De Percin
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Virginie Audard
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Djihad Hadjadj
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Jeanne Chen
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - David Biau
- Department of Orthopedic Surgery, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Philippe Anract
- Department of Orthopedic Surgery, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Eric Pasmant
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- Department of Genetics, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- Correspondence: ; Tel.: +33-1-58-41-23-30; Fax: +33-1-58-41-14-34
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Pautier P, Italiano A, Piperno-Neumann S, Chevreau C, Penel N, Firmin N, Boudou-Rouquette P, Bertucci F, Balleyguier C, Lebrun-Ly V, Ray-Coquard I, Kalbacher E, Bardet A, Bompas E, Collard O, Isambert N, Guillemet C, Rios M, Archambaud B, Duffaud F, ITALIANO A, PAUTIER P, LECESNE A, PIPERNO-NEUMANN S, CHEVREAU C, CUPISSOL D, PENEL N, ALEXANDRE J, BERTUCCI F, RAY-COQUARD I, LEBRUN-LY V, KALBACHER E, DUFFAUD F, DELCAMBRE C, BOMPAS E, COLLARD O, ISAMBERT N, GUILLEMET C, SOULIE P, RIOS M, SAADA-BOUZID E. Doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin alone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol 2022; 23:1044-1054. [DOI: 10.1016/s1470-2045(22)00380-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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Subbiah V, Braña I, Longhi A, Boni V, Delord JP, Awada A, Boudou-Rouquette P, Sarantopoulos J, Shapiro GI, Elias A, Ratan R, Fernandez C, Kahatt C, Cullell-Young M, Siguero M, Zeaiter A, Chawla SP. Antitumor Activity of Lurbinectedin, a Selective Inhibitor of Oncogene Transcription, in Patients with Relapsed Ewing Sarcoma: Results of a Basket Phase II Study. Clin Cancer Res 2022; 28:2762-2770. [PMID: 35486638 PMCID: PMC9306456 DOI: 10.1158/1078-0432.ccr-22-0696] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Lurbinectedin suppresses the oncogenic transcription factor EWS-FLI1 through relocalization to the nucleolus, and delays tumor growth in mice bearing Ewing sarcoma xenografts. On the basis of this rationale, lurbinectedin was evaluated in patients with relapsed Ewing sarcoma. PATIENTS AND METHODS This open-label, single-arm, Basket phase II trial included a cohort of 28 treated adult patients with confirmed Ewing sarcoma, measurable disease as per Response Evaluation Criteria In Solid Tumors (RECIST) v.1.1, Eastern Cooperative Oncology Group performance status ≤2, adequate organ function, no central nervous system metastasis, and pretreated with ≤2 chemotherapy lines for metastatic/recurrent disease. Patients received lurbinectedin 3.2 mg/m2 as a 1-hour infusion every 3 weeks. Primary endpoint was overall response rate (ORR) as per RECIST v.1.1. Secondary endpoints included time-to-event parameters and safety profile. RESULTS ORR was 14.3% [95% confidence interval (CI), 4.0%-32.7%], with median duration of response of 4.2 months (95% CI, 2.9-5.5 months). Median progression-free survival was 2.7 months (95% CI, 1.4-4.3 months), clinical benefit rate was 39.3%, and disease control rate was 57.1%. With 39% censoring, median overall survival was 12.0 months (95% CI, 8.5-18.5 months). Most common grade 3/4 adverse events were neutropenia (57%), anemia, thrombocytopenia, and treatment-related febrile neutropenia (14% each). No deaths or discontinuations were due to toxicity. CONCLUSIONS Lurbinectedin was active in the treatment of relapsed Ewing sarcoma and had a manageable safety profile. Lurbinectedin could represent a valuable addition to therapies for Ewing sarcoma, and is currently being evaluated in combination with irinotecan in advanced Ewing sarcoma in a phase Ib/II trial.
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Affiliation(s)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas.,Corresponding Author: Vivek Subbiah, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. Phone: 713-563-1930; Fax: 713-792-0334; E-mail:
| | - Irene Braña
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Valentina Boni
- START Madrid–Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - Ahmad Awada
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Anthony Elias
- University of Colorado Cancer Center, Aurora, Colorado
| | - Ravin Ratan
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Minot-This MS, Boudou-Rouquette P, Jouinot A, de Percin S, Balakirouchenane D, Khoudour N, Tlemsani C, Chauvin J, Thomas-Schoemann A, Goldwasser F, Blanchet B, Alexandre J. Relation between Plasma Trough Concentration of Pazopanib and Progression-Free Survival in Metastatic Soft Tissue Sarcoma Patients. Pharmaceutics 2022; 14:pharmaceutics14061224. [PMID: 35745797 PMCID: PMC9231369 DOI: 10.3390/pharmaceutics14061224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Pazopanib (PAZ) is an oral angiogenesis inhibitor approved to treat soft tissue sarcoma (STS) but associated with a large interpatient pharmacokinetic (PK) variability and narrow therapeutic index. We aimed to define the specific threshold of PAZ trough concentration (Cmin) associated with better progression-free survival (PFS) in STS patients. Methods: In this observational study, PAZ Cmin was monitored over the treatment course. For the primary endpoint, the 3-month PFS in STS was analyzed with logistic regression. Second, we performed exposure−overall survival (OS) (Cox model plus Kaplan−Meier analysis/log-rank test) and exposure−toxicity analyses. Results: Ninety-five STS patients were eligible for pharmacokinetic/pharmacodynamic (PK/PD) assessment. In the multivariable analysis, PAZ Cmin < 27 mg/L was independently associated with a risk of progression at 3 months (odds ratio (OR) 4.21, 95% confidence interval (CI) (1.47−12.12), p = 0.008). A higher average of PAZ Cmin over the first 3 months was associated with a higher risk of grade 3−4 toxicities according to the NCI-CTCAE version 5.0 (OR 1.07 per 1 mg/L increase, CI95 (1.02−1.13), p = 0.007). Conclusion: PAZ Cmin ≥ 27 mg/L was independently associated with improved 3-month PFS in STS patients. Pharmacokinetically-guided dosing could be helpful to optimize the clinical management of STS patients in daily clinical practice.
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Affiliation(s)
- Marie-Sophie Minot-This
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
| | - Pascaline Boudou-Rouquette
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
- Correspondence:
| | - Anne Jouinot
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
- INSERM U-1016, CNRS UMR-8104, University of Paris, Institut Cochin, 75014 Paris, France
| | - Sixtine de Percin
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
| | - David Balakirouchenane
- Department of Pharmacokinetics and Pharmacochemistry, AP-HP, CARPEM, Cochin Hospital, 75014 Paris, France; (D.B.); (N.K.); (A.T.-S.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University of Paris, PRES Sorbonne Paris Cité, CARPEM, 75006 Paris, France
| | - Nihel Khoudour
- Department of Pharmacokinetics and Pharmacochemistry, AP-HP, CARPEM, Cochin Hospital, 75014 Paris, France; (D.B.); (N.K.); (A.T.-S.); (B.B.)
| | - Camille Tlemsani
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
| | | | - Audrey Thomas-Schoemann
- Department of Pharmacokinetics and Pharmacochemistry, AP-HP, CARPEM, Cochin Hospital, 75014 Paris, France; (D.B.); (N.K.); (A.T.-S.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University of Paris, PRES Sorbonne Paris Cité, CARPEM, 75006 Paris, France
| | - François Goldwasser
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
- Lixoft, 92160 Antony, France;
| | - Benoit Blanchet
- Department of Pharmacokinetics and Pharmacochemistry, AP-HP, CARPEM, Cochin Hospital, 75014 Paris, France; (D.B.); (N.K.); (A.T.-S.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University of Paris, PRES Sorbonne Paris Cité, CARPEM, 75006 Paris, France
| | - Jérôme Alexandre
- Institut du Cancer Paris CARPEM, AP-HP, APHP.Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, 75014 Paris, France; (M.-S.M.-T.); (A.J.); (S.d.P.); (C.T.); (F.G.); (J.A.)
- Centre de Recherche des Cordeliers, Université Paris-Sorbonne, INSERM, 75005 Paris, France
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Brahmi M, Gautier J, Dufresne A, Marec-Berard P, Cropet C, Vizoso S, Bissuel L, Valentin T, Entz-Werle N, Bompas E, Toulmonde M, Kalbacher E, Duffaud F, Penel N, Mir O, Gantzer J, Boudou-Rouquette P, Firmin N, Ray-Coquard IL, Blay JY. REGOMAIN: A randomized, placebo-controlled, double-blinded, multicenter, comparative phase II study of the efficacy of regorafenib as maintenance treatment in patients (pts) with high-grade bone sarcomas (HGBS) at diagnosis or relapse and without complete remission after standard treatment. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps11585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11585 Background: Primary metastatic osteosarcoma (OS) patients are treated with a curative intent following the same principles of non-metastatic OS, while the treatment of recurrent OS is primarily surgical in the case of isolated lung metastases. When complete removal of all metastases cannot be achieved, the prognosis remains poor, with a median Progression-Free Survival (PFS) between 3 to 8 months, and therefore there is a clinical need to reduce the risk of progression after the initial treatment sequence. The REGOBONE study reported a significant PFS benefit of regorafenib (REG) compared to placebo (in osteosarcomas: median PFS: 16.4 versus 4.1 weeks) and a manageable safety profile in patients with histologically confirmed HGBS (i.e., osteosarcoma or other bone sarcomas with the exception of Ewing sarcomas, chondrosarcoma and chordoma). Methods: This multicenter trial is ongoing to study the efficacy and safety of maintenance REG in pts > = 16 years old with HGBS, without complete remission but with no progressive disease after standard treatment, either at diagnosis or at relapse. Sixty pts will be randomly allocated in a 1:1 ratio to receive either oral REG at a daily dose of 120mg or its matching placebo, continuously for a maximum of 12 months. Randomization is stratified according to the setting of the disease: initial diagnosis versus relapse. The primary objective is to compare the efficacy (PFS) between the 2 arms. The expected 4-month PFS rates are 30% in the control arm and 60% in the REGO arm (HR = 0.42). Fifty-two events will provide 87% power to show significant improvement in PFS, using a 2-sided log-rank test at a 5% level. Secondary endpoints include Overall Response Rate (ORR), Disease Control Rate (DCR), Time to Treatment Failure (TTF), Overall Survival (OS), Quality of Life (QoL), and safety profile. Radiological endpoints will be evaluated using the RECIST 1.1 with tumor assessments every 2 months (first 6 months) and then every 3 months. Translational objectives will identify predictive biomarkers for efficacy of REG as maintenance therapy. Pts of the control arm who experience disease progression may switch to receive open label REG. As of Feb 1st, 2022, 3 patients have been randomized. 14 sites of the French Sarcoma Group will participate. An amendment is being implemented to lower the age limit (12 years old) and to expand tumor types to other HGBS (Ewing sarcomas, chondrosarcomas, Undifferentiated Pleomorphic Sarcomas, Leiomyosarcomas and angiosarcomas). Clinical trial information: NCT04698785.
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Affiliation(s)
| | | | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Claire Cropet
- Unite de Biostatistique et d'Evaluation des Therapeutiques-Direction de la Recherche et d l'Innovation, Centre Leon Berard, Lyon, France
| | | | | | | | | | | | - Maud Toulmonde
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
| | - Elsa Kalbacher
- Groupe d’Investigateurs Nationaux pour l’Etute des Cancers Ovariens and CHRU Jean Minjoz, Besançon, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | - Pascaline Boudou-Rouquette
- AP-HP, Hôpital Cochin Port-Royal, Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Paris, France
| | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
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21
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Gonzalez Serrano A, Laurent M, Barnay T, Martinez-Tapia C, Audureau E, Boudou-Rouquette P, Aparicio T, Rollot-Trad F, Soubeyran P, Bellera CA, Paillaud E, Caillet P, Canoui-Poitrine F. A decision curve analysis of the clinical usefulness of a two-step frailty assessment strategy in older patients with prostate, breast, colorectal, or lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12011 Background: Geriatric Assessment (GA) is recommended to assess the health status and select the most appropriate cancer treatment in older patients. However, GA is resource- and time-consuming. Thus, a two-step approach using frailty screening has been recommended. We aimed to evaluate the usefulness of frailty screening over GA for identifying unfit individuals who need GA and reducing unnecessary GA in fit individuals in a population of older outpatients with cancer. Methods: We analyzed patients age 70 and older with prostate, breast, colorectal, or lung cancer included in the multicenter, prospective ELCAPA cohort study (NCT02884375) between February 2007 and December 2019. All patients had a GA at inclusion. GA was the reference test. We defined unfit patients as those having at least one abnormal score in the following domains: functional status, mobility, comorbidity, cognition, mental health status, nutrition, and polypharmacy. We defined unfit patients according to the G8 and modified G8 scores using the recommended cut-offs (≤ 14 out of 17 points and ≥ 6 out of 35 points, respectively). We calculated each screening tool's sensitivity, specificity, and positive and negative predictive values. We used decision curve analysis to estimate the net benefit (the percentage of patients found to be unfit) of screening over GA. We assessed the avoided unnecessary GAs for each screening tool (reducing unnecessary GA in fit patients without decreasing the number of unfit patients undergoing [necessary] GA). We calculated these estimates across different threshold probabilities corresponding to the value of missing an unfit patient compared to exposing a fit patient to an unnecessary GA. A probability of 0.33 indicated that missing an unfit patient was two times worse than referring a fit patient to an unnecessary GA. A probability of 0.50 indicated that missing an unfit patient was the same as exposing a fit patient to an unnecessary GA. Results: We analyzed 1,648 patients with prostate (15%), breast (52%), colorectal (22%), or lung cancer (11%). The median age was 81 years, 559 patients (34%) had metastatic disease, and 1,428 patients (87%) were unfit. The sensitivity (95% CI) and specificity were 85% (84-87) and 59% (57-61) for the G8 score, and 86% (84-87) and 60% (58-63) for the modified G8 score. With a threshold probability of 0.33, the net benefit was 0.71 for the G8 score, 0.72 for the modified G8 score, and 0.80 for GA. With a threshold probability of 0.50, the net benefit was 0.68 for the G8 score, 0.69 for the modified G8 score, and 0.73 for GA. We did not observe a reduction in unnecessary GA of screening tools over GA. Conclusions: Frailty screening tools showed good diagnostic performances. However, our findings suggest that the GA-for-all strategy provides the higher clinical benefit in older patients with cancer.
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Affiliation(s)
| | - Marie Laurent
- Université Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Thomas Barnay
- Université Paris Est Créteil, ERUDITE Research Unit, Créteil, France
| | | | | | | | - Thomas Aparicio
- Department of Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France
| | - Florence Rollot-Trad
- Institut Curie, Geriatric Oncology, Department of Supportive care, Paris, France
| | - Pierre Soubeyran
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
| | - Carine A. Bellera
- Institut Bergonié, Clinical and Epidemiological Research Unit, Bordeaux, France
| | - Elena Paillaud
- AP-HP, Hôpital Européen Georges Pompidou, Department of Geriatrics, Paris, France
| | - Philippe Caillet
- AP-HP, Hôpital Européen Georges Pompidou, Department of Geriatrics, Paris, France
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22
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Paillaud E, Galvin A, Pulido M, Perrin C, Grellety T, Boudou-Rouquette P, Teyssonneau D, Ayati S, Saint-Lezer A, Culine S, Annonay M, Soulem-Laviec H, Boulahssass R, Baldini C, Tchalla A, Soubeyran PL, Lalet C, Mebarki S, Hue L, Mathoulin-Pélissier S. Health literacy in patients with cancer: A multicenter national study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6541 Background: Health literacy (HL) is defined as the motivation and skills to access, understand, evaluate, and use information to make appropriate health decisions. The level of LS is low in Europe, including in France. For chronic patients, a low literacy is associated with limited skills in the self-management of the disease, the monitoring of treatments and is an obstacle in therapeutic education. In France, there is no study on patients with cancer. However, our pilot study with older adults with cancer showed that 72% had a low level of LS, a level defined by a questionnaire validated in French (Functional, Communicative and Critical Health Literacy-FCCHL, a score ≤ 4 = low level). The objective of this multicenter study is to evaluate HL in 2 cohorts of cancer patients: adults aged 65 and over (OLD) and adults aged 18 to 64 (Y). Methods: This multicenter cross-sectional study enrolled 1,518 patients aged 18 and over from 27/09/21 to 29/10/21 in 26 centers. Patients were either admitted in outpatient unit, or seen in oncology/geriatric oncology consultation, and with a treatment plan. They completed the FCCHL and 11 questions on the use of digital. Demographic and health data were also collected. The FCCHL consists of 3 subscales evaluating functional (access to information – 5 items), interactive (understanding of information – 5 items) and critical (use of information – 4 items) HL. The score for each subscale is calculated by taking the sum obtained for each item divided by the number of items and varies from 1 (low) to 5 (high). The overall score is calculated from the subscale scores. The primary endpoint was the rate of patients with an overall score of HL ≤ 4 (no. of subjects estimated at 420 per cohort, considering non-evaluable patients and an expected rate of HL ≤ 4 from 70% to 80%). Patients’ characteristics and their use of digital have been described. In addition, a multivariate exploratory analysis of the factors associated with an LS≤ 4 in the OLD cohort was performed. Results: Most patients (1,327(87%)) had completed all the FFCHL items (658 (84%) OLD cohort; 669 (91%) Y cohort). The proportion of men was higher in the OLD cohort (48% vs 34% Y cohort). Many of the patients lived at home in the 2 cohorts (98%) and half in urban area (56% cohort OLD vs 52% cohort Y). The patients had an advanced stage of cancer (70% OLD cohort vs 61% Y cohort). A low level of HL was reported in 70% of the Y cohort and in 78.7% of the OLD cohort. The use of digital tools was lower in the OLD cohort: 41% had never used the internet for their health vs. 14% in cohort Y; this use was very low for online consultations (respectively 83 and 64% never used them). For the OLD cohort, only advanced and/or metastatic cancer stage was associated with HL≤ 4 (after center adjustment). Conclusions: These results show a low level of HL in older as in the younger population. Actions need to be implemented for the detection of moderate or weak HL in the way to reduce barriers in the management of cancer treatments.
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Affiliation(s)
- Elena Paillaud
- AP-HP, Hôpital Européen Georges Pompidou, Department of Geriatrics, Paris, France
| | - Angéline Galvin
- Université de Bordeaux, INSERM U1219 Bordeaux Population Health, EPICENE Team, Bordeaux, France
| | - Marina Pulido
- INSERM CIC-EC 14.01, Unité de Recherche et d’Epidémiologie Cliniques, Institut Bergonié, Comprehensive Cancer Center, PACAN platform, Bordeaux, France
| | | | | | - Pascaline Boudou-Rouquette
- AP-HP, Hôpital Cochin Port-Royal, Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Paris, France
| | | | - Siavoshe Ayati
- Centre Georges-François Leclerc, Comprehensive Cancer Center, Dijon, France
| | | | - Stephane Culine
- Department of Medical Oncology, Hospital Saint-Louis, Paris, France
| | - Mylene Annonay
- Centre hospitalier de Martinique, Fort-De-France, France
| | | | - Rabia Boulahssass
- Centre Hospitalier Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | - Capucine Baldini
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Achille Tchalla
- Centre hospitalier universitaire de Limoges, Geriatric medicine unit, Limoges, France
| | | | - Caroline Lalet
- INSERM CIC-EC 14.01, Unité de Recherche et d’Epidémiologie Cliniques, Institut Bergonié, Comprehensive Cancer Center, PACAN platform, Bordeaux, France
| | - Soraya Mebarki
- Geriatric Oncology Unit, European Georges-Pompidou Hospital, APHP Centre, Paris, France
| | - Lucas Hue
- INSERM CIC-EC 14.01, Unité de Recherche et d’Epidémiologie Cliniques, Institut Bergonié, Comprehensive Cancer Center, PACAN platform, Bordeaux, France
| | - Simone Mathoulin-Pélissier
- INSERM CIC-EC 14.01, Unité de Recherche et d’Epidémiologie Cliniques, Institut Bergonié, Comprehensive Cancer Center, PACAN platform, Bordeaux, France
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Gonzalez-Serrano A, Laurent M, Barnay T, Martínez-Tapia C, Audureau E, Boudou-Rouquette P, Aparicio T, Rollot-Trad F, Soubeyran P, Bellera C, Caillet P, Paillaud E, Canouï-Poitrine F. Utilité clinique d'une stratégie d’évaluation de la fragilité en deux étapes: une analyse par courbe de décision de patients âgés atteints d'un cancer de la prostate, du sein, colorectal et du poumon. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Penel N, Bonvalot S, Bimbai AM, Meurgey A, Le Loarer F, Salas S, Piperno-Neumann S, Chevreau C, Boudou-Rouquette P, Dubray-Longeras P, Kurtz JE, Guillemet C, Bompas E, Italiano A, Le Cesne A, Orbach D, Thery J, Le Deley MC, Blay JY, Mir O. Lack of prognostic value of CTNNB1 mutation profile in desmoid-type fibromatosis. Clin Cancer Res 2022; 28:4105-4111. [PMID: 35294527 DOI: 10.1158/1078-0432.ccr-21-4235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This prospective nationwide cohort study aimed to investigate desmoid-type fibromatosis (DF) outcomes, focusing on the prognostic value of CTNNB1 mutations. EXPERIMENTAL DESIGN ALTITUDES (NCT02867033) was a nationwide prospective cohort study of DF diagnosed between January 2016 and December 2020. At diagnosis, CTNNB1 molecular alterations were identified using next-generation sequencing or Sanger sequencing. The primary endpoint was event-free survival (EFS) (progression, relapse, or death). We enrolled 628 patients managed by active surveillance (AS), surgical resection (SR), or systemic treatment as front-line therapy. RESULTS Overall, 516 (82.2%) patients (368 females [71.3%], median age 40.3 years [range, 1-89]) were eligible for analysis. In 435 (84.3%) cases, there was one CTNNB1 molecular alteration: p.T41A, p.S45F, or p.S45P. The front-line management was AS in 352 (68.2%), SR in 120 (23.3%), and systemic treatments in 44 (8.5%) patients. CTNNB1 mutation distribution was similar across the three therapeutic groups. The median follow-up period was 24.7 (range, 0.4-59.7) months. The estimated 3-year EFS rate was 66.2% (95%CI, 60.5%-71.2%). DF harboring p.S45F was significantly associated with male sex (p=0.03), non-abdominal wall sites (p=0.05), pain (p=0.007), and large tumor size (p=0.025). CTNNB1 p.S45F mutation was not significantly associated with EFS, either in univariate (hazard ratio [HR]=1.06; 95% confidence interval [CI], 0.65-1.73; p=0.81), or in multivariate analysis (HR=0.91; 95% CI, 0.55-1.49; p=0.71). CONCLUSIONS We found that CTNNB1 mutation profile was associated with unfavorable prognostic factors but was not a prognostic factor for EFS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jean-Yves Blay
- Centre Leon Bérard, Univ Claude Bernard, Unicancer, Lyon, France
| | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
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Boudou-Rouquette P, de Moura A, Martinez-Tapia C, Serrano AG, Chahwakilian A, Jouinot A, Ulmann G, Orvoën G, Chambraud C, Durand JP, Caillet P, Goldwasser F, Paillaud E, Canouï-Poitrine F, Aregui A, Baronn M, Bringuier M, Bouvard E, Caillet P, Cosqueric G, Corsin L, Cudennec T, Chahwakilian A, Djender A, Dupuydupin E, Ebadi N, Fossey-Diaz V, Gisselbrecht M, Goldstein C, Gonzalez B, Laurent M, Leguen J, Lefevre M, Lazarovici-Nagera C, Lorisson E, Massias J, Mebarki S, Orvoen G, Pamoukdjian F, Scain AL, de Lempdes GR, Rollot-Trad F, Varnier G, Vincent H, Paillaud E, Raynaud-Simon A, Boudou-Rouquette P, Brain E, Culine S, Frelaut M, Ghebriou D, Gligorov J, Lopez-Trabada-Ataz SHD, Mir O, Tournigand C, Aparicio T, Touboul C, Lagrange JL, Benyahia S, Bonhomme S, Mota A, Philocles G, Ouakinine C, Audureau E, Bastuji-Garin S, Canouï-Poitrine F, Loriot MA, Natella PA, Martinez-Tapia C, Reinald N, Rello S, Lafage M, Allain M, Chambraud C, Baudin A, Bobin M, Canovas J, Chaoui S, Iratni L, Garrigou S, Lacour S, Mabungu H, Morisset L, Saadaoui B. Energy expenditure profiles and the risk of early limiting toxicity in older patients with cancer: The ELCAPA-25 prospective cohort survey. Clin Nutr 2022; 41:1073-1082. [DOI: 10.1016/j.clnu.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022]
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Moreau-Bachelard C, Campion L, Toulmonde M, Le Cesne A, Brahmi M, Italiano A, Mir O, Piperno-Neumann S, Laurence V, Firmin N, Penel N, Duffaud F, Chevreau C, Bertucci F, Narciso B, Dubray-Longeras P, Delcambre C, Saada-Bouzid E, Boudou-Rouquette P, Soulie P, Perrin C, Blay JY, Bompas E. Patterns of care and outcomes of 417 patients with METAstatic SYNovial sarcoma (METASYN): real-life data from the French Sarcoma Group (FSG). ESMO Open 2022; 7:100402. [PMID: 35202953 PMCID: PMC9058906 DOI: 10.1016/j.esmoop.2022.100402] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
Background Synovial sarcoma (SS) occurs in both adult and pediatric patients. The primary aim of this study is to describe the outcomes, prognostic factors, and treatment of patients with metastatic SS within a nationwide cohort. Patients and methods All pediatric and adult patients with metastatic SS are registered in the French Sarcoma Group database. Data were collected from the national database https://conticabase.sarcomabcb.org/ up to March 2020. Descriptive and comparative analyses were conducted using SAS 9.4 and Stata Special Edition 16.1 software. Results Between January 1981 and December 2019, 417 patients with metastatic SS from 17 French sarcoma centers were included, including 64 (15.3%) under the age of 26 years. Median age was 42.5 years (range 9-87 years). The metastases were synchronous (cohort 1) or metachronous (cohort 2) in 18.9% (N = 79) and 81.1% (N = 338) patients, respectively. Median overall survival (OS) from the date of metastasis was 22.3 months (95% confidence interval 19.7-24.1 months). First-line chemotherapy without ifosfamide and/or doxorubicin was unfavorable for progression-free survival and OS (P < 0.001). Concerning cohort 1, young age, surgery of the primary tumor, and single metastatic site were independent favorable prognostic factors for OS. In cohort 2, surgery within an expert French Sarcoma Group center, absence of chemotherapy in the perioperative setting, the lungs as a single metastatic site, time to first metastasis >12 months, local therapy, and ifosfamide in the first metastatic line were independent favorable prognostic factors. Conclusions The outcome of patients with metastatic SS is influenced by local treatment, management in reference centers, and cytotoxic treatments given in the perioperative and metastatic setting. METASYN is the largest retrospective study on metastatic adult and pediatric SS. This study confirms that surgery remains the mainstay for improving OS in reference centers. METASYN emphasizes the importance of focal treatment of metastases for OS. This study offers real-life results in a metastatic setting and is a useful support for developing new strategies.
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Affiliation(s)
| | - L Campion
- ICO Centre René Gauducheau, Oncology, Nantes, France; CNRS, Inserm, CRCINA, Nantes, France
| | - M Toulmonde
- Institut Bergonié, Medical Oncology, Bordeaux, France
| | - A Le Cesne
- Department of Ambulatory Cancer Care & Sarcoma Group, Gustave Roussy, Villejuif, France
| | - M Brahmi
- Centre Leon Berard, Medical Oncology, Lyon, France
| | - A Italiano
- Institut Bergonié, Medical Oncology, Bordeaux, France
| | - O Mir
- Department of Ambulatory Cancer Care & Sarcoma Group, Gustave Roussy, Villejuif, France
| | | | - V Laurence
- Institut Curie, Medical Oncology, Paris, France
| | - N Firmin
- Department of Medical Oncology, ICM, INSERM U1194, IRCM, Université Montpellier, Montpellier, France
| | - N Penel
- Centre Oscar Lambret, Medical Oncology, Lille, France
| | - F Duffaud
- Hôpital De La Timone, Medical Oncology, Marseille, Aix Marseille Université, Marseille, France
| | - C Chevreau
- IUCT Oncopole, Oncology, Medical Toulouse, Toulouse, France
| | - F Bertucci
- Institut Paoli-Calmettes (IPC), Medical Oncology, Marseille, France
| | - B Narciso
- CHRU Bretonneau, Medical Oncology, Tours, France
| | | | - C Delcambre
- Centre François Baclesse, Medical Oncology, Caen, France
| | - E Saada-Bouzid
- Centre Antoine Lacassagne, Medical Oncology, Nice, France
| | | | - P Soulie
- ICO Centre Paul Pain, Medical Oncology, Angers, France
| | - C Perrin
- Centre Eugène Marquis, Medical Oncology, Rennes, France
| | - J Y Blay
- Centre Leon Berard, Medical Oncology, Lyon, France
| | - E Bompas
- ICO Centre René Gauducheau, Oncology, Nantes, France.
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Martinez-Tapia C, Laurent M, Paillaud E, Caillet P, Ferrat E, Lagrange JL, Rwabihama JP, Allain M, Chahwakilian A, Boudou-Rouquette P, Bastuji-Garin S, Audureau E. Predicting Frailty and Geriatric Interventions in Older Cancer Patients: Performance of Two Screening Tools for Seven Frailty Definitions-ELCAPA Cohort. Cancers (Basel) 2022; 14:cancers14010244. [PMID: 35008408 PMCID: PMC8750824 DOI: 10.3390/cancers14010244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023] Open
Abstract
Screening tools have been developed to identify patients warranting a complete geriatric assessment (GA). However, GA lacks standardization and does not capture important aspects of geriatric oncology practice. We measured and compared the diagnostic performance of screening tools G8 and modified G8 according to multiple clinically relevant reference standards. We included 1136 cancer patients ≥ 70 years old referred for GA (ELCAPA cohort; median age, 80 years; males, 52%; main locations: digestive (36.3%), breast (16%), and urinary tract (14.8%); metastases, 43.5%). Area under the receiver operating characteristic curve (AUROC) estimates were compared between both tools against: (1) the detection of ≥1 or (2) ≥2 GA impairments, (3) the prescription of ≥1 geriatric intervention and the identification of an unfit profile according to (4) a latent class typology, expert-based classifications from (5) Balducci, (6) the International Society of Geriatric Oncology task force (SIOG), or using (7) a GA frailty index according to the Rockwood accumulation of deficits principle. AUROC values were ≥0.80 for both tools under all tested definitions. They were statistically significantly higher for the modified G8 for six reference standards: ≥1 GA impairment (0.93 vs. 0.89), ≥2 GA impairments (0.90 vs. 0.87), ≥1 geriatric intervention (0.85 vs. 0.81), unfit according to Balducci (0.86 vs. 0.80) and SIOG classifications (0.88 vs. 0.83), and according to the GA frailty index (0.86 vs. 0.84). Our findings demonstrate the robustness of both screening tools against different reference standards, with evidence of better diagnostic performance of the modified G8.
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Affiliation(s)
- Claudia Martinez-Tapia
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
| | - Marie Laurent
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Internal Medicine and Geriatric Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Elena Paillaud
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Oncology Unit, AP-HP, Hôpital Europeen Georges Pompidou, F-75015 Paris, France
| | - Philippe Caillet
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Oncology Unit, AP-HP, Hôpital Europeen Georges Pompidou, F-75015 Paris, France
| | - Emilie Ferrat
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Primary Care Department, School of Medicine, Université Paris Est Créteil (UPEC), F-94010 Créteil, France
| | - Jean-Léon Lagrange
- Department of Medical Oncology, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France;
| | - Jean-Paul Rwabihama
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Geriatric Department, AP-HP, Hôpital Joffre-Dupuytren, F-91210 Draveil, France
| | - Mylène Allain
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Clinical Research Unit (URC Mondor), AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Anne Chahwakilian
- Oncogeriatrics, Geriatric Department, AP-HP, Hôpital Broca, F-75013 Paris, France;
| | | | - Sylvie Bastuji-Garin
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Public Health Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
| | - Etienne Audureau
- Université Paris Est Créteil (UPEC), INSERM, IMRB, F-94010 Creteil, France; (C.M.-T.); (M.L.); (E.P.); (P.C.); (E.F.); (J.-P.R.); (M.A.); (S.B.-G.)
- Clinical Research Unit (URC Mondor), AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
- Public Health Department, AP-HP, Hôpital Henri-Mondor, F-94010 Creteil, France
- Correspondence: ; Tel.: +33-149-813-664
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Poisson J, Martinez-Tapia C, Heitz D, Geiss R, Albrand G, Falandry C, Gisselbrecht M, Couderc AL, Boulahssass R, Liuu E, Boudou-Rouquette P, Chah Wakilian A, Gaxatte C, Pamoukdjian F, de Decker L, Antoine V, Cattenoz C, Solem-Laviec H, Guillem O, Medjenah H, Natella PA, Canouï-Poitrine F, Laurent M, Paillaud E. Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer). J Cachexia Sarcopenia Muscle 2021; 12:1477-1488. [PMID: 34519440 PMCID: PMC8718093 DOI: 10.1002/jcsm.12776] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. METHODS A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. RESULTS Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. CONCLUSIONS More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.
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Affiliation(s)
- Johanne Poisson
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France
| | - Claudia Martinez-Tapia
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
| | - Damien Heitz
- Oncology and Hematology Unit, Strasbourg University Hospital Center - Hautepierre Hospital, Strasbourg, France
| | - Romain Geiss
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Gilles Albrand
- Geriatric Oncology Unit, Antoine Charial hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Geriatrics Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mathilde Gisselbrecht
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Anne-Laure Couderc
- AP-HM, Division of Internal Medicine, Geriatric Medicine and Therapeutic, Sainte Marguerite Hospital, Marseille, France
| | | | - Evelyne Liuu
- Geriatric Department, CHU La Milétrie, Poitiers, France
| | | | - Anne Chah Wakilian
- Geriatric Department, Broca Hospital, Paris Centre Hospitals, Paris Descartes University, Paris, France
| | - Cedric Gaxatte
- Geriatric Oncology Unit, Lille University Hospital, Lille, France
| | - Fréderic Pamoukdjian
- AP-HP, Geriatric Oncology Unit, Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Laure de Decker
- Clinical Gerontology Department, Nantes University Hospital Center, Nantes, France
| | - Valery Antoine
- Department of Geriatric Medicine, Nimes University Hospital, Nimes, France
| | | | - Heidi Solem-Laviec
- Geriatric Oncology Unit, Oncology Supportive Care Department, François Baclesse Regional Cancer Center, Caen, France
| | - Olivier Guillem
- Geriatric Medicine Unit, Inter-communal Hospital Center from Southern Alps, Gap, France
| | - Hayat Medjenah
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Pierre André Natella
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Florence Canouï-Poitrine
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France.,Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Marie Laurent
- Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France.,INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
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Valter R, Paillaud E, Boudou-Rouquette P, Oubaya N, Aregui A, Lorisson E, Brain E, Rochette de Lempdes G, Laurent M, Canouï-Poitrine F, Martinez-Tapia C. Comparison of the prognostic values of nutrition-related screening tools in older patients with cancer: a prospective multicenter study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boudou-Rouquette P, Arrondeau J, Gervais C, Durand JP, Fabre E, De Percin S, Villeminey CV, Piketty AC, Rassy N, Ulmann G, Damotte D, Mansuet-Lupo A, Giraud F, Alifano M, Wislez M, Alexandre J, Jouinot A, Goldwasser F. Development and validation of a host-dependent, PDL1-independent, biomarker to predict 6-month progression-free survival in metastatic non-small cell lung cancer (mNSCLC) patients treated with anti-PD1 immune checkpoint inhibitors (ICI) in the CERTIM Cohort: The ELY study. EBioMedicine 2021; 73:103630. [PMID: 34688030 PMCID: PMC8536532 DOI: 10.1016/j.ebiom.2021.103630] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICI) are dramatically active in a minority of non-small cell lung cancer (NSCLC) patients. We studied here the relationship between patients's metabolism and outcome under ICI. Methods Metastatic NSCLC patients underwent a nutritional assessment prior to initiating immunotherapy. Resting energy expenditure (REE) was measured (mREE) using ambulatory indirect calorimetry and compared with the theoretical value (tREE) provided by the Harris and Benedict formula. The primary endpoint was 6-month progression-free survival (PFS). Secondary endpoints included objective response rate (ORR) and disease control rate (DCR) based on investigator review per RECIST v1.1. and overall survival (OS). The association of patient's metabolism with 6-month PFS was first explored in a single-center training cohort to estimate the effect size. The relationship between patient's metabolism and 6-month PFS was then tested in an independent non interventional observational prospective cohort (ELY) of 100 patients recruited in two tertiary university centers. Findings In the entire cohort, the ORR was 14% for the hypermetabolic group (n = 10/74) vs 38% for the normometabolic group (n = 26/68), respectively (estimated difference 25%, 95CI 9–40%, p = 0.001). The DCR was 28% for the hypermetabolic group (n = 21/74) vs 53% for the normometabolic group (n = 36/68), respectively (estimated difference 25%, 95CI 7–42%, p = 0.005). In the validation cohort (100 patients, 2 centers), normometabolic patients (defined as mREE/tREE < 110%) had increased 6-month PFS (57% versus 22%; odds ratio: 4.76; IC95 [1.87 – 12.89]; p<0.001) and improved overall survival (HR 2.20; IC95: 1.41–3.44; p<0.001). The positive and negative predictive values of normometabolism to identify non-progressive patients at 6 months, were 57% and 78% respectively, sensitivity was 72% and specificity was 66%. In multivariate analysis including PD-L1 tumor status, basal metabolism was an independent predictive factor for 6-month PFS. Interpretation Normometabolism is a new independent parameter to identify mNSCLC patients who will benefit from ICI, with both improved tumor response, 6-month PFS, and survival. Funding This work was supported by Baxter (04012016).
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France.
| | - Jennifer Arrondeau
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Claire Gervais
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France
| | - Jean-Philippe Durand
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Thoracic Oncology Department, Hôpital Européen Georges Pompidou (HEGP), AP-HP; Cancer Research for PErsonalized Medicine (CARPEM); Paris University, France
| | - Elizabeth Fabre
- Thoracic Oncology Department, Hôpital Européen Georges Pompidou (HEGP), AP-HP; Cancer Research for PErsonalized Medicine (CARPEM); Paris University, France
| | - Sixtine De Percin
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Clémentine Vaquin Villeminey
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne-Catherine Piketty
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Nathalie Rassy
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France
| | - Guillaume Ulmann
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Clinical Chemistry, Cochin Hospital, AP-HP, Paris University, France; URP 4466 PRETRAM, AP-HP, Paris University, France
| | - Diane Damotte
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pathology Department, Cochin Hospital, AP-HP, Paris University, France; Centre de recherche des Cordeliers, INSERM U1138, Paris University, France
| | - Audrey Mansuet-Lupo
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pathology Department, Cochin Hospital, AP-HP, Paris University, France; Centre de recherche des Cordeliers, INSERM U1138, Paris University, France
| | - Frédérique Giraud
- Molecular Genetics Department, Cochin Hospital, AP-HP, Paris University, France
| | - Marco Alifano
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Thoracic Surgery Department, Cochin Hospital, AP-HP, Paris University, France
| | - Marie Wislez
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pneumology Department, Cochin Hospital, AP-HP, Paris University, France
| | - Jérôme Alexandre
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - François Goldwasser
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; URP 4466 PRETRAM, AP-HP, Paris University, France
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Boudou-Rouquette P, Martin E, Kempf E, Penel N, Toulmonde M, Bompas E, Duffaud F, Firmin N, Bertucci F, Kurtz JE, Chaigneau L, Isambert N, Saada-Bouzid E, Dubray-Longeras P, Larousserie F, Anract P, Chevreau C, Blay JY, Piperno-Neumann S. Rare bone sarcomas: A retrospective analysis of 145 adult patients from the French Sarcoma Group. Int J Cancer 2021; 150:825-836. [PMID: 34611903 DOI: 10.1002/ijc.33837] [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: 03/01/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022]
Abstract
The benefit of chemotherapy (CT) in rare bone sarcomas is not documented in prospective studies. Our retrospective study from the French sarcoma network for bone tumors ResOs was performed in adult patients (pts) from 1976 to 2014, with histologically verified diagnosis of leiomyosarcomas (LMS), undifferentiated pleomorphic sarcoma (UPS) or radiation-associated sarcomas of bone. The median follow-up was 4.7 years (95% CI: 3.7-6.5). Clinical features, treatment modalities and outcomes were recorded and analyzed from 145 pts (median age 53 years [range 20-87]). Site of disease was extremities (66%) or axial skeleton (34%), 111 (77%) presented with localized and potentially resectable disease. The most common histological subtypes were UPS (58%) and LMS (33%); 58% were high-grade tumors. Surgery was performed in 127 pts. In the 111 localized pts, 28 pts (25%) underwent upfront surgery or exclusive radiotherapy (RT; >50 Gy) without CT, whereas 83 pts (75%) received either neoadjuvant (n = 26) or adjuvant CT (n = 13) or both (n = 44). Neoadjuvant and adjuvant CT was mostly doxorubicin-based (95%/86%) and cisplatin-based (67%/63%). R0 resection was achieved in 59 pts, and a good histological response in 15 patients (25%). Adjuvant RT was performed in 24 (22%) pts. For the whole cohort (n = 145), the 5-year overall survival (OS) rate was 53% [42; 62]. In univariate analysis, age ≤ 60 was associated with a longer disease-free survival (DFS) (P = .0436). Neoadjuvant and adjuvant CT tended to be associated with better DFS (P = .056) with no significant impact on OS in this retrospective series.
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris, France.,AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, Toulouse, France.,Department of Biostatistics, IUCT Oncopole, Toulouse, France
| | - Emmanuelle Kempf
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - Nicolas Penel
- Clinical Research and Innovation Department, Head of the General Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - Florence Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille, France.,Department of Medical Oncology, Aix-Marseille Université (AMU), Marseille, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Strasbourg, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Institut Regional du Cancer en Franche-Comté-University Hospital, Besançon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Pascale Dubray-Longeras
- Department of Medical Oncology, Cellular Therapy and Clinic Hematology Unit for Adults, Clermont-Ferrand, France
| | - Frédérique Larousserie
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Pathology, Cochin Hospital, Paris, France.,Department of Pathology, Paris University, Paris, France
| | - Philippe Anract
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Orthopedic Surgery, Cochin Hospital, Paris, France.,Department of Orthopedic Surgery, Paris University, Paris, France
| | - Christine Chevreau
- Department of Medical Oncology, UCT-Oncopôle Institut Claudius Regaud, Toulouse, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, LYRICAN, Universite de Lyon, Lyon, France
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Lavit E, Aldea M, Piperno-Neumann S, Firmin N, Italiano A, Isambert N, Kurtz JE, Delcambre C, Lebrun V, Soibinet-Oudot P, Chevreau C, Bompas E, Le Maignan C, Boudou-Rouquette P, Le Cesne A, Mancini J, Blay JY, Duffaud F. Treatment of 120 adult osteosarcoma patients with metachronous and synchronous metastases: A retrospective series of the French Sarcoma Group. Int J Cancer 2021; 150:645-653. [PMID: 34562271 DOI: 10.1002/ijc.33823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Treatment options for metastatic osteosarcomas are scarce. Following failure of standard first line therapy, patients who relapse present a challenging treatment dilemma, and have a poor prognosis. Surgical removal of all metastases is essential. A retrospective analysis of patients with metastatic osteosarcomas was conducted in 15 French Sarcoma Group centers. From January 2009 to December 2018, we identified 120 adult patients; 36 with synchronous and 84 with metachronous metastases with 74 males and 46 females. Mean age was 30 years (18-53). Metastatic sites were lung, bone and other in 91, 11 and 24 patients, respectively. Mean time to first metachronous metastases was 22 months (4-97). All patients except 13 (10.8%) with metachronous metastases received a first line systemic treatment for relapse, and 39 patients (32.5%) were included in a clinical trial. Eighty-one patients (67.5%) had local treatment of distant metastases. Median progression free survival (PFS) and overall survival (OS) were 5.5 (95% CI 4.6-6.4) and 20.5 months (95% CI 13.2-27.7) respectively for the overall group. In multivariate analysis, more than five metastases, time to first metastases <24 months, were statistically significant negative prognostic factors for OS and PFS (P = .002, ≤.001 and P = .006, ≤.001, respectively). Surgery of metastases was associated with better prognosis on OS and PFS (P = .001 and .037, respectively). The presence of bone metastases was a negative prognostic factor on OS but not on PFS (P = .021). In reference sarcoma centers, relapsed osteosarcoma patients with more than one metastasis commonly receive more than one line of systemic therapy, and are included in clinical trial if available.
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Affiliation(s)
- Elise Lavit
- Department of Oncology, Hôpital La Timone, Marseille, France
| | | | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Jean-Emmanuel Kurtz
- Department of Onco-Hematology, University Hospital Strasbourg, Strasbourg, France
| | | | - Valérie Lebrun
- Department of Oncology, University Hospital Dupuytren, Limoges, France
| | | | | | | | | | | | | | - Julien Mancini
- Department of Oncology, Hôpital La Timone, Marseille, France.,Aix Marseille University, Inserm, IRD, SESSTIM, Marseille, France
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Tlemsani C, Arrondeau J, De Percin S, Gataa I, Bretagne M, Ajgal Z, Huillard O, Wislez M, Coriat R, Alexandre J, Boudou-Rouquette P, Goldwasser F. Impact of the COVID-19 pandemic on the management of cancer patients: the experience of the cancer outpatients department of a university hospital in Paris. Clin Med (Lond) 2021; 21:e552-e555. [PMID: 38594868 DOI: 10.7861/clinmed.2020-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer patients are a highly vulnerable group in the COVID-19 pandemic and it has been necessary for oncology units to adapt to this unexpected situation. We present our management of outpatients with cancer during the pandemic. We applied two major adaptations: extending the intervals between injections for maintenance therapy and protocol adaptation for patients with comorbidities. Between 17 March and 30 April 2020, 406 patients were treated in our outpatients department. Protocols were adapted for 94 (23.1%) patients. Among them, 49% had an extended interval between treatment administrations, 22.3% had modified protocols to reduce toxicity, 20.2% had therapeutic interruptions and 5.3% did not receive their treatment because of a COVID-19 infection. Overall, protocol adaptations concerned more than 20% of the patients. This pandemic was an opportunity for oncologists to re-examine the risk versus benefit balance of administering immunosuppressive treatment and highlighted that oncology daily routine should not be applied automatically.
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Blay JY, Penel N, Ray-Coquard IL, Cousin S, Bertucci F, Bompas E, Eymard JC, Saada-Bouzid E, Soulie P, Boudou-Rouquette P, Dufresne A, Le Cesne A, Mir O, Gambotti L, Legrand F, Simon C, Lamrani-Ghaouti A, Chevret S, Massard C. High clinical activity of pembrolizumab in chordoma, alveolar soft part sarcoma (ASPS) and other rare sarcoma histotypes: The French AcSé pembrolizumab study from Unicancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11520] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11520 Background: AcSé Pembrolizumab is a Phase 2, non-randomized parallel arms, open-label, multicentric study from Unicancer investigating the efficacy and safety of pembrolizumab monotherapy in different cohorts of patients with rare cancers (NCT03012620). Here we report the results of pembrolizumab in the rare sarcoma cohort. Methods: Selected histotypes were all rare sarcomas patients (pts) (incidence < 0.2/100,000/year). Main inclusion criteria were age > 18, ECOG PS≤1 and advanced or metastatic disease resistant to standard treatment. Patients received pembrolizumab 200 mg IV as a 30-minute infusion on Day 1 of every 21-day cycle for a maximum of 2 years. The primary endpoint was the confirmed objective response rate according to RECIST v1.1 at 12 weeks. Secondary endpoints included clinical benefit rate, duration of response, progression-free survival (PFS), overall survival (OS), and safety. Five groups of pts were distinguished, namely chordoma, alveolar soft-part sarcoma (ASPS), desmoplastic small round cell tumor (DSRCT), smarca4 deficient malignant rhabdoid tumor (SMRT), and other histotypes. Results: 98 patients including 34 with chordoma, 14 ASPS, 11 SMRT, 8 DSCRT and 31 with other histotypes, were included from July 2017 to December 2020. The median number of cycles was 5 (range, 1 to 35) with 78 (79.6%) patients who discontinued the trial after a median of 4 cycles. There were 6 (7.3%) partial response (PR) at 12 weeks. The best response was CR in 1 patient (1%), PR in 14 patients (14.3%), and stable disease (SD) in 33 (33.7%). Median duration of response was 8.2 months [IQR, 4.1 to 9.0]. The occurrence of best response depended on the histotype, with 3 (8.8%) responses in chordoma, 7 (50%) in ASPS, 3 (27%) in SMRT, 1 (12.5%) in DSCRT and 1 (3.2%) in other histotypes (p = 0.0011). At the data cut off, median PFS was 2.75 months, and median OS was 19.7 months on the overall population. Outcomes differed according to the histotype group, with the 12 months PFS rates at 31.2% (chordoma), 35.7% (ASPS), 18.2% (SMRT), 0% (DSCRT) and 3.3% (other), respectively (p < 0.0001), and median PFS at 6.6 (chordoma), 7.5 (ASPS), 1.1 (SMRT), 2.1 (DSCRT) and 2.1 months (other), while 1-year OS rates were 76.6% (chordoma), 85.7% (ASPS), 36.4% (SMRT), 17.5% (DSCRT) and 42.9% (other) with median OS only reached for SMRT (2.4 months), DSRCT (10 months), and the other histotype group (7.1 months) (p = 0.004). The side effect profile of pembrolizumab was similar to other tumor type. Conclusions: Pembrolizumab is safe and well tolerate in this pop od STS pts, AcSé study reports high levels response rate and prolonged activity in selected subtypes of rare sarcomas. Clinical trial information: NCT03012620.
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Affiliation(s)
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | - Sophie Cousin
- Medical Oncology, Institute Bergonié, Bordeaux, France
| | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | | | | | | | | | | | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | | | | | | | | | - Christophe Massard
- Gustave Roussy-Department of Therapeutic Innovation and Early Trials (DITEP), Paris, France
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Duffaud F, Chabaud S, Gautier J, Ferlay C, Vizoso S, Brahmi M, Benezech S, Dufresne A, Marec-Berard P, Ray-Coquard IL, Kalbacher E, Collard O, Penel N, Rios M, Bompas E, Chevreau C, Mir O, Boudou-Rouquette P, Blay JY, Piperno-Neumann S. REGOSTA: A randomized, placebo-controlled, double-blinded, multicenter study evaluating the efficacy and safety of regorafenib (REGO) as maintenance therapy after first-line treatment in patients (pts) with osteosarcoma (OS) and non-osteosarcomas (non-OS) of bone (non-Ewing, non-chondrosarcomas and non-chordomas). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps11576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11576 Background: Pts with OS and non-OS of bone are treated with a multimodal sequence therapy of neoadjuvant chemotherapy (CT), surgery and adjuvant CT, followed by a close surveillance until recurrence. At recurrence, the prognosis remains poor with objective response rates of 3-29%, and a median Progression-Free Survival (PFS) of less than 4 months in OS. There is a clinical need to reduce the risk of recurrence after the initial treatment sequence. The REGOBONE study reported a significant clinical benefit of regorafenib compared to placebo in patients with relapsed OS (median PFS: 16.4 versus 4.1 weeks). Methods: This multicenter trial is ongoing to study the efficacy and safety of maintenance REGO in pts > = 16 years, with complete remission after initial treatment sequence of their bone sarcoma. 168 pts will be randomly allocated in a 1:1 ratio to receive either oral REGO or its matching placebo (control arm) at a daily dose of 120mg, continuously and for a maximum of 12 months. Randomization will be stratified according to the following risk factors: metastases (mets) at diagnosis and/or poor response to neoadjuvant CT versus no mets at diagnosis and good response to neoadjuvant CT. The primary objective is to compare the efficacy (Relapse-Free Survival) between the 2 arms. The expected 3-year RFS rates are 55% in the control arm and 74.6% in the REGO arm (HR = 0.5). 66 events will provide 80% power to show significant improvement in RFS, using a 2-sided log-rank test at a 5% level. Secondary endpoints include Time to Treatment Failure, Overall Survival, Quality of Life, safety profile, and compliance to treatment. Radiological endpoints will be evaluated using the RECIST 1.1. Translational objectives will be to identify predictive biomarkers for efficacy of REGO as maintenance therapy using liquid biopsies. As of Feb 1st, 2021, 3 patients have been randomized. 15 sites of the French Sarcoma Group will participate. Clinical trial information: NCT04055220.
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Affiliation(s)
| | - Sylvie Chabaud
- Departement of Clinical Research,Centre Léon-Bérard, Lyon, France
| | | | | | | | | | - Sarah Benezech
- Centre Léon Bérard, Institut d'Hématologie et Oncologie Pédiatrique, Lyon, France
| | | | | | | | | | - Olivier Collard
- Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | | | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
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Penel N, Bonvalot S, Bimbai AM, Salas S, Le Loarer F, Meurgey A, Piperno-Neumann S, Collard O, Kurtz JE, Guillemet C, Chevreau C, Ryckewaert T, Italiano A, Boudou-Rouquette P, Orbach D, Le Cesne A, Thery J, Le Deley MC, Blay JY, Mir O. Prognosis value of S45F mutation of CTNNB1 in desmoid-type fibromatosis (DF): Prospective analysis of 500 consecutive patients (pts) from ALTITUDES trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11510 Background: DF rare locally aggressive fibroblastic non-metastasizing tumor, with an unpredictable course. Its management remains challenging, there is a current shift in standard of care from large surgical resection (SR) to active surveillance (AS). Most of DF display somatic mutation of CTNNB1, with three major hotpots: S45F, T41A and S45P. The poor prognosis of S45F is a matter of debate (Timbergen et al. Ann Surg 2019). Methods: ALTITUDES (NCT02867033) is a nationwide prospective registry of DF, diagnosed from January 2016 to December 2020 and confirmed by central pathological review. CTNNB1 mutations were identified by NGS. Primary endpoint was event-free survival (including disease progression or relapse). We have selected pts managed by AS, SR or systemic treatments as front-line. Pt undergoing R2 resection and then managed by follow-up were part of AS group. Prognostic factors were assessed using univariate and multivariate Cox Model. Results: From the 630-pts enrolled in ALTITUDES, 500 (79.3%) were eligible for the present analysis. Exclusion criteria were diagnosis before 2016 in 13 pts, multiple DF in 33 pts, 39 pts without CTNNB1 mutation analysis, and 45 pts receiving other treatments. The study population included 349 females (69.8%), the median age was 40 years (range 1-89). Abdominal wall was the predominant primary site: 161 pts (32.2%). In 430 (86.0%) cases, there was a CTNNB1 mutation, including, S45F in 56 cases (11.2%). In 70 cases (14.0%), we did not identify CTNNB1 mutation. The front-line managements were AS in 361 pts (72.2%), SR with R0/R1 margins in 57 cases (11.4%) and systemic treatments in 82 pts (16.5%). The median follow-up was 23 months (Range, 0.4-55). Overall, progression or relapse occurred in 128 pts (25.6%). We observed a significant EFS-difference between treatment groups, both in univariate and multivariate analysis with, compared to AS, a better outcome in patients with SR and worse outcome in patients who had received a systemic treatment (p = 0.01 in multivariate analysis). The risk of event was significantly associated with the tumor size, with a HR = 1.46 in tumors larger than 50 mm compared to smaller tumors (95%CI, 1.01-2.10, p = 0.04). We did not observe any significant association between the CTNNB1 mutational status and the outcome: compared to patients with another mutation, the hazard ratio associated with a S45F mutation was HR = 0.84 (95%CI, 0.48-1.46, p = 0.53) in multivariate analysis. Age, gender, location (abdominal wall versus other) were not associated with EFS. Conclusions: In this large prospective study, S45F was not an independent poor prognostic factor in DF. Size and front-line treatment drive both the outcome. The understanding and prediction of natural course of DF require further studies.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | - Sébastien Salas
- CEPCM Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | | | | | - Olivier Collard
- Institut de Cancérologie Lucien Neuwirth, Saint Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
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Lafont C, Chah Wakilian A, Lemogne C, Gouraud C, Fossey-Diaz V, Orvoen G, Lhuillier N, Paillaud E, Bastuji-Garin S, Zebachi S, Hanon O, Goldwasser F, Boudou-Rouquette P, Canouï-Poitrine F. Diagnostic Performance of the 4-Item Geriatric Depression Scale for Depression Screening in Older Patients with Cancer: The ELCAPA Cohort Study. Oncologist 2021; 26:e983-e991. [PMID: 33683759 DOI: 10.1002/onco.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In older patients with cancer, depression is difficult to assess because of its heterogeneous clinical expression. The 4-item version of the Geriatric Depression Scale (GDS-4) is quick and easy to administer but has not been validated in this population. The present study was designed to test the diagnostic performance of the GDS-4 in a French cohort of older patients with cancer before treatment. MATERIALS AND METHODS Our cross-sectional analysis of data from the Elderly Cancer Patient cohort covered all patients with cancer aged ≥70 years and referred for geriatric assessment at two centers in France between 2007 and 2018. The GDS-4's psychometric properties were evaluated against three different measures of depression: the geriatrician's clinical diagnosis (based on a semistructured interview), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and a cluster analysis. The scale's sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated. RESULTS In a sample of 2,293 patients (median age, 81 years; women, 46%), the GDS-4's sensitivity and specificity for detecting physician-diagnosed depression were, respectively, 90% and 89%. The positive and negative likelihood ratios were 8.2 and 0.11, and the AUROC was 92%. When considering the subset of patients with data on all measures of depression, the sensitivity and specificity values were, respectively, ≥90% and ≥72%, the positive and negative likelihood ratios were, respectively, ≥3.4 and ≤ 0.11, and the AUROC was ≥91%. CONCLUSION The GDS-4 appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. IMPLICATIONS FOR PRACTICE Considering the overlap between symptoms of cancer and symptoms of depression, depression is particularly difficult to assess in older geriatric oncology and is associated with poor outcomes; there is a need for a routine psychological screening. Self-report instruments like the 4-item version of the Geriatric Depression Scale appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. Asking four questions might enable physicians to screen older patients with cancer for depression and then guide them toward further clinical evaluation and appropriate care if required.
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Affiliation(s)
- Charlotte Lafont
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | | | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Clément Gouraud
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, Paris, France
| | | | - Galdric Orvoen
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - Nathalie Lhuillier
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, HEGP, Service de Gériatrie, F-75015, Paris, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Olivier Hanon
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - François Goldwasser
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | | | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
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Ulmann G, Bergoin E, Neveux N, Jouinot A, Durand JP, Boudou-Rouquette P, Goldwasser F, Cynober L. Creatinine to cystatin c ratio (sarcopenia index) is a predictor of mortality in cancer patients. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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39
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Fournel L, Boudou-Rouquette P, Prieto M, Hervochon R, Guinet C, Arrondeau J, Alexandre J, Damotte D, Wislez M, Batteux F, Icard P, Goldwasser F, Alifano M. Nivolumab increases pulmonary artery pressure in patients treated for non-small cell lung cancer. Cancer Chemother Pharmacol 2020; 86:497-505. [PMID: 32936316 DOI: 10.1007/s00280-020-04142-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The widespread use of Nivolumab results in an increasing number of side effects and adverse events. Herein, we evaluated the impact of Nivolumab on crude and normalized pulmonary artery diameter (PAD). METHODS We analyzed clinical, morphometric, pathological and radiological data of lung cancer patients treated by Nivolumab in an 18-month period. Blinded radiological evaluation was performed, by three observers measuring axial PAD and Aorta diameter (AoD) in secondarily matched pre- and post-Nivolumab CT-scans. Correlation between ΔPAD and clinicopathological data was investigated. RESULTS 59 patients receiving Nivolumab for treatment of advanced lung carcinoma were identified. Pre-and post-Nivolumab comparison of CT-scan measures revealed that mean PAD was 26.3 ± 2.8 mm versus 28.0 ± 3.0 mm (p < 0.001), and mean PAD/AoD ratio was 0.82 ± 0.09 versus 0.87 ± 0.11 (p < 0.001), respectively. Median ΔPAD was 0.05 [0.01-0.122] was significantly higher in hypometabolic patients exhibiting low Rest Energy Expenditure (p = 0.03). Patients exhibiting ΔPAD > 1% had significantly lower serum albumin level (p = 0.03), and higher nutritional risk (p = 0.02), compared to others. Unlike Nivolumab therapy, there was no increase of PAD after chemotherapy in the same cohort of patients with available scans (n = 45, 25.9 ± 2.9 mm pre-chemotherapy versus 25.7 ± 2.4 mm post-chemotherapy, p = 0.51). Anti-PD-1 treatment was associated with immune-related adverse events in 11 (18.6%) cases including 2 cases of life-threatening acute pulmonary hypertension, both exhibiting post-treatment PAD/AoD ratio > 1. CONCLUSION Nivolumab is associated to PAD enlargement, a potential marker of pulmonary hypertension, sometimes leading to lethal adverse events. Careful CT-scan and echocardiographic evaluation of PAD should be part of the therapeutic work-up of patients receiving Nivolumab, especially those suffering cancer-associated malnutrition.
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Affiliation(s)
- Ludovic Fournel
- Thoracic Surgery Department, Cochin Hospital, AP-HP.Center-University of Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.
| | - Pascaline Boudou-Rouquette
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Oncology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Mathilde Prieto
- Thoracic Surgery Department, Cochin Hospital, AP-HP.Center-University of Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Remi Hervochon
- Radiology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Claude Guinet
- Radiology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Jennifer Arrondeau
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Oncology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Jérôme Alexandre
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Oncology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Diane Damotte
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Pathology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Marie Wislez
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Respiratory Medicine and Thoracic Oncology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Frédéric Batteux
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Biology and Immunology Department, AP-HP.Center, University of Paris, Paris, France
| | - Philippe Icard
- Thoracic Surgery Department, Cochin Hospital, AP-HP.Center-University of Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM U-119, UNICAEN, University of Caen-Normandy, Caen, France
| | - François Goldwasser
- Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France.,Oncology Department, Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
| | - Marco Alifano
- Thoracic Surgery Department, Cochin Hospital, AP-HP.Center-University of Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Cochin Hospital, AP-HP.Center-University of Paris, Paris, France
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Boudou-Rouquette P, Gataa I, De Percin S, Tlemsani C, Biau D, Dumaine V, Audard V, Larousserie F, Anract P, Jouinot A, Goldwasser F. Abstract 3721: Relationship between insulin resistance and chemosensitivity of high grade bone sarcoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant chemotherapy with intercalated surgery is the standard of care for resectable high-grade bone sarcoma (BS) but identification of biomarkers for chemosensitivity prediction is still needed. Insulin-like Growth Factor (IGF) pathway was first linked with sarcoma biology approximately 30 years ago (El-Brady OM, 1990).
Methods: We recruited 138 pts with newly diagnosed primary localized or metastatic BS. We measured fasting blood glucose and insulin, body mass index (BMI). The HOMA-IR (Homeostasis Model Assessment) score ((Glucose (mmol/l) x Insulin) / 22.5), which has been proven to reliably detect insulin resistance IR was calculated, and patients with HOMA-IR > 2.6 were considered as IR. We collected characteristics usually associated with insulin resistance: age, obesity, diabetes, dyslipidemia and hypertension.
Results: Out of 138 pts, 50 (36%) were insulin resistant: HOMA-IR >2.6. Thirty-two IR patients (64%) had no cardiovascular risk factor. In univariate analysis, IR was associated with obesity (BMI > 30 kg/m2)(22% vs 3%, p=0.0015), but not with age (median 36,8 vs 41 years, p=0.19). IR was more prevalent in Ewing sarcoma (14/29; 48%) and chondrosarcoma (7/16; 44%) followed by osteosarcoma (25/67; 37%) and other rare bone sarcomas (4/26; 15.3%), but not significantly (p=0.097). After neoadjuvant chemotherapy and surgery of Ewing tumor and osteosarcoma, pathologic tumor necrosis was higher in IR pts (88.9 vs 75%, p= 0.028).
Conclusion: Our results suggest that metabolic profile may help to discriminate best candidates for neoadjuvant chemotherapy in high-grade bone sarcomas. Further studies are needed to confirm and explain these results.
Citation Format: Pascaline Boudou-Rouquette, Ithar Gataa, Sixtine De Percin, Camille Tlemsani, David Biau, Valerie Dumaine, Virginie Audard, Frédérique Larousserie, Philippe Anract, Anne Jouinot, François Goldwasser. Relationship between insulin resistance and chemosensitivity of high grade bone sarcoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3721.
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Pautier P, Floquet A, Chevreau C, Penel N, Guillemet C, Delcambre C, Cupissol D, Selle F, Isambert N, Piperno-Neumann S, Saada-Bouzid E, Bertucci F, Bompas E, Boudou-Rouquette P, Collard O, Le Brun Ly V, Toulmonde M, Le Cesne A, Lacas B, Duffaud F. A single-arm multicenter phase II trial of doxorubicin (Doxo) in combination with trabectedin (Trab) given as first-line treatment to patients with metastatic/advanced uterine (U-LMS) and soft tissue leiomyosarcoma (ST-LMS): Final results of the LMS-02 study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11506 Background: U-LMS and ST-LMS are rare tumors with poor prognosis when locally advanced or metastatic, and with moderate chemosensitivity. Overall response rates (ORR) given in the 1st-line setting do not exceed 50% for U-LMS and 35% for ST-LMS with a mean response duration of 3- 6 months without impact on overall survival (OS). In 2015 we reported very encouraging results of the LMS-02 study (NCT02131480) with ORR of 59.6% in U-LMS, and 39.3% in ST-LMS with manageable toxicity (Pautier; Lancet oncol 2015). Herein, we report the updated results of progression-free survival (PFS) and final results of overall survival (OS). Methods: Patients (pts) received 60 mg/m² intravenous Doxo followed by trabectedin 1.1 mg/m2 as a 3-hour infusion on Day 1 and pegfilgrastim on Day 2, repeated every 3 weeks for up to 6 cycles. Surgery for residual disease was permitted. Patients were stratified into U-LMS and ST-LMS groups. Results: Overall, 108 patients with LMS with a median age of 59 years and mostly metastatic disease (85%) were enrolled. Of those, 77 patients (71.3%) have received all 6 cycles of treatment, and 20 patients (18.5%) had metastasis resection. With a median follow-up of 7.2 years (95% CI: 6.9 - 8.2), the overall median PFS was 10.1 months (95% CI: 8.5 - 12.6), being 8.3 months (95 CI: 7.4 - 10.3) and 12.9 months (95% CI: 9.2 - 14.1) in U and ST group, respectively. Median OS was 34.4 months (95% CI: 26.9 - 42.7), being 27.5 months (95% CI: 17.9 - 38.2) in U-LMS and 38.7 months (95% CI: 31.0 - 52.9) in ST-LMS group. The median OS among the 20 pts with surgery was not reached vs 31.6 months in the population without surgery (95% IC: 23.9 - 35.4). Conclusions: The Doxo +Trab combination is an effective 1st-line therapy for pts with LMS, with promising PFS and OS results and an acceptable safety profile. Merely for comparison, the most recent results of Doxo alone in metastatic LMS, given in 1st-line setting in a phase III ANNOUNCE trial conducted during the same period, reported median PFS of 6.9 months, and median OS of 21.9 months (ASCO 2019 LBA3). Results of the LMS04 trial (NCT02997358), a randomized phase III study comparing this combination vs Doxo alone in 1st-line therapy in metastatic LMS are pending. Clinical trial information: NCT02131480 .
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Affiliation(s)
- Patricia Pautier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | | | | | | | | | | | | | | | | | | | - Olivier Collard
- Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | - Maud Toulmonde
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
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Beinse G, Reitter D, Segaux L, Carvahlo-Verlinde M, Rousseau B, Tournigand C, Cudennec T, Laurent M, Boudou-Rouquette P, Paillaud E, Canouï-Poitrine F, Caillet P. Potential drug-drug interactions and risk of unplanned hospitalization in older patients with cancer: A survey of the prospective ELCAPA (ELderly CAncer PAtients) cohort. J Geriatr Oncol 2020; 11:586-592. [DOI: 10.1016/j.jgo.2019.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/02/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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Barth C, Colombet I, Montheil V, Huillard O, Boudou-Rouquette P, Tlemsani C, Alexandre J, Goldwasser F, Vinant P. First referral to an integrated onco-palliative care program: a retrospective analysis of its timing. BMC Palliat Care 2020; 19:31. [PMID: 32164672 PMCID: PMC7069048 DOI: 10.1186/s12904-020-0539-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Methods The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. Conclusions The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
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Affiliation(s)
- Claire Barth
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Isabelle Colombet
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France. .,Université de Paris, Public Health, Paris, France.
| | - Vincent Montheil
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
| | | | | | | | - Jérôme Alexandre
- Université de Paris, Public Health, Paris, France.,Oncologie médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - François Goldwasser
- Université de Paris, Public Health, Paris, France.,Oncologie médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Pascale Vinant
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
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Boudou-Rouquette P, Grignano E, Arrondeau J, Burroni B, Chouchana L. Diffuse large B-cell lymphoma after nivolumab treatment for lung cancer: A case report and a World Health Organization pharmacovigilance database review. Eur J Cancer 2020; 130:20-22. [PMID: 32171105 DOI: 10.1016/j.ejca.2020.02.006] [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] [Received: 12/16/2019] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Pascaline Boudou-Rouquette
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP; Paris Descartes University, USPC, Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Hôpital Cochin, AP-HP, 75014, Paris, France.
| | - Eric Grignano
- Hematology Department, Paris Centre Teaching Hospitals, AP-HP; Paris Descartes University, USPC, Paris, France
| | - Jennifer Arrondeau
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP; Paris Descartes University, USPC, Paris, France; Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Hôpital Cochin, AP-HP, 75014, Paris, France
| | - Barbara Burroni
- Pathology Department, Paris Centre Teaching Hospitals, AP-HP; Paris Descartes University, USPC, Paris, France
| | - Laurent Chouchana
- Pharmacovigilance Regional Centre, Paris Centre Teaching Hospitals, AP-HP; Paris Descartes University, USPC, Paris, France
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Tiako Meyo M, Jouinot A, Giroux-Leprieur E, Fabre E, Wislez M, Alifano M, Leroy K, Boudou-Rouquette P, Tlemsani C, Khoudour N, Arrondeau J, Thomas-Schoemann A, Blons H, Mansuet-Lupo A, Damotte D, Vidal M, Goldwasser F, Alexandre J, Blanchet B. Predictive Value of Soluble PD-1, PD-L1, VEGFA, CD40 Ligand and CD44 for Nivolumab Therapy in Advanced Non-Small Cell Lung Cancer: A Case-Control Study. Cancers (Basel) 2020; 12:cancers12020473. [PMID: 32085544 PMCID: PMC7072584 DOI: 10.3390/cancers12020473] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
A large interindividual variability has been observed in anti Programmed cell Death 1 (anti-PD1) therapies efficacy. The aim of this study is to assess the correlation of soluble PD-1 (sPD-1), soluble Programmed cell Death Ligand 1 (sPD-L1), Vascular Endothelial Growth Factor A (VEGFA), soluble CD40 ligand (sCD40L) and soluble CD44 (sCD44), with survival in nivolumab-treated metastatic non-small cell lung cancer (NSCLC) patients. Plasma biomarkers were assayed at baseline and after two cycles of nivolumab. A cut-off of positivity for sPD-1, sPD-L1 and sCD40L expressions was defined as a plasma level above the lower limit of quantification. Baseline sPD-1 and sPD-L1 levels were subsequently analyzed in a control group of EGFR-mutated (Epidermal Growth Factor Receptor) NSCLC patients. Association between survival and biomarkers was investigated using Cox proportional hazard regression model. Eighty-seven patients were included (51 nivolumab-treated patients, 36 in EGFR-mutated group). In nivolumab group, baseline sPD-1, sPD-L1 and sCD40L were positive for 15(29.4%), 27(52.9%) and 18(50%) patients, respectively. We defined a composite criteria (sCombo) corresponding to sPD-1 and/or sPD-L1 positivity for each patient. In nivolumab group, baseline sCombo positivity was associated with shorter median progression-free survival (PFS) (78 days 95%CI (55–109) vs. 658 days (222-not reached); HR: 4.12 (1.95–8.71), p = 0.0002) and OS (HR: 3.99(1.63–9.80), p = 0.003). In multivariate analysis, baseline sCombo independently correlated with PFS (HR: 2.66 (1.17–6.08), p = 0.02) but not OS. In EGFR-mutated group, all patients were baseline sCombo positive; therefore this factor was not associated with survival. After two cycles of nivolumab, an increased or stable sPD-1 level independently correlated with longer PFS (HR: 0.49, 95%CI (0.30–0.80), p = 0.004) and OS (HR: 0.39, 95%CI (0.21–0.71), p = 0.002). VEGFA, sCD40L and sCD44 did not correlate with survival. We propose a composite biomarker using sPD-1and sPDL-1 to predict nivolumab efficacy in NSCLC patients. A larger validation study is warranted.
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Affiliation(s)
- Manuela Tiako Meyo
- Drug Biology–Toxicology, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; (N.K.); (M.V.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, 75006 Paris, France;
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
- Correspondence: ; Tel.: +331-5841-2313; Fax: +331-5841-2315
| | - Anne Jouinot
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
- Institut Cochin, INSERM U1016, 75014 Paris, France
| | - Etienne Giroux-Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-AmbroiseParé Hospital and EA 4340 University Versailles-Saint Quentin en Yvelines, 92100 Boulogne, France;
| | - Elizabeth Fabre
- Department of Thoracic Oncology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France;
| | - Marie Wislez
- Department of Pneumology, Cochin Hospital, APHP, 75014 Paris, France;
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, APHP, 75014 Paris, France;
| | - Karen Leroy
- Department of Cyto-pathology, Cochin Hospital, AP-HP, 75014 Paris, France; (K.L.); (A.M.-L.); (D.D.)
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
| | - Camille Tlemsani
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
| | - Nihel Khoudour
- Drug Biology–Toxicology, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; (N.K.); (M.V.); (B.B.)
| | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
| | - Audrey Thomas-Schoemann
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, 75006 Paris, France;
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
| | - Hélène Blons
- Department of Cyto-pathology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France;
| | - Audrey Mansuet-Lupo
- Department of Cyto-pathology, Cochin Hospital, AP-HP, 75014 Paris, France; (K.L.); (A.M.-L.); (D.D.)
| | - Diane Damotte
- Department of Cyto-pathology, Cochin Hospital, AP-HP, 75014 Paris, France; (K.L.); (A.M.-L.); (D.D.)
| | - Michel Vidal
- Drug Biology–Toxicology, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; (N.K.); (M.V.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, 75006 Paris, France;
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
- Institut Cordeliers, INSERM U1147, 75006 Paris, France
| | - Jérôme Alexandre
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris Descartes University, CARPEM, 75014 Paris, France; (A.J.); (P.B.-R.); (C.T.); (J.A.); (F.G.); (J.A.)
- Institut Cochin, INSERM U1016, 75014 Paris, France
- Institut Cordeliers, INSERM U1147, 75006 Paris, France
| | - Benoit Blanchet
- Drug Biology–Toxicology, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; (N.K.); (M.V.); (B.B.)
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, 75006 Paris, France;
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Hirsch L, Bellesoeur A, Boudou-Rouquette P, Arrondeau J, Thomas-Schoemann A, Kirchgesner J, Gervais C, Jouinot A, Chapron J, Giraud F, Wislez M, Alexandre J, Blanchet B, Goldwasser F. The impact of body composition parameters on severe toxicity of nivolumab. Eur J Cancer 2019; 124:170-177. [PMID: 31794927 DOI: 10.1016/j.ejca.2019.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The occurrence of severe, acute limiting toxicity in patients receiving anti-programmed cell death receptor-1 monoclonal antibodies, such as nivolumab, is largely unpredictable. Sarcopenia was found to be associated with anti-cytotoxic T-lymphocyte-associated protein 4 acute toxicity. We explore the clinical and pharmacological parameters influencing nivolumab toxicity, including body composition. METHODS From June 2015 to January 2017, all consecutive patients treated with nivolumab in our institution were prospectively included. We studied the relationship between muscle mass assessed by computed tomography, nivolumab trough level (Cmin) at day 14 assessed using the enzyme-linked immunosorbent assay method, and the occurrence of immune grade III or IV toxicity or any toxicity leading to treatment discontinuation (immune-related acute limiting toxicity [irALT]). RESULTS In our population (n = 92) with a majority of lung cancer (72%), forty-five (51.7%) patients were sarcopenic. The median plasma nivolumab Cmin at day 14 was 15.4 μg/mL (interquartile range = 11.8-21.0). In multivariate analysis, hypoalbuminaemia (<35 g/L) was independently associated with low nivolumab Cmin on day 14 (odds ratio [OR] = 0.09; 95% confidence interval [CI] = 0.01-0.59, p = 0.01) and overweight/obesity with high nivolumab Cmin on day 14 (OR = 5.94; 95% CI = 1.25-28.29, p = 0.03). We observed 22 irALTs in 19 patients (21%). The most frequent irALT was respiratory (6.5%) disorders and gastrointestinal (4.3%) disorders. Patients with sarcopenia were at significantly increased risk of experiencing an irALT (OR = 3.84; 95% CI = 1.02-14.46, p = 0.047). No association was found between toxicity and nivolumab plasma Cmin at day 14. CONCLUSIONS Our results highlight the importance of assessing body composition and suggest that sarcopenia could predict severe immune-related toxicity of nivolumab in real life.
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Affiliation(s)
- Laure Hirsch
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France.
| | - Audrey Bellesoeur
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France
| | | | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France
| | - Audrey Thomas-Schoemann
- Department of Clinical Pharmacy, Cochin Hospital, AP-HP 5, CERTIM, Paris, France; UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Université Paris Descartes, PRES Sorbonne Paris Cité, 75006, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology, Saint-Antoine Hospital, AP-HP 6, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis D'Épidémiologie et de Santé Publique, Paris, France
| | - Claire Gervais
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France
| | - Anne Jouinot
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France; Cochin Institute, Inserm U1016, Université Paris Descartes, Paris, France
| | - Jeanne Chapron
- Department of Pneumology, Cochin Hospital, AP-HP 5, Paris, France
| | | | - Marie Wislez
- Department of Pneumology, Cochin Hospital, AP-HP 5, Paris, France; Cordeliers Research Center, Université Paris Descartes, Université de Paris, UMRS1138 "Inflammation, Complement and Cancer" Team, F-75006, Paris, France
| | - Jérôme Alexandre
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France; Cochin Institute, Inserm U1016, Université Paris Descartes, Paris, France
| | - Benoit Blanchet
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Université Paris Descartes, PRES Sorbonne Paris Cité, 75006, Paris, France; Department of Pharmacokinetics and Pharmacochemisty, Cochin Hospital, AP-HP 5, CARPEM, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, AP-HP 5, CARPEM, CERTIM, Paris, France; Laboratory of Biological Nutrition EA, Pharmacy University, Université Paris Descartes, 4466, Paris, France
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Damotte D, Warren S, Arrondeau J, Boudou-Rouquette P, Mansuet-Lupo A, Biton J, Ouakrim H, Alifano M, Gervais C, Bellesoeur A, Kramkimel N, Tlemsani C, Burroni B, Duche A, Letourneur F, Si H, Halpin R, Creasy T, Herbst R, Ren X, Morel P, Cesano A, Goldwasser F, Leroy K. The tumor inflammation signature (TIS) is associated with anti-PD-1 treatment benefit in the CERTIM pan-cancer cohort. J Transl Med 2019; 17:357. [PMID: 31684954 PMCID: PMC6829827 DOI: 10.1186/s12967-019-2100-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background The 18-gene tumor inflammation signature (TIS) is a clinical research assay that enriches for clinical benefit to immune checkpoint blockade. We evaluated its ability to predict clinical benefit of immunotherapy in cancer patients treated with PD-1 checkpoint inhibitors in routine clinical care. Methods The CERTIM cohort is a prospective cohort which includes patients receiving immune checkpoint inhibitors in Cochin University hospital. RNA extracted from 58 archival formalin fixed paraffin embedded tumor blocks (including 38 lung cancers, 5 melanomas, 10 renal carcinomas, 4 urothelial carcinomas and 1 colon carcinoma) was hybridized to a beta version of the NanoString® PanCancer IO360™ CodeSet using nCounter® technology. Gene expression signatures were correlated with tumor responses (by RECIST criteria) and overall survival. PD-L1 immunostaining on tumor cells was assessed in 37 non-small cell lung cancer (NSCLC) samples and tumor mutational burden (TMB) measured by whole exome sequencing in 19 of these. Results TIS scores were significantly associated with complete or partial response to anti-PD-1 treatment in the whole cohort (odds ratio = 2.64, 95% CI [1.4; 6.0], p = 0.008), as well as in the NSCLC population (odds ratio = 3.27, 95% CI [1.2; 11.6], p = 0.03). Patients whose tumor had a high TIS score (upper tertile) showed prolonged overall survival compared to patients whose tumor had lower TIS scores, both in the whole cohort (hazard ratio = 0.37, 95% CI [0.18, 0.76], p = 0.005) and in the NSCLC population (hazard ratio = 0.36, 95% CI [0.14, 0.90], p = 0.02). In the latter, the TIS score was independent from either PD-L1 staining on tumor cells (spearman coefficient 0.2) and TMB (spearman coefficient − 0.2). Conclusions These results indicate that validated gene expression assay measuring the level of tumor microenvironment inflammation such as TIS, are accurate and independent predictive biomarkers and can be easily implemented in the clinical practice.
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Affiliation(s)
- Diane Damotte
- Team Cancer, Immune Control and Escape, Cordeliers Research Center, UMRS 1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,University Paris Descartes, Paris, France.,Department of Pathology, Hôpital Cochin, AP-HP, Paris, France.,CERTIM, Hôpital Cochin, APHP, Paris, France
| | | | - Jennifer Arrondeau
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Pascaline Boudou-Rouquette
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Audrey Mansuet-Lupo
- Team Cancer, Immune Control and Escape, Cordeliers Research Center, UMRS 1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,University Paris Descartes, Paris, France.,Department of Pathology, Hôpital Cochin, AP-HP, Paris, France.,CERTIM, Hôpital Cochin, APHP, Paris, France
| | - Jérôme Biton
- Team Physiopathologie, cibles et thérapies de la polyarthrite rhumatoide Laboratoire Immunologie et Immunopathologie-Li2P, UMR1125, Université Paris 13, Bobigny, France
| | - Hanane Ouakrim
- Team Cancer, Immune Control and Escape, Cordeliers Research Center, UMRS 1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,University Paris Descartes, Paris, France.,Department of Pathology, Hôpital Cochin, AP-HP, Paris, France
| | - Marco Alifano
- Team Cancer, Immune Control and Escape, Cordeliers Research Center, UMRS 1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,University Paris Descartes, Paris, France.,CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Thoracic Surgery, Hôpital Cochin, AP-HP, Paris, France
| | - Claire Gervais
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Audrey Bellesoeur
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Nora Kramkimel
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Cutaneous Diseases, Hôpital Cochin, AP-HP, Paris, France
| | - Camille Tlemsani
- CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Barbara Burroni
- Department of Pathology, Hôpital Cochin, AP-HP, Paris, France
| | - Angéline Duche
- Genomic platform, INSERM U1016, Institut Cochin, Paris, France
| | | | - Han Si
- Oncology Research, MedImmune, Gaithersburg, MD, USA
| | | | - Todd Creasy
- Oncology Research, MedImmune, Gaithersburg, MD, USA
| | | | - Xing Ren
- NanoString Technologies, Seattle, WA, USA
| | | | | | - François Goldwasser
- University Paris Descartes, Paris, France.,CERTIM, Hôpital Cochin, APHP, Paris, France.,Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France
| | - Karen Leroy
- University Paris Descartes, Paris, France. .,CERTIM, Hôpital Cochin, APHP, Paris, France. .,Department of Genetic and Molecular Biology, Hôpital Cochin, AP-HP, 27 rue du Faubourg St Jacques, 75014, Paris, France.
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48
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Biton J, Ouakrim H, Dechartres A, Alifano M, Mansuet-Lupo A, Si H, Halpin R, Creasy T, Bantsimba-Malanda C, Arrondeau J, Goldwasser F, Boudou-Rouquette P, Fournel L, Roche N, Burgel PR, Goc J, Devi-Marulkar P, Germain C, Dieu-Nosjean MC, Cremer I, Herbst R, Damotte D. Impaired Tumor-Infiltrating T Cells in Patients with Chronic Obstructive Pulmonary Disease Impact Lung Cancer Response to PD-1 Blockade. Am J Respir Crit Care Med 2019. [PMID: 29518341 DOI: 10.1164/rccm.201706-1110oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patients with chronic obstructive pulmonary disease (COPD) have a higher prevalence of lung cancer. The chronic inflammation associated with COPD probably promotes the earliest stages of carcinogenesis. However, once tumors have progressed to malignancy, the impact of COPD on the tumor immune microenvironment remains poorly defined, and its effects on immune-checkpoint blockers' efficacy are still unknown. OBJECTIVES To study the impact of COPD on the immune contexture of non-small cell lung cancer. METHODS We performed in-depth immune profiling of lung tumors by immunohistochemistry and we determined its impact on patient survival (n = 435). Tumor-infiltrating T lymphocyte (TIL) exhaustion by flow cytometry (n = 50) was also investigated. The effectiveness of an anti-PD-1 (programmed cell death-1) treatment (nivolumab) was evaluated in 39 patients with advanced-stage non-small cell lung cancer. All data were analyzed according to patient COPD status. MEASUREMENTS AND MAIN RESULTS Remarkably, COPD severity is positively correlated with the coexpression of PD-1/TIM-3 (T-cell immunoglobulin and mucin domain-containing molecule-3) by CD8 T cells. In agreement, we observed a loss of CD8 T cell-associated favorable clinical outcome in COPD+ patients. Interestingly, a negative prognostic value of PD-L1 (programmed cell death ligand 1) expression by tumor cells was observed only in highly CD8 T cell-infiltrated tumors of COPD+ patients. Finally, data obtained on 39 patients with advanced-stage non-small cell lung cancer treated by an anti-PD-1 antibody showed longer progression-free survival in COPD+ patients, and also that the association between the severity of smoking and the response to nivolumab was preferentially observed in COPD+ patients. CONCLUSIONS COPD is associated with an increased sensitivity of CD8 tumor-infiltrating T lymphocytes to immune escape mechanisms developed by tumors, thus suggesting a higher sensitivity to PD-1 blockade in patients with COPD.
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Affiliation(s)
- Jérôme Biton
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Hanane Ouakrim
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France.,4 Department of Pathology
| | - Agnès Dechartres
- 5 Department of Clinical Epidemiology, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France.,6 METHODS Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, UMR1153, INSERM, Paris, France.,7 Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Biostatistique Santé Publique Information Médicale, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; and
| | - Marco Alifano
- 2 Paris Descartes-Paris 5 University, Paris, France.,8 Department of Thoracic Surgery
| | - Audrey Mansuet-Lupo
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France.,4 Department of Pathology
| | - Han Si
- 9 Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Rebecca Halpin
- 9 Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Todd Creasy
- 9 Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Claudie Bantsimba-Malanda
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France.,9 Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Jennifer Arrondeau
- 2 Paris Descartes-Paris 5 University, Paris, France.,10 Department of Medical Oncology, and
| | - François Goldwasser
- 2 Paris Descartes-Paris 5 University, Paris, France.,10 Department of Medical Oncology, and
| | | | - Ludovic Fournel
- 2 Paris Descartes-Paris 5 University, Paris, France.,8 Department of Thoracic Surgery
| | - Nicolas Roche
- 11 Department of Respiratory and Intensive Care Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Régis Burgel
- 11 Department of Respiratory and Intensive Care Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremy Goc
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Priyanka Devi-Marulkar
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Claire Germain
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Marie-Caroline Dieu-Nosjean
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Isabelle Cremer
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France
| | - Ronald Herbst
- 9 Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Diane Damotte
- 1 Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,2 Paris Descartes-Paris 5 University, Paris, France.,3 Pierre et Marie Curie-Paris 6 University, Paris, France.,4 Department of Pathology
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49
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Jouinot A, Ulmann G, Vazeille C, Durand JP, Boudou-Rouquette P, Arrondeau J, Tlemsani C, Fournel L, Alifano M, Wislez M, Chapron J, Le Bris C, Mansuet-Lupo A, Damotte D, Neveux N, De Bandt JP, Alexandre J, Cynober L, Goldwasser F. Hypermetabolism is an independent prognostic factor of survival in metastatic non-small cell lung cancer patients. Clin Nutr 2019; 39:1893-1899. [PMID: 31443979 DOI: 10.1016/j.clnu.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Metastatic non-small cell lung cancer (NSCLC) is the first cause of cancer death worldwide. Increased resting energy expenditure (REE) is frequent among cancer patients and may contribute to cancer cachexia. The aim of this study was to examine the prognostic value of increased REE in metastatic NSCLC patients. METHODS This observational study was conducted between June 2012 and November 2017 in the outpatient unit of the oncology department of Cochin hospital, Paris. Consecutive patients with newly diagnosed stage IV NSCLC underwent measurement of REE by indirect calorimetry before treatment initiation. Uni- and multivariate analysis of overall survival (OS, Cox models) included age, sex, smoking habit, histological subtype, performance status, body mass index, weight loss, albumin and CRP levels and the ratio of measured REE to the REE predicted by the Harris Benedict formula (mREE/pREE). RESULTS 144 patients were enrolled: mean age 64 years, 63% male, 90% non-squamous carcinoma, including 17% with ALK/EGFR alteration. In univariate analysis, tobacco consumption (p = 0.007), histo-molecular subtype (p < 10-3), performance status (p = 0.04), weight loss (p < 10-4), albumin (p < 10-4), CRP (p = 0.001) and mREE/pREE ratio (>vs ≤ 120%: HR = 2.16, p < 10-3) were significant prognostic factors of OS. Median OS were 6.1 and 17.3 months in patients with mREE/pREE ratio > and ≤120%, respectively. In multivariate analysis, histo-molecular subtype (non-squamous ALK/EGFR mutated vs squamous carcinoma: HR = 0.25, p = 0.006), weight loss (>vs ≤ 5%: HR = 1.98, p = 0.004), albumin (≥vs < 35 g/L: HR = 0.56, p = 0.02) and mREE/pREE ratio (> vs ≤120%: HR = 1.90, p = 0.004) were identified as independent prognostic factors. CONCLUSIONS Elevated resting energy expenditure emerges as an independent prognostic factor in metastatic NSCLC.
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Affiliation(s)
- Anne Jouinot
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, Paris, France.
| | - Guillaume Ulmann
- Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
| | - Clara Vazeille
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Jean-Philippe Durand
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
| | - Pascaline Boudou-Rouquette
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Jennifer Arrondeau
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Camille Tlemsani
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Ludovic Fournel
- Thoracic Surgery Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Paris Descartes University, Paris, France
| | - Marco Alifano
- Thoracic Surgery Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Paris Descartes University, Paris, France
| | - Marie Wislez
- Pneumology Department, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France
| | - Jeanne Chapron
- Pneumology Department, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France
| | - Camille Le Bris
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Audrey Mansuet-Lupo
- Pathology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Centre de recherche des Cordeliers, INSERM U1138, Paris Descartes University, USPC, Paris, France
| | - Diane Damotte
- Pathology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Centre de recherche des Cordeliers, INSERM U1138, Paris Descartes University, USPC, Paris, France
| | - Nathalie Neveux
- Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
| | - Jean-Pascal De Bandt
- Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
| | - Jérôme Alexandre
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France
| | - Luc Cynober
- Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
| | - François Goldwasser
- Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France
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50
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Bouaoud J, Beinse G, Epaillard N, Amor-Sehlil M, Bidault F, Brocheriou I, Hervé G, Spano JP, Janot F, Boudou-Rouquette P, Benassarou M, Schouman T, Goudot P, Malouf G, Goldwasser F, Bertolus C. Lack of efficacy of neoadjuvant chemotherapy in adult patients with maxillo-facial high-grade osteosarcomas: A French experience in two reference centers. Oral Oncol 2019; 95:79-86. [DOI: 10.1016/j.oraloncology.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/08/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
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