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Laville D, Désage AL, Fournel P, Bayle-Bleuez S, Neifer C, Picot T, Sulaiman A, Tiffet O, Forest F. Spread Through Air Spaces in Stage I to III Resected Lung Adenocarcinomas: Should the Presence of Spread Through Air Spaces Lead to an Upstaging? Am J Surg Pathol 2024; 48:596-604. [PMID: 38298024 DOI: 10.1097/pas.0000000000002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
In recent years, the concept of spread through air spaces (STAS) has been discussed as an adverse prognostic factor for lung cancer. The aim of our study is to clarify the prognostic role of STAS in relation to the main recognized prognostic factors in a retrospective cohort of 330 European patients who underwent stages I to III lung adenocarcinoma resection. On univariate analysis, the presence of STAS was related to progression-free survival (PFS; hazard ratio [HR]: 1.48; 95% CI: 1.02-2.19; P = 0.038) and overall survival (OS; HR: 1.61; 95% CI: 1.03-2.52; P = 0.50). On multivariate analysis, STAS was related to PFS (HR: 1.51; 95% CI: 1.00-2.17; P = 0.050) and to OS (HR: 1.67; 95% CI: 1.00-2.81; P = 0.050). We showed that the presence of STAS was associated with lower PFS, equivalent to the next pathologic T stage, especially the median PFS of T3 stages without STAS was at 62.8 months while the median PFS of T3 stages with STAS was at 15.7 months, closer to the median PFS of 17.4 months in T4 stages. To conclude, STAS is an independent prognostic factor of PFS in this European cohort and is close to significance for OS. We suggest that the presence of STAS might lead to an upstaging of lung adenocarcinoma.
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Affiliation(s)
| | | | | | | | - Chaouki Neifer
- Thoracic Surgery, North Hospital, University Hospital of Saint Etienne, Saint Etienne, France
| | | | - Abdulrazzak Sulaiman
- Thoracic Surgery, North Hospital, University Hospital of Saint Etienne, Saint Etienne, France
| | - Olivier Tiffet
- Thoracic Surgery, North Hospital, University Hospital of Saint Etienne, Saint Etienne, France
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Elhaitmy Y, El Anssari S, Fournel P, Mellas N, Bouleftour W, Lamuraglia M. Case report: Immunotherapy inducing unexpected overall survival in choroidal melanoma: about a case. Front Oncol 2024; 14:1319792. [PMID: 38706606 PMCID: PMC11066258 DOI: 10.3389/fonc.2024.1319792] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Choroidal melanoma (CM) is the most common malignant ocular tumor in adults. The current treatment of metastatic CM is limited by the intrinsic resistance of CM to conventional systemic therapies. Immunotherapy alone or in association with cytotoxic treatment became a realist option treatment. Advancements in molecular biology have resulted in the identification of a number of promising prognostic and therapeutic targets. Herein, we report a rare case of 36-year-old patient with metastatic CM who presented a good long response to treatment with double immunotherapy reaching 3 years of overall survival, which has never been described in the literature.
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Affiliation(s)
- Youssef Elhaitmy
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Oncology, Hassan II University Hospital, Fez, Morocco
| | - Soukaina El Anssari
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Oncology, Hassan II University Hospital, Fez, Morocco
| | - Pierre Fournel
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Nawfel Mellas
- Department of Oncology, Hassan II University Hospital, Fez, Morocco
| | - Wafa Bouleftour
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Michele Lamuraglia
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
- Oncology Unit, Hopital Prive de la Seine Saint Denis, Le Blanc-Mesnil, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, Paris, France
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Bouleftour W, Mondiere-Wichurski A, Fournel P, Reboul Q. COVID-19 Outbreak Impact on Cancer Multidisciplinary Team Meetings. A Multicenter French Experience. Cancer Invest 2024; 42:4-11. [PMID: 38317281 DOI: 10.1080/07357907.2024.2311856] [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: 12/05/2022] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
Multidisciplinary team meeting (MDT) became a standard of care in cancer management. The COVID-19 epidemic induced unprecedented pressure on the health system. The impact of this health crisis on MDTs held within a regional French health structures was analyzed. A decrease in the total number of records discussed in hematological, digestive, thoracic, gynecological and genitourinary MDTs was observed following the 1st wave of the COVID-19 pandemic. This decrease was generally maintained during the 2nd and 3rd wave. MDTs activity back in order from the 4th wave. The COVID-19 pandemic has challenged MDTs settings. The implementation of virtual technologies offers an opportunity to improve MDTs organization.
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Affiliation(s)
- Wafa Bouleftour
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Pierre Fournel
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
- Cancerology Coordination Center, Oncoloire of Department Loire and Northern Ardeche, France Saint-Etienne
| | - Quentin Reboul
- Cancerology Coordination Center, Oncoloire of Department Loire and Northern Ardeche, France Saint-Etienne
- Surgical Mutual Clinic, Saint-Etienne, France
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Grosjean V, Fournel P, Picot T, Tiffet O, Forest F. Hyalinizing clear cell carcinoma of the lung with EWSR1::CREM fusion. Histopathology 2023. [PMID: 37211641 DOI: 10.1111/his.14942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Vincent Grosjean
- Department of Pathology and Molecular Pathology, University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
| | - Pierre Fournel
- Department of Pneumology, University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
| | - Tiphanie Picot
- Department of Pathology and Molecular Pathology, University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
| | - Fabien Forest
- Department of Pathology and Molecular Pathology, University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
- Unité de Recherche en Cancérologie du CHU de Saint-Etienne (URCAS), University Hospital of Saint Etienne, North Hospital. Avenue Albert Raimond, Saint Etienne, France
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Gervais R, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Decroisette C. First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study). Cancer Immunol Immunother 2023; 72:91-99. [PMID: 35729418 DOI: 10.1007/s00262-022-03232-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
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Affiliation(s)
- Renaud Descourt
- Oncology Department, Brest University Hospital, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Jean-Bernard Auliac
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France
| | - Lionel Falchero
- Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France
| | - Radj Gervais
- Oncology Department, Caen François-Baclesse Cancer Center, Caen, France
| | - Rémi Veillon
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Florian Guisier
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | | | | | - Marie Bernardi
- Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Pierre Fournel
- Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Hélène Doubre
- Pneumology Department, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France.
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Racadot S, Thennevet I, Ouldbey Y, Kaminsky MC, Bosset M, Martin L, Tao Y, Sire C, de Raucourt D, Alfonsi M, Malaurie E, Tourani JM, Fournel P, Vauleon E, Modesto A, Rolland F, Metzger S, Pommier P, Chabaud S, Dussart S. Afatinib maintenance therapy following post-operative radiochemotherapy in head and neck squamous cell carcinoma: Results from the phase III randomised double-blind placebo-controlled study BIB2992ORL (GORTEC 2010-02). Eur J Cancer 2023; 178:114-127. [PMID: 36434888 DOI: 10.1016/j.ejca.2022.10.023] [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: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We investigated the efficacy and safety of afatinib maintenance therapy in patients with head and neck squamous cell carcinoma (HNSCC) with macroscopically complete resection and adjuvant radiochemotherapy (RCT). METHODS This French multicentric randomised phase III double-blind placebo-controlled study included adult patients with ECOG-PS≤2, normal haematological, hepatic and renal functions, and non-metastatic, histologically confirmed HNSCC of the oral cavity, oropharynx, larynx or hypopharynx, with macroscopically complete resection and adjuvant RCT (≥2 cycles of cisplatin 100 mg/m2 J1, J22, J43 and 66Gy (2Gy/fraction, 5 fractions/week, conventional or intensity modulated radiotherapy ≥60Gy). Randomised patients were planned to receive either afatinib (afa arm) or placebo (control arm (C)) as maintenance therapy for one year. Primary endpoint was disease free survival (DFS). A 15% improvement in DFS was expected at 2 years with afatinib (from 55 to 70%). RESULTS Among the 167 patients with resected HNSCC included in 19 cancer centres and hospitals from Dec 2011, 134 patients were randomised to receive one-year maintenance afatinib or placebo (afa:67; C:67). Benefit/risk ratio was below assumptions and independent advisory committee recommended to stop the study in Feb 2017, the sponsor decided premature study discontinuation, with a 2-year follow-up for the last randomised patient. 2y-DFS was 61% (95% CI 0.48-0.72) in the afatinib group and 64% (95% CI 0.51-0.74) in the placebo group (HR 1.12, 95% CI 0.70-1.80). CONCLUSION Maintenance therapy with afatinib compared with placebo following post-operative RCT in patients with HNSCC did not significantly improve 2y-DFS and should not be recommended in this setting outside clinical trials. CLINICALTRIALS gov identifier NCT01427478.
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Affiliation(s)
- Séverine Racadot
- Department of Radiotherapy, Leon Berard Cancer Center, Lyon, France.
| | | | - Yaelle Ouldbey
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | | | - Mathieu Bosset
- Department of Radiotherapy, Centre de radiothérapie Marie Curie, Hopital privé Drôme Ardèche, Valence, France
| | - Laurent Martin
- Department of Radiotherapy, Centre Guillaume le Conquérant, Le Havre, France
| | - Yungan Tao
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Christian Sire
- Department of Radiotherapy, Centre Hospitalier de Bretagne Sud, Hôpital du Scorff, Lorient, France
| | | | - Marc Alfonsi
- Department of Radiotherapy, Institut Sainte Catherine, Avignon, France
| | - Emmanuelle Malaurie
- Department of Radiotherapy, Centre Hospitalier Intercommunal, Créteil, France
| | | | - Pierre Fournel
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Elodie Vauleon
- Department of Oncology, Centre Eugène Marquis, Rennes, France
| | - Anouchka Modesto
- Department of Radiotherapy, Institut Claudius Régaud, Toulouse Oncopôle, Toulouse, France
| | - Frédéric Rolland
- Department of Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Séverine Metzger
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | - Pascal Pommier
- Department of Radiotherapy, Leon Berard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | - Sophie Dussart
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
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Kalecinski J, Werlen AL, Sene MT, Bertholet M, Granottier M, Moundir K, Salque C, Vazille C, Brosse C, Langlet H, Regnier Denois V, Fournel P. Représentations et pratiques du jeûne et des régimes restrictifs pendant la chimiothérapie. Sante Publique 2022; 34:481-506. [PMID: 36577676 DOI: 10.3917/spub.224.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction : The idea of therapeutic fasting with healing virtues is circulating among cancer patients. Our study aims to improve knowledge of this practice, which is contraindicated in France during chemotherapy, and to establish recommendations to facilitate exchanges between doctors and patients.Methods : Chemotherapy patients completed a self-questionnaire on diet, therapeutic fasting and alternative medicine. A subsample of patients intending to follow dietary restrictions were interviewed.Results : Among the 133 participants, more than half had changed their diet and/or had heard of therapeutic fasting. Twenty-one patients intended to fast or have dietary restrictions during chemotherapy. These were mainly women, with an average age of 56 years, being treated for breast cancer, using alternative medications. They had little interaction with the health care team but would have liked to have had some with their oncologist. Nine patients were interviewed. They had tested short fasting and/or a ketogenic diet to improve treatment efficacy, reduce side effects and/or gain more control over their management. They did not dare to talk about it with the oncologist but regretted their silence. They are often advised by naturopaths and have tested homeopathy to accompany their treatment.Conclusions : Patients explain that they want to put all the odds in their favor. They would like the medical profession to offer times for discussion on fasting, silence being perceived as potentially harmful.
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Désage AL, Tissot C, Bayle-Bleuez S, Muron T, Deygas N, Grangeon-Vincent V, Monange B, Torche F, Vercherin P, Kaczmarek D, Tiffet O, Forest F, Vergnon JM, Bouleftour W, Fournel P. Adjuvant chemotherapy for completely resected IIA-IIIA non-small cell lung cancer: compliance to guidelines, safety and efficacy in real-life practice. Transl Lung Cancer Res 2022; 11:2418-2437. [PMID: 36636405 PMCID: PMC9830267 DOI: 10.21037/tlcr-22-345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/23/2022] [Indexed: 12/27/2022]
Abstract
Background Since randomised clinical trials demonstrated a survival benefit of adjuvant chemotherapy (AC) following curative-intent lung surgery, AC has been implemented as a standard therapeutic strategy for patients with a completely resected IIA-IIIA non-small cell lung cancer (NSCLC). Regarding the moderate benefit of AC and the lack of literature on AC use in real-life practice, we aimed to evaluate compliance to guidelines, AC safety and efficacy in a less selected population. Methods Between January 2009 and December 2014, we retrospectively analysed 210 patients with theoretical indication of AC following curative-intent lung surgery for a completely resected IIA-IIIA NSCLC. The primary objective of this retrospective study was to evaluate compliance to AC guidelines. Secondary objectives included safety and efficacy of AC in real-life practice. Results Among 210 patients with a theoretical indication of AC, chemotherapy administration was validated in multidisciplinary team (MDT) for 62.4% of them and 117 patients (55.7%) finally received AC. Patient's clinical conditions were the main reasons advanced in MDT for no respect to AC guidelines. Most of the patients received cisplatin-vinorelbine (86.3%) and AC was initiated within 8 weeks following lung surgery for 73.5% of patients. One-half of patients who received AC experienced side effects leading to either dose-intensity modification or treatment interruption. In real-life practice, AC was found to provide a survival benefit over surgery alone. Factors related to daily-life practice such as delayed AC initiation or incomplete AC planned dose received were not associated with an inferior survival. Conclusions Although AC use might differ from guidelines in real-life practice, this retrospective study highlights that AC can be used safely and remains efficient among a less selected population. In the context of immunotherapy and targeted therapies development in peri-operative treatment strategies, the place of AC has to be precised in the future.
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Affiliation(s)
- Anne-Laure Désage
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Tissot
- Oncology Department, Private Loire Hospital (HPL), Saint-Etienne, France
| | - Sophie Bayle-Bleuez
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Thierry Muron
- Oncology Department, Private Loire Hospital (HPL), Saint-Etienne, France.,Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Nadine Deygas
- Department of Pulmonology, Gier Hospital, Saint-Chamond, France
| | | | - Brigitte Monange
- Department of Medical Oncology, Emile Roux Hospital, Le Puy-en-Velay, France
| | - Fatah Torche
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul Vercherin
- Public Health and Medical Informatics Department, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - David Kaczmarek
- Thoracic and Digestive Surgery Department, Private Loire Hospital (HPL), Saint-Etienne, France
| | - Olivier Tiffet
- Department of Thoracic Surgery, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Fabien Forest
- Pathology Department, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Michel Vergnon
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Wafa Bouleftour
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pierre Fournel
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
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Perquis MP, Tissot C, Bouleftour W, Bayle-Bleuez S, Vercherin P, Forest F, Fournel P. Analyse de la prise en charge des cancers bronchiques avec mutation du gène de l’EGFR. Rev Mal Respir 2022; 39:731-739. [DOI: 10.1016/j.rmr.2022.08.010] [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] [Received: 01/10/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022]
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10
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Decroisette C, Monnet I, Ricordel C, Demaegdt A, Falchero L, Bylicki O, Geier M, Justeaux G, Bernardi M, Andre M, Guisier F, Fournel P, Vieillot S, Hauss P, Schott R, Crequit J, Auliac J, Chouaid C, Greillier L. 1035P A phase II trial of nivolumab and denosumab association as second-line treatment for stage IV non-small-cell lung cancer (NSCLC) with bone metastases: DENIVOS study (GFPC 06-2017). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bilger G, Toffart AC, Darrason M, Duruisseaux M, Ulmer L, Wang P, Leprieur EG, Girard N, Massiani MA, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot AB, Decroisette C. Paclitaxel–bevacizumab combination in advanced non-squamous non-small-cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study. Ther Adv Med Oncol 2022; 14:17588359221099399. [PMID: 35694190 PMCID: PMC9174558 DOI: 10.1177/17588359221099399] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Compared with docetaxel, the phase-III trial, ULTIMATE, showed a significant
improvement of progression-free survival (PFS) with paclitaxel–bevacizumab
combination (PB) as second- or third-line treatment in advanced non-small
cell lung cancer (NSCLC). With the increase of immunotherapy treatment in
first-line settings, the optimal treatment after first-line failure must be
redefined. Methods: This multicentric retrospective study identified all advanced NSCLC patients
treated with PB as second-line therapy and beyond. The main efficacy
outcomes assessed were objective response rate (ORR), disease control rate
(DCR), PFS, and overall survival (OS). The adverse events were reported
according to Common Terminology Criteria for Adverse Events (CTCAE). Results: From January 2010 to February 2020, 314 patients in 16 centers received the
PB combination. Most patients were male (55%), with a median age of 60 years
(19–82), 95% had adenocarcinoma, 27% had a performance status ⩾2, 45% had
brain metastases at the time of inclusion. They mostly received the PB
combination either in second (20%) or in third-line (39%), and 28% were
treated just after ICI failure. ORR and DCR were 40% and 77%, respectively;
median PFS and OS were 5.7 [interquartile range (IQR): 3.2–9.6] and 10.8
[IQR: 5.3–19.6] months, respectively. All grade adverse events concerned 82%
of patients, including 53% asthenia and 39% neurotoxicity, and 25% of
patients continued monotherapy (mostly with bevacizumab) alone due to
toxicity. Median PFS for patients treated after ICI failure (ICI+) was
significantly superior compared with those not previously treated with ICI
(ICI−): 7.0 [IQR: 4.2–11.0] versus 5.2 [IQR: 2.9–8.8]
months, p = 0.01, without statistically significant
difference for OS between these two groups. In multivariate analysis,
factors associated with superior PFS were previous ICI treatment and
performance status of 0–1. Only a performance status of 0–1 was associated
with superior OS. Conclusion: PB combination as second-line treatment or beyond for advanced non-squamous
NSCLC had acceptable toxicity and a clinically relevant efficacy and is an
option as salvage treatment for these patients, more particularly after ICI
progression.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, 38700 Grenoble, France. Oncology, Grenoble University Hospital, Grenoble, France
| | - Anne-Claire Toffart
- Centre Hospitalier Universitaire de Grenoble, Grenoble, FranceOncology, Grenoble University Hospital, Grenoble, France
| | - Marie Darrason
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, Pierre-Bénite, France
- Department of Pneumology and Thoracic Oncology, University Hospital of Lyon, Pierre-Bénite, France
- Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France
- Lyon Institute of Philosophical Research, Lyon 3 University, Lyon, France
| | | | - Lucie Ulmer
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
| | | | | | | | | | - Paul Bore
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Julian Pinsolle
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | | | | | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Claire Tissot
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Service d’Oncologie Médicale, Institut de Cancérologie, CHU de Saint-Etienne, Saint-Etienne Cedex 2, France
| | - Anne Baranzelli
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Alexis B. Cortot
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
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12
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Dagher S, Sulaiman A, Bayle-Bleuez S, Tissot C, Grangeon-Vincent V, Laville D, Fournel P, Tiffet O, Forest F. Spread Through Air Spaces (STAS) Is an Independent Prognostic Factor in Resected Lung Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14092281. [PMID: 35565410 PMCID: PMC9101151 DOI: 10.3390/cancers14092281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: There is no histoprognostic grading for lung squamous cell carcinoma (LUSC). Different prognostic factors have been described in the recent literature and are not always studied in parallel. Our objective was to search for morphological histopathological prognostic factors in LUSC. Materials and Methods: In this single-center retrospective study of 241 patients, all patients with LUSC who underwent surgical excision over a 12-year period were included. The primary endpoint was 5-year overall survival. Results: STAS was present in 86 (35.7%) patients. The presence of Spread Through Air Spaces (STAS) was correlated with tumor location (p < 0.001), pathological stage (p = 0.039), tumor differentiation (p = 0.029), percentage of necrosis (p = 0.004), presence of vascular and/or lymphatic emboli, budding (p = 0.02), single cell invasion (p = 0.002) and tumor nest size (p = 0.005). The percentage of tumor necrosis was correlated with the overall survival at 5 years: 44.6% of patients were alive when the percentage of necrosis was ≥50%, whereas 68.5% were alive at 5 years when the necrosis was <30% (p < 0.001). When vasculolymphatic emboli were present, the percentage of survival at 5 years was 42.5% compared to 65.5% when they were absent (p = 0.002). The presence of isolated cell invasion was correlated with a lower 5-year survival rate: 51.1% in the case of presence, versus 66% in the case of absence (p = 0.02). In univariate analysis, performance status, pathological stage pT or pN, pleural invasion, histopathological subtype, percentage of tumor necrosis, vasculolymphatic invasion, single-cell invasion, budding and tumor nest size correlated with the percentage of survival at 5 years. On multivariate analysis, only STAS > 3 alveoli (HR, 2.74; 95% CI, 1.18−6.33) was related to overall survival. Conclusion: In conclusion, extensive STAS is an independent factor of poor prognosis in LUSC. STAS is correlated with the presence of other poor prognostic factors such as emboli and pleural invasion and would reflect greater tumor aggressiveness.
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Affiliation(s)
- Sami Dagher
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
| | - Abdulrazzaq Sulaiman
- Department of Thoracic Surgery, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (A.S.); (O.T.)
| | - Sophie Bayle-Bleuez
- Department of Pneumology, University Hospital of Saint Etienne, 42055 Saint Etienne, France;
| | - Claire Tissot
- Lucien Neuwirth Cancer Institute, 42271 Saint Etienne, France; (C.T.); (P.F.)
| | | | - David Laville
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
| | - Pierre Fournel
- Lucien Neuwirth Cancer Institute, 42271 Saint Etienne, France; (C.T.); (P.F.)
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (A.S.); (O.T.)
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
- Department of Molecular Biology of Solid Tumors, University Hospital of Saint Etienne, 42055 Saint Etienne, France
- Correspondence: ; Tel.: +33-(0)-477-127-734
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13
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Desage AL, Bouleftour W, Tiffet O, Fournel P, Tissot C. Use of adjuvant chemotherapy in resected non-small cell lung cancer in real-life practice: a systematic review of literature. Transl Lung Cancer Res 2021; 10:4643-4665. [PMID: 35070767 PMCID: PMC8743521 DOI: 10.21037/tlcr-21-557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/01/2021] [Indexed: 11/06/2022]
Abstract
Background Methods Results Discussion
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Affiliation(s)
- Anne-Laure Desage
- Department of Medical Oncology, Lucien Neuwirth Cancerology Institute, Saint Priest en Jarez, France
| | - Wafa Bouleftour
- Department of Medical Oncology, Lucien Neuwirth Cancerology Institute, Saint Priest en Jarez, France
| | - Olivier Tiffet
- Department of General Surgery, Saint Etienne Hospital, Saint-Etienne, France
| | - Pierre Fournel
- Department of Medical Oncology, Lucien Neuwirth Cancerology Institute, Saint Priest en Jarez, France
| | - Claire Tissot
- Department of Medical Oncology, Lucien Neuwirth Cancerology Institute, Saint Priest en Jarez, France
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14
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Bilger G, Toffart A, Darrason M, Duruisseaux M, Ulmer L, Wang P, Leprieur EG, Girard N, Massiani M, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot A, Decroisette C. P25.01 Efficacy of Weekly Paclitaxel-Bevacizumab Combination in Advanced NSCLC: AVATAX, A Retrospective Multicentric Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.380] [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: 12/01/2022]
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15
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Martel-Lafay I, Monnet I, Lardy-Cleaud A, Danhier S, Salem N, Gallocher O, Fournel P, Chouaid C, Bylicki O. Feasibility of Stereotactic Body Radiation Therapy on Unresectable Stage III NSCLC with Peripheral Primary Tumor: A Prospective Study (GFPC 01-14). Curr Oncol 2021; 28:3804-3811. [PMID: 34677242 PMCID: PMC8534340 DOI: 10.3390/curroncol28050324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Concomitant radiochemotherapy (RTCT) is the standard treatment for unresectable stage III non-small cell lung cancer (NSCLC). However, in patients with a peripheral primary tumor, the irradiated volume may include a large portion of normal lung and RT-CT is not possible. This multicenter phase II trial in unresectable stage III NSCLC with peripheral primary tumor evaluated the feasibility of stereotactic body radiation therapy (SBRT) in peripheral tumor after concomitant radio-chemotherapy (RT-CT). Nineteen patients were included and analyzed (median age, 60.9 years; male, 78%; adenocarcinoma, 74%; median size of peripheral primary tumor, 19 mm). At 6 months, the disease control rate was 79% (15/19). SBRT toxicity was generally mild with one (5%) patient having grade 3 lung toxicity. Recruitment for this study was stopped prior to completion, firstly due to the approval of adjuvant durvalumab after RT-CT, which was not anticipated in the design, and secondly due to the small number of stage III NSCLC patients with a peripheral tumor that was accessible to SBRT. Nevertheless, the combination of RT-CT and SBRT appeared to be feasible and safe.
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Affiliation(s)
| | | | - Audrey Lardy-Cleaud
- Centre Léon Bérard, Direction de la Recherche Clinique et de l′Innovation, 69008 Lyon, France;
| | | | - Naji Salem
- Institute Paoli Calmettes, 13009 Marseille, France;
| | | | | | - Christos Chouaid
- Inserm U955, UPEC, IMRB, équipe CEpiA, Créteil, CHI Créteil, 94010 Créteil, France
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16
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Demontrond P, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaid C, Decroisette C. First-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥ 50%) advanced non-small cell lung cancer (aNSCLC) in the real world: A national French bispective multicentric cohort—ESCKEYP trial (GFPC 05-2018). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9091] [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
9091 Background: To determine real-world outcomes with first line pembrolizumab monotherapy, for aNSCLC with PD-L1 TPS ≥50%. Methods: Bispective, national and multicentric study including consecutively aNSCLC patients who initiated first-line pembrolizumab monotherapy from May 5, 2017 (marketing authorization of pembrolizumab monotherapy in France) to Nov 22, 2019 (marketing authorization of pembrolizumab-chemotherapy for non-squamous aNSCLC). Data were collected on medical charts. Responses were locally assessed according to RECIST v1.1; overall survival (OS) and real-world progression-free survival (rwPFS) were assessed by Kaplan-Meier method. Results: 845 patients (pts) were included by 33 centres: 67.8% were men, PS 0/1/≥2: 25.5%/46.9%/27.6%, active/former/nonsmokers: 39.1%/51.7%/6.4%, adenocarcinoma: 70.8%; stage IV at diagnosis: 91.6%; median number of metastatic sites at baseline: 2±1 (brain (20.8%), liver (13.9%) and bone (35%)); KRAS mutated: 27.7%, PDL1 TPS > 75%: 53.7% At the cut off date (31 December 2020), on the 783/845 (92.7%) evaluable pts, CR, PR, disease stabilization and progression were reported on 4.7%, 42.6%, 24.1% and 28.6% of cases, respectively; 588 (69.6%) pts had discontinued pembrolizumab, 390 (66.4%) had a first disease progression; 320/390 (82.1%) received a second line treatment, mainly platinum-based chemotherapy (90.6%). With a median follow up of 25,8 [95%CI: 24,8-26,7] months, median rwPFS and median OS were 8,2 [95%CI: 6,9-9,5] and 22,6 [95%CI: 18,5-27,4] months, respectively; 6, 12, 18-months survival rates were 76,8%, 64,8% and 54,3%. 835 adverse events were reported in 48% of the patients, grade ≥3 in 13.8% of cases, mainly asthenia, colitis, pneumonitis. For evaluable patients receiving a platinum-based doublet in second line (266/290, 89%), CR, PR, disease stabilization and progression were reported on 1.9%, 41%, 35.3% and 21.8% of cases, respectively. Uni and multivariate analysis of factors related to OS will be presented at the congress. Conclusions: Despite a less stringent selection of patients, pembrolizumab as a single agent achieves similar tumor shrinkage, rwPFS and OS than those of pivotal clinical trials.
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Affiliation(s)
- Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | - Remi Veillon
- CHU Bordeaux, Service Des Maladies Respiratoires, Bordeaux, France
| | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
| | | | | | | | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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17
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Bilger G, Toffart AC, Darasson M, Duruisseaux M, Ulmer L, Wang P, Giroux Leprieur E, Girard N, Massiani MA, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot A, Decroisette C. Efficacy of weekly paclitaxel-bevacizumab combination in advanced nonsquamous non-small cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21086] [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
e21086 Background: With the growing role of immunotherapy (ICI) as first-line setting for advanced NSCLC, strategies must be redefined after failure. The combination paclitaxel-bevacizumab showed in the ULTIMATE trial a significant superiority versus docetaxel as second or third-line treatment. Limited restropective studies has demonstrated unexpected efficacy of chemotherapy after prior progression on ICI. This combination could be use as salvage treatment following ICI. Methods: This multi-centric retrospective study identifies patients treated with the combination paclitaxel-bevacizumab in metastatic non-squamous NSCLC as second-line therapy or beyond. Main objectives were to describe safety and efficacy of this combination, with a special attention to the sub-group treated just after ICI. Results: From January 2010 to February 2020, 314 patients started the paclitaxel-bevacizumab combination : 55% male, with a median age of 60 years, 27% with a performance status ≥2, 45% with brain metastases. A majority of patients were treated in second (20%) and third-line (39%), and 28% were treated just after ICI failure (88/314). Objective response rate (ORR) was 40% and disease control rate was 77 %. Median progression-free survival (PFS) and overall survival (OS) were 5,7 months [IQ,3,2–9,6] and 10,8 months [IQ,5,3–19,6] respectively. All grades adverse events concerned 82% of patients, including 53% asthenia and 39% neurotoxicity, and 25% of patients continued a monotherapy alone due to toxicity. Median PFS for patients treated after ICI failure (ICI+) was significantly superior compare to those not previously treated with ICI (ICI-) : 7,0 months [IQ,4,2–11,0] vs 5,2 months [IQ,2,9–8,8] p (log-rank) = 0,01. There was not statistically significant difference in term of OS between this two groups. In multivariate analysis, factors associated with superior PFS were previous ICI treatment (ICI+) and performance status. Conclusions: This study confirms an acceptable toxicity profile associated with interesting efficacy of the combination paclitaxel-bevacizumab as second-line treatment or beyond for non–squamous NSCLC patients, particularly after progression with ICI.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Marie Darasson
- URCOT, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Michaël Duruisseaux
- URCOT, Hôpital Louis Pradel, Hospices Civils de Lyon Cancer Institute, Lyon, France
| | - Lucie Ulmer
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
| | | | | | | | | | - Paul Bore
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | | | | | | | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Claire Tissot
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | - Alexis Cortot
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
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Forest F, Laville D, Habougit C, Corbasson M, Bayle-Bleuez S, Tissot C, Fournel P, Tiffet O, Péoc'h M. Histopathological typing in diffuse malignant epithelioid mesothelioma: implication for prognosis and molecular basis. Pathology 2021; 53:728-734. [PMID: 33965253 DOI: 10.1016/j.pathol.2021.01.010] [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: 09/18/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
The prognostic impact of tumour grading, cytological and architectural patterns and stromal features in diffuse pleural malignant epithelioid mesothelioma (MEM) has been partly studied but not correlated to molecular features. We performed a retrospective study on 92 MEM in our department in order to assess the prognostic role of architectural and stromal patterns, especially tumour to stroma ratio. Secondly, based on The Cancer Genome Atlas (TCGA) database, we analysed the differentially expressed genes in prognostic groups of interest. Our results showed that tumour grading, tumour to stroma ratio and predominant pattern were related to overall survival, p≤0.001, p=0.01 and p=0.001, respectively. In univariate analysis, for high grade tumours hazard ratio (HR) was 4.75 (2.47-9.16), for stroma poor tumours HR=0.016, for predominant tubular or tubulopapillary pattern HR=0.044. In multivariate analysis, high grade tumours were related to overall survival [HR=3.09 (1.50-6.35), p=0.002] and predominant tubular or tubulopapillary pattern [HR=0.56 (0.32-0.99), p=0.045]. In TCGA analysis, after grading of diagnostic slides, we showed that KRTDAP and CXRCR1 expression was higher in low grade tumours, unlike PDZD7 and GPR176 expression which was higher in high grade tumours. FAM81B had a higher expression in stroma poor tumours. We did not find any differentially expressed genes in the architectural patterns group. Our work suggests that tumour grading is an important parameter in MEM with an underlying genomic basis. The role of tumour to stroma ratio needs to be investigated and might also have a genomic basis.
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Affiliation(s)
- Fabien Forest
- University Hospital of Saint Etienne, North Hospital, Department of Pathology, Saint Etienne, France; University Hospital of Saint Etienne, North Hospital, Plateforme de Biologie Moléculaire des Tumeurs Solides, Saint Etienne, France; Corneal Graft Biology, Engineering, and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - David Laville
- University Hospital of Saint Etienne, North Hospital, Department of Pathology, Saint Etienne, France
| | - Cyril Habougit
- University Hospital of Saint Etienne, North Hospital, Department of Pathology, Saint Etienne, France
| | - Margot Corbasson
- University Hospital of Saint Etienne, North Hospital, Department of Pathology, Saint Etienne, France
| | - Sophie Bayle-Bleuez
- University Hospital of Saint Etienne, North Hospital, Department of Pneumology, Saint Etienne, France
| | - Claire Tissot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, North Hospital, Saint Etienne, France
| | - Pierre Fournel
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, North Hospital, Saint Etienne, France
| | - Olivier Tiffet
- University Hospital of Saint Etienne, North Hospital, Department of Thoracic Surgery, Saint Etienne, France
| | - Michel Péoc'h
- University Hospital of Saint Etienne, North Hospital, Department of Pathology, Saint Etienne, France; Corneal Graft Biology, Engineering, and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
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Desage AL, Bouleftour W, Rivoirard R, Magne N, Collard O, Fournel P, Tissot C. Vaccination and Immune Checkpoint Inhibitors: Does Vaccination Increase the Risk of Immune-related Adverse Events? A Systematic Review of Literature. Am J Clin Oncol 2021; 44:109-113. [PMID: 33350679 DOI: 10.1097/coc.0000000000000788] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have become part of cancer treatments. Their main side effects are immune-related adverse events (irAEs). So far, there has been no recommendation regarding routine vaccinations during ICIs treatment. Clinicians are aware of the risk of irAEs increases in this specific situation. The aim of this review of literature is to summarize the main studies about vaccination and ICIs interactions. METHODS A systematic assessment of literature articles was performed by searching in PubMed (MEDLINE), and major oncology meeting following PRISMA guidelines. RESULTS This review highlights the lack of literature. Indeed, most of the studies published were about influenza vaccination. Vaccination for patients under ICIs causes a humoral response and seems to be associated with an increase rate of seroconversion. Interestingly vaccination may provoke irAEs in ICIs-treated patients. So far, inactivated vaccines have not been contraindicated during ICI treatment. CONCLUSION Larger prospective studies are needed in order to define a consensus on the use of vaccines under immunotherapy.
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Affiliation(s)
| | | | | | - Nicolas Magne
- Radiotherapy Department, Lucien Neuwirth Cancerology Institute, Saint Priest en Jarez, France
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20
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Gomes F, Faivre-Finn C, Mistry H, Bezjak A, Pourel N, Fournel P, Van Meerbeeck J, Blackhall F. Safety of G-CSF with concurrent chemo-radiotherapy in limited-stage small cell lung cancer - Secondary analysis of the randomised phase 3 CONVERT trial. Lung Cancer 2021; 153:165-170. [PMID: 33545577 DOI: 10.1016/j.lungcan.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The use of granulocyte colony-stimulating factors (G-CSF) during concurrent chemo-radiotherapy (cCTRT) for small cell lung cancer is not recommended by the American Society of Clinical Oncology due to safety concerns. This secondary analysis explored the safety and the role of prophylactic G-CSF (proG-CSF) in the delivery of cCTRT. MATERIAL AND METHODS Secondary analysis of 487 patients treated as per protocol on the phase 3 CONVERT trial which randomized patients between once-daily RT or twice-daily. RESULTS 180 of 487 eligible patients (37 %) received proG-CSF, 60 (33 %) as primary prophylaxis and 120 (67 %) as secondary prophylaxis following myelotoxic events. The regimen incidence of febrile neutropenia (FN) was 22 %. Its incidence in the proG-CSF group reduced significantly when proG-CSF was administered (22 % vs 10 %; OR 0.4; 95 %CI 0.2-0.7; p = 0.002). The rate of blood transfusion was higher in the proG-CSF group (51 % vs 31 %; OR 2.4; 95 %CI 1.6-3.5; p < 0.001). The incidence of severe thrombocytopenia was also higher is this group (28 % vs 15 %; OR 2.2; 95 %CI 1.4-3.5; p = 0.001). But this was significantly higher in those on secondary vs primary prophylaxis (34 % vs 15 %; OR 2.9; 95 %CI 1.3-7.4 p = 0.009) No differences observed in RT-related toxicity, treatment-related mortality or any survival outcomes. The optimal dose intensity (85 % or higher) of cisplatin was achieved in more patients within the proG-CSF group (75 % vs 67 %; OR 1.5; 95 %CI 0.9-2.3; p = 0.056). CONCLUSION There was no evidence that G-CSF directly caused myelotoxicity, instead most patients started G-CSF due to higher myelotoxicity risk. G-CSF maintained the planned dose intensity and there was no detrimental effect on survival. G-CSF may be considered as a supportive measure in this setting.
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Affiliation(s)
- Fabio Gomes
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK; Department of Radiotherapy-related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Hitesh Mistry
- Division of Cancer Sciences/Pharmacy, University of Manchester, Manchester, UK
| | - Andrea Bezjak
- Canadian Cancer Trials Group, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | | | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancerologie de la Loire, St. Priest En Jarez, France
| | - Jan Van Meerbeeck
- ERN/Lung, Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Bouleftour W, Muron T, Guillot A, Tinquaut F, Rivoirard R, Jacquin JP, Saban-Roche L, Boussoualim K, Tavernier E, Augeul-Meunier K, Collard O, Mery B, Pupier S, Oriol M, Bourmaud A, Fournel P, Vassal C. Effectiveness of a nurse-led telephone follow-up in the therapeutic management of patients receiving oral antineoplastic agents: a randomized, multicenter controlled trial (ETICCO study). Support Care Cancer 2021; 29:4257-4267. [DOI: 10.1007/s00520-020-05955-3] [Citation(s) in RCA: 3] [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: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022]
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22
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Bernichon E, Tissot C, Bayle-Bleuez S, Rivoirard R, Bouleftour W, Forest F, Tinquaut F, Mery B, Fournel P. Predictive resistance factors in lung cancer patients treated with Nivolumab. Retrospective study. Bull Cancer 2020; 108:250-265. [PMID: 33358747 DOI: 10.1016/j.bulcan.2020.10.010] [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] [Received: 06/23/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Immunotherapy is the current treatment in non-small cell lung cancer (NSCLC). 20% of patients treated with immunotherapy have a prolonged response. What about the remaining 80%? How can we explain that some patients get no benefit from immunotherapy? MATERIEL AND METHODS We retrospectively analyzed predictive factors of primary or secondary resistance to immunotherapy in NSCLC patients from 2 French hospitals between 2015 and 2018. Moreover, we evaluated whether PD1 inhibitor had an impact on the antitumor effects of salvage chemotherapy administered after immunotherapy. We chose to focus on taxanes. RESULTS Ninety-six patients were included in this cohort, 65(68%) patients were considered as having primary resistance and 31(32%) secondary resistance. Resistant populations did not differ. At immunotherapy initiation, median survival was 4.6 months for primary resistant patients (95%CI-4.6-6.8) and 15.6 months (95%CI-9.8-NA) for secondary resistant patients. The disease control rates with taxane were 15% in pre immunotherapy conditions vs 50% in post immunotherapy. Response rates improved regardless of the status of resistance. CONCLUSION This study enriches data about immunotherapy in real-life in NSCLC. Prognostic resistance factors still seem complicated to identify. The high rate of taxane responders in post immunotherapy in this retrospective cohort support the use of taxane in therapeutic escape.
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Affiliation(s)
- Emilie Bernichon
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Claire Tissot
- CHU de Saint-Étienne, Pneumology department, Saint-Étienne, France
| | | | - Romain Rivoirard
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Wafa Bouleftour
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - Fabien Forest
- CHU de Saint-Étienne, Anatomo-pathology department, Saint-Étienne, France
| | - Fabien Tinquaut
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Benoite Mery
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
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Da Cruz V, Yvorel V, Casteillo F, Tissot C, Luchez A, Bayle-Bleuez S, Fournel P, Tiffet O, Péoc'h M, Forest F. Histopathological subtyping is a prognostic factor in stage IV lung adenocarcinoma. Lung Cancer 2020; 147:77-82. [PMID: 32682188 DOI: 10.1016/j.lungcan.2020.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
Lung adenocarcinoma is a heterogeneous tumor made of different architectural patterns. These tumors are classified into subtypes according to the predominant pattern in the primary tumor because the predominant pattern is related to overall survival. The prognostic role of these subtypes in stage IV disease is not well known, and most lung adenocarcinomas are diagnosed at the stage of metastatic disease. We aimed to evaluate the prognostic role of histopathological subtypes in lung adenocarcinoma metastases in a retrospective study of 253 patients with clinical, histopathological and molecular data. The presence of the solid subtype was related to overall survival (p = 0.045); the median overall survival was 6.8 months (95 % confidence interval (95 %CI) 4.4-9.1) when present and 11.1 months (95 %CI 8.6-21.3) when absent. Thyroid transcription factor 1 (TTF-1) immunohistochemistry was related to overall survival (p < 0.001); the median overall survival was 11.2 months (95 %CI 8.4-17.7) when positive and 4 months (95 %CI 2.3-5.7) when negative. On multivariate analysis, the presence of the solid subtype (p = 0.0036, hazard ratio (HR) 1.55, 95 %CI 1.03-2.34), TTF-1 positivity (p = 0.044, HR 0.64, 95 %CI 0.42-0.98), age <60 years at the time of resection (p = 0.017, HR 1.89; 95 %CI 1.12-3.21), performance status <2 (p = 0.017, HR 0.57; 95 %CI 0.36-0.91), treatment by chemotherapy (p = 0.033, HR 0.54, 95 %CI 0.31-0.95), and treatment by tyrosine kinase inhibitor or immunotherapy (p = 0.013, HR 0.36, 95 %CI 0.17-0.81) were related to overall survival. The evaluation of architectural pattern in metastases in stage IV patients provides further information for physicians about patient prognosis. This information might be included in clinical trials in patients with stage IV lung adenocarcinoma.
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Affiliation(s)
- Vanessa Da Cruz
- Department of Pathology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Violaine Yvorel
- Department of Pathology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - François Casteillo
- Department of Pathology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Claire Tissot
- Department of Pneumology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Antoine Luchez
- Department of Pneumology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Sophie Bayle-Bleuez
- Department of Pneumology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Pierre Fournel
- Department of Medical Oncology Lucien Neuwirth Cancer Institute 42270 Saint Priest-En-Jarez, France
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Michel Péoc'h
- Department of Pathology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Etienne, North Hospital, Avenue Albert Raimond, 42055 Saint Etienne CEDEX 2, France; Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, EA2521, France.
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24
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Arpin D, Charpentier MC, Bernardi M, Monnet I, Boni A, Watkin E, Goubin-Versini I, Lamy R, Gérinière L, Geier M, Forest F, Gervais R, Madrosyk A, Guisier F, Serrand C, Locher C, Decroisette C, Fournel P, Auliac JB, Jeanfaivre T, Letreut J, Doubre H, Francois G, Piton N, Chouaïd C, Damotte D. PD-L1-expression patterns in large-cell neuroendocrine carcinoma of the lung: potential implications for use of immunotherapy in these patients: the GFPC 03-2017 "EPNEC" study. Ther Adv Med Oncol 2020; 12:1758835920937972. [PMID: 32684990 PMCID: PMC7343361 DOI: 10.1177/1758835920937972] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/05/2020] [Indexed: 01/11/2023] Open
Abstract
Background Few data are available on programmed cell-death-protein-1-ligand-1 (PD-L1) expression on large-cell neuroendocrine carcinomas of the lung (LCNECs). We analyzed PD-L1 expression on tumor (TCs) and inflammatory cells (ICs) from LCNEC patients to assess relationships between this expression, clinical characteristics, and disease outcomes. Methods PD-L1 expression was determined by immunohistochemistry with monoclonal antibody 22C3 in consecutive LCNEC patients managed in 17 French centers between January 2014 and December 2016. Results After centralized review, only 68 out of 105 (64%) patients had confirmed LCNEC diagnoses. Median overall survival (OS) (95% CI) was 11 (7-16) months for all patients, 7 (5-10), 21 (10-not reached) and not reached months for metastatic, stage III and localized forms (p = 0.0001). Respectively, 11% and 75% of the tumor samples were TC+ and IC+, and 66% had a TC-/IC+ profile. Comparing IC+ versus IC- metastatic LCNEC, the former had significantly longer progression-free survival [9 (4-13) versus 4 (1-8) months; p = 0.03], with a trend towards better median OS [12 (7-18) versus 9.5 (4-14) months; p = 0.21]. Compared to patients with TC- tumors, those with TC+ LCNECs tended to have non-significantly shorter median OS [4 (1-6.2) versus 11 (8-18) months, respectively]. Median OS was significantly shorter for patients with TC+/IC- metastatic LCNECs than those with TC-IC+ lesions (2 versus 8 months, respectively; p = 0.04). Conclusion TC-/IC+ was the most frequent PD-L1-expression profile for LCNECs, a pattern quite specific compared with non-small-cell lung cancer and small-cell lung cancer. IC PD-L1 expression seems to have a prognostic role.
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Affiliation(s)
- Dominique Arpin
- Department of Pneumology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | | | - Marie Bernardi
- Department of Pneumology, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Emmanuel Watkin
- Departement of pathology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | | | - Régine Lamy
- Department of Pneumology, Centre Hospitalier Bretagne-Sud, Lorient, France
| | - Laurence Gérinière
- Department of Pneumology, Centre Hospitalier Lyon-Sud, HCL, Lyon, France
| | - Margaux Geier
- Department of Medical Oncology, CHU Morvan, Brest, France
| | - Fabien Forest
- Department of Pathology, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Radj Gervais
- Department of Medical Oncology, Centre Francois-Baclesse, Caen, France
| | - Anne Madrosyk
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Florian Guisier
- Department of Pneumology, CHU Charles-Nicolle, Rouen, France
| | - Cécile Serrand
- Department of Pneumology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Chrystèle Locher
- Department of Pneumology, Grand Hôpital de L'Est Francilien, site de Meaux, Meaux, France
| | | | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancérologie Lucien-Neuwirth, Saint-Etienne, France
| | - Jean-Bernard Auliac
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Jacques Letreut
- Department of Pneumology, Hopital Européen, Marseille, France
| | - Hélène Doubre
- Department of Pneumology, Hôpital Foch, Surennes, France
| | | | - Nicolas Piton
- Department of Pathology, CHU Charles-Nicolle, Rouen, France
| | - Christos Chouaïd
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, Créteil, 94010, France
| | - Diane Damotte
- Department of Pathology, Cochin Hospital APHP, Paris, France
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25
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Girard N, Petat A, Dansin E, Fabien C, Greillier L, Pichon E, Kerjouan M, Clément Duchene C, Mennecier B, Westeel V, Thillays F, Quantin X, Ginoux M, Oulkhouir Y, Thiberville L, Ricordel C, Molina T, Fournel P, Bigay-Game L, Besse B. Treatment strategies for thymic carcinoma in a real-life setting: Insights from the rythmic network. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9072] [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
9072 Background: Thymic carcinomas are an aggressive and difficult to treat subset of thymic epithelial tumors (TETs) that represent a heterogeneous group of rare intrathoracic malignancies. Most of the current knowledge and guidelines tumors rely on surgically-oriented databases focusing on early-stage disease, and small prospective, single-arm trials conducted in metastatic thymic carcinomas, mostly in a refractory, late-line setting. “Réseau tumeurs THYMiques et Cancer” (RYTHMIC) is the nationwide network for TETs in France. The management of any patient has to be systematically discussed on a real-time basis at a national multidisciplinary tumor board; a database is hosted by the French Thoracic Cancer Intergroup (IFCT). Methods: We took advantage of the RYTHMIC prospective database to describe baseline characteristics, analyze treatment strategies, and provide landmark outcomes in a cohort of consecutive patients with thymic carcinoma. The inclusion period was January 2012 to April 2017. Results: A total of 213 patients were analyzed. Overall, 60 (28%) patients were considered as surgical candidates upfront, 91 (43%) received primary chemotherapy, and 62 (29%) received exclusive chemotherapy. Median OS was 49.2 months (IC95%: 34.8-63.6); OS was significantly longer in patients with a lower stage at diagnosis (p < 0.001), who were operated on upfront, as opposed to patients who received primary or exclusive chemotherapy (p < 0.001). Surgery, conducted upfront or after primary chemotherapy, was significantly associated with more prolonged OS (p < 0.001); complete resection and postoperative radiotherapy were also predictors of better outcome (p = 0.018 and p = 0.081, respectively). Exclusive chemotherapy was delivered to 62 patients with advanced disease, who all received platinum-based regimen as first-line treatment; PAC regimen was delivered to 66% of patients. Best objective response to first-line chemotherapy was partial response in 33 (53%) patients. Median PFS was 8.0 months (IC95%: 5.0-11.1). Median OS was 32.9 months (IC95%: 20.6-45.1). Response to first-line chemotherapy and squamous histology were the only significant predictors of OS (p = 0.002 and p = 0.040, respectively). Conclusions: Our cohort is the first to analyze in depth outcomes and treatment strategies in a prospective cohort of consecutive patients with thymic carcinoma. While we confirm the major prognostic impact of surgery, our data highlight the need for optimized multidisciplinary management and innovative therapies as the survival of patients remains limited.
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Affiliation(s)
- Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, Paris, France
| | | | | | | | - Laurent Greillier
- Assistance Publique–Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Eric Pichon
- Centre Hospitalier Universitaire Tours, Tours, France
| | | | | | | | | | | | - Xavier Quantin
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | | | | | | | | | | | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
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26
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Gobbini E, Toffart AC, Pérol M, Assié JB, Duruisseaux M, Coupez D, Dubos C, Westeel V, Delaunay M, Guisier F, Veillon R, Gounant V, Giroux Leprieur E, Vanel FR, Chaabane N, Dansin E, Babey H, Decroisette C, Barlesi F, Daniel C, Fournel P, Mezquita L, Oulkhouir Y, Canellas A, Duchemann B, Molinier O, Alcazer V, Moro-Sibilot D, Levra MG. Immune Checkpoint Inhibitors Rechallenge Efficacy in Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2020; 21:e497-e510. [PMID: 32605892 DOI: 10.1016/j.cllc.2020.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/30/2020] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICPi) rechallenge could represent an attractive option in non-small-cell lung cancer (NSCLC), yet no sufficient data supporting this strategy are available. This retrospective observational multicenter national study explored the efficacy of anti-programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) rechallenge in advanced NSCLC patients, looking for potential clinical features associated with greater outcomes. PATIENTS AND METHODS We retrospectively collected data from 144 advanced NSCLC patients whose disease was rechallenged with ICPis after ≥ 12 weeks of discontinuation. The progression-free survival (PFS) and overall survival (OS) were calculated from first or second ICPi initiation to disease progression (PFS1 and PFSR, respectively), death, or last follow-up (OS1, OSR), respectively. RESULTS The median (interquartile range) age was 63 (58-70) years. Most patients were male (67%) and smokers (87%). Most had adenocarcinomas (62%) and/or stage IV disease at diagnosis (66%). The best response at rechallenge was not associated with that under the first ICPi (P = 1.10-1). The median (95% confidence interval) PFS1 and PFSR were 13 (10-16.5) and 4.4 (3-6.5) months, respectively. The median (95% confidence interval) OS1 and OSR were 3.3 (2.9-3.9) and 1.5 (1.0-2.1) years, respectively. Longer PFSR and OSR were found in patients discontinuing first ICPi because of toxicity or clinical decision, those not receiving systemic treatment between the two ICPis, and those with good Eastern Cooperative Oncology Group performance status at rechallenge. Only performance status proved to affect outcomes at multivariate analysis. CONCLUSION Patients discontinuing first ICPi because of toxicity or clinical decision, those able to maintain a treatment-free period, and those with good performance status may be potential candidates for rechallenge.
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Affiliation(s)
- Elisa Gobbini
- Thoracic Oncology Unit SHUPP, CHU Grenoble-Alpes, Grenoble, France; Cancer Research Center Lyon, Center Léon Bérard, Lyon, France.
| | | | - Maurice Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Michaël Duruisseaux
- Unité de Recherche Commune en Oncologie Thoracique (URCOT), Hospices Civils de Lyon Cancer Institute, Lyon, France; Anticancer Antibodies Laboratory, Cancer Research Center of Lyon, Inserm 1052, CNRS 5286, Lyon, France; Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Dahna Coupez
- Thoracic Oncology Unit, CHU Nantes, Nantes, France
| | - Catherine Dubos
- Thoracic Oncology Unit, Center François Baclesse, Caen, France
| | | | | | - Florian Guisier
- Pneumology, Thoracic Oncology, and Respiratory Intensive Care Unit, CHU Rouen, Rouen, France
| | - Rémi Veillon
- Respiratory Diseases Department, F-33000, CHU Bordeaux, Bordeaux, France
| | - Valérie Gounant
- Thoracic Oncology Department, CIC 1425 INSERM, Center Bichat, Paris, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Pare, Paris, France
| | | | - Nouha Chaabane
- Pulmonology Service, AP-HP Paris Center University Hospitals, Cochin Hospital, Paris, France
| | - Eric Dansin
- Thoracic Oncology Unit, Center Oscar Lambret, Lille, France
| | - Hélène Babey
- Thoracic Oncology Unit, CHRU Brest, Brest, France
| | | | - Fabrice Barlesi
- Aix-Marseille Université, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Catherine Daniel
- Thoracic Oncology Unit, Institute Curie, Paris/Saint Cloud, France
| | - Pierre Fournel
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint, France
| | - Laura Mezquita
- Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif, France
| | | | - Anthony Canellas
- Pulmonology Unit, APHP Hôpital Tenon and GRC 04 Theranoscan Sorbonne University, Paris, France
| | | | | | - Vincent Alcazer
- Cancer Research Center Lyon, Center Léon Bérard, Lyon, France
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Mezquita L, Swalduz A, Jovelet C, Ortiz-Cuaran S, Howarth K, Planchard D, Avrillon V, Recondo G, Marteau S, Benitez JC, De Kievit F, Plagnol V, Lacroix L, Odier L, Rouleau E, Fournel P, Caramella C, Tissot C, Adam J, Woodhouse S, Nicotra C, Auclin E, Remon J, Morris C, Green E, Massard C, Pérol M, Friboulet L, Besse B, Saintigny P. Clinical Relevance of an Amplicon-Based Liquid Biopsy for Detecting ALK and ROS1 Fusion and Resistance Mutations in Patients With Non-Small-Cell Lung Cancer. JCO Precis Oncol 2020; 4:PO.19.00281. [PMID: 32923908 PMCID: PMC7448797 DOI: 10.1200/po.19.00281] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Liquid biopsy specimen genomic profiling is integrated in non-small-cell lung cancer (NSCLC) guidelines; however, data on the clinical relevance for ALK /ROS1 alterations are scarce. We evaluated the clinical utility of a targeted amplicon-based assay in a large prospective cohort of patients with ALK/ROS1-positive NSCLC and its impact on outcomes. PATIENTS AND METHODS Patients with advanced ALK/ROS1-positive NSCLC were prospectively enrolled in the study by researchers at eight French institutions. Plasma samples were analyzed using InVisionFirst-Lung and correlated with clinical outcomes. RESULTS Of the 128 patients included in the study, 101 were positive for ALK and 27 for ROS1 alterations. Blood samples (N = 405) were collected from 29 patients naïve for treatment with tyrosine kinase inhibitors (TKI) or from 375 patients under treatment, including 105 samples collected at disease progression (PD). Sensitivity was 67% (n = 18 of 27) for ALK/ROS1 fusion detection. Higher detection was observed for ALK fusions at TKI failure (n = 33 of 74; 46%) versus in patients with therapeutic response (n = 12 of 109; 11%). ALK-resistance mutations were detected in 22% patients (n = 16 of 74) overall; 43% of the total ALK-resistance mutations identified occurred after next-generation TKI therapy. ALK G1202R was the most common mutation detected (n = 7 of 16). Heterogeneity of resistance was observed. ROS1 G2032R resistance was detected in 30% (n = 3 of 10). The absence of circulating tumor DNA mutations at TKI failure was associated with prolonged median overall survival (105.7 months). Complex ALK-resistance mutations correlated with poor overall survival (median, 26.9 months v NR for single mutation; P = .003) and progression-free survival to subsequent therapy (median 1.7 v 6.3 months; P = .003). CONCLUSION Next-generation, targeted, amplicon-based sequencing for liquid biopsy specimen profiling provides clinically relevant detection of ALK/ROS1 fusions in TKI-naïve patients and allows for the identification of resistance mutations in patients treated with TKIs. Liquid biopsy specimens from patients treated with TKIs may affect clinical outcomes and capture heterogeneity of TKI resistance, supporting their role in selecting sequential therapy.
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Affiliation(s)
- Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
| | - Cécile Jovelet
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Sandra Ortiz-Cuaran
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
| | | | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | | | - Gonzalo Recondo
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Solène Marteau
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
| | | | | | | | - Ludovic Lacroix
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Luc Odier
- Department of Pneumology, Hôpital Nord-Ouest Villefranche, Villefranche Sur Saône, France
| | - Etienne Rouleau
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | | | - Claire Tissot
- Department of Pneumology, CHU Nord Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Julien Adam
- Pathology Department, Gustave Roussy, Villejuif, France
| | | | - Claudio Nicotra
- Early Drug Development Department, Gustave Roussy, Villejuif, France
| | - Edouard Auclin
- Medical Oncology Department, George Pompidou Hospital, Paris, France
| | | | | | | | - Christophe Massard
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
- Early Drug Development Department, Gustave Roussy, Villejuif, France
| | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
| | - Luc Friboulet
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
- Paris-Sud University, Orsay, France
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
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Drareni K, Dougkas A, Laville M, Souquet P, Fournel P, Nazare JA, Giboreau A, Bensafi M. Influence de la baisse de la fonction olfactive sur le comportement alimentaire de patients sous chimiothérapie à base de Cisplatine. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guisier F, Dubos-Arvis C, Viñas F, Doubre H, Ricordel C, Ropert S, Janicot H, Bernardi M, Fournel P, Lamy R, Pérol M, Dauba J, Gonzales G, Falchero L, Decroisette C, Assouline P, Chouaid C, Bylicki O. Efficacy and Safety of Anti–PD-1 Immunotherapy in Patients With Advanced NSCLC With BRAF, HER2, or MET Mutations or RET Translocation: GFPC 01-2018. J Thorac Oncol 2020; 15:628-636. [DOI: 10.1016/j.jtho.2019.12.129] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/04/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022]
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Perol M, Fournel P, Lamy R, Auliac JB, Chouaid C. Efficacy and safety of programmed cell-death-protein-1 and its ligand inhibitors in pretreated patients with epidermal growth-factor receptor-mutated or anaplastic lymphoma kinase-translocated lung adenocarcinoma. Medicine (Baltimore) 2020; 99:e18726. [PMID: 32011450 PMCID: PMC7220079 DOI: 10.1097/md.0000000000018726] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Immune-checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC) harboring molecular alterations remains poorly elucidated. This study was undertaken to determine ICI efficacy against epidermal growth-factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1)-mutated NSCLC patients in the real-world setting.In this retrospective, multicenter study on adults with ICI-treated EGFR-mutated or ALK- or ROS1-translated NSCLCs, we analyzed clinical characteristics and outcomes: ICI-treatment duration, and progression-free survival (PFS), objective response rate, duration of response, and overall survival (OS) from immunotherapy initiation.Fifty-one NSCLC patients (mean age, 58.0 years) were included from 20 French centers: 61% were never-smokers and 59% were women. Among them, 82% had EGFR-activating mutations, 16% ALK translocations, or 2% ROS1 translocations. Before ICI therapy, patients had received a median of 3 treatment lines (including tyrosine-kinase inhibitor). The median PFS was 2.1 (95% confidence interval [CI], 1.5-3.2) months for the entire cohort, 2.2 (95% CI, 1.4-3.2) for EGFR-mutated patients, and 2.4 (95% CI, 2.1-not reached) months for ALK-translocated patients. The median OS was 14.7 (95% CI, 12.1-19.2) months for the entire population and 13.9 (95% CI, 8.8-20.0) and 19.2 (95% CI, 13.1-not reached) months for EGFR-mutated and ALK-translocated patients, respectively. Seven (13.7%) patients were treated with ICI for >9 months. Toxicities were reported in 22% (11/51), including 8% (4/51) grade ≥3.In this real-world setting, analysis of ICI PFS against EGFR-mutated or ALK-translocated NSCLC patients appeared close to that observed in pretreated unselected NSCLC patients. The more promising OS probably linked to post-ICI treatments. Large prospective studies on these patient subsets are needed.
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Affiliation(s)
- Olivier Bylicki
- Service de Pneumologie, Hôpital d’Instruction des Armées Percy, Clamart
| | - Florian Guisier
- Service de Pneumologie, Centre Hospitalier Universitaire de Rouen, Rouen
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
| | | | - Radj Gervais
- Département d’oncologie, Centre François Baclesse, Caen
| | - Henri Janicot
- Service de Pneumologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - Maurice Perol
- Service d’Oncologie Thoracique, Centre Léon Bérard, Lyon
| | - Pierre Fournel
- Département d’oncologie, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez
| | - Régine Lamy
- Service de Pneumologie, Centre Hospitalier Bretagne Sud-Lorient, Lorient
| | - Jean-Bernard Auliac
- Service de Pneumologie, Centre Hospitalier F. Quesnay, Mantes-la-Jolie, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
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Chanal E, Bouleftour W, Rivoirard R, Bosaki C, Forges F, Jacquin JP, Fournel P, Mery B, Saban-Roche L. [Posterior Reversible Encephalopathy Syndrome (PRES): About 4 cases]. Presse Med 2019; 48:1026-1031. [PMID: 31653541 DOI: 10.1016/j.lpm.2019.08.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Edouard Chanal
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Wafa Bouleftour
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France.
| | - Romain Rivoirard
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Claire Bosaki
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Fabien Forges
- Institut de cancérologie Lucien-Neuwirth, département de pharmacie, 42271 Saint-Priest-en-Jarez, France
| | - Jean-Philippe Jacquin
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Pierre Fournel
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Benoite Mery
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Léa Saban-Roche
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
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Chanal E, Bouleftour W, Guillot A, Rowinski E, Bernichon E, Tremeau L, Lardon R, Lacroix B, Lorin S, Delorme G, Perraud Y, Armand C, Levigne F, Vallard A, Langrand-Escure J, Fournel P, Benoite M, Vassal C. Current management of stage I testicular germ cell tumors in a French cancer institute. A practice analysis over the 10 past years. Bull Cancer 2019; 106:1086-1093. [PMID: 31582176 DOI: 10.1016/j.bulcan.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations. METHODS Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006-2011] and [2012-2016] according to the European Association of Urology Guidelines in 2011. RESULTS Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006-2010 versus 53% between 2011-2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006-2010). Surveillance was used for 64% of NSGCT. CONCLUSIONS In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.
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Affiliation(s)
- Edouard Chanal
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Wafa Bouleftour
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France.
| | - Aline Guillot
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Elise Rowinski
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Emilie Bernichon
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | | | - Renaud Lardon
- Clinique mutualiste chirurgicale de Saint-Étienne, Urology department, Saint-Étienne, France
| | - Bertrand Lacroix
- Clinique mutualiste chirurgicale de Saint-Étienne, Urology department, Saint-Étienne, France
| | - Stephane Lorin
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Gregory Delorme
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Yves Perraud
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Corinne Armand
- Hôpital Privé de la Loire, Urology department, Loire, France
| | | | - Alexis Vallard
- Institut de cancérologie Lucien-Newirth, Department of Radiotherapy, Saint-Priest-en-Jarez, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Newirth, Department of Radiotherapy, Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Mery Benoite
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Cecile Vassal
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
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Gobbini E, Toffart A, Perol M, Assié J, Duruisseaux M, Coupez D, Gervais R, Westeel V, Delaunay M, Guisier F, Veillon R, Gounant V, Leprieur EG, Vanel F, Chaabane N, Dansin E, Babey H, Decroisette C, Barlesi F, Girard N, Fournel P, Mezquita L, Oulkhouir Y, Canellas A, Duchemann B, Molinier O, Moro-Sibilot D, Levra MG. MA07.05 Immune Checkpoint Inhibitor (ICPi) Re-Challenge: Outcomes Analysis in a French National Cohort of Non-Small-Cell Lung Cancer (NSCLC) Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.550] [Citation(s) in RCA: 5] [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] [Indexed: 10/25/2022]
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Swalduz A, Souquet PJ, Pérol M, Moro-Sibilot D, Schiffler C, Chabaud S, Fayet Y, Rogasik M, Labrosse H, Farsi F, Brun P, Decroisette C, Bombaron P, Bringuier PP, Haddad V, Forest F, Peoc’h M, Lantuejoul S, de Fraipont F, Ray-Coquard I, Fournel P. Compliance to regional recommendations for molecular analyses and management of advanced lung cancer patients. Future Oncol 2019; 15:2139-2149. [DOI: 10.2217/fon-2018-0943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We performed a clinical audit of the management of patients with EGFR mutations, 1 year after the introduction of EGFR tyrosine kinase inhibitor ( EGFR-TKI) in first-line treatment. Methods: Compliance was defined by tumor molecular profiling for stage IIIB and IV non-small-cell lung cancer and first-line treatment as recommended by the French guidelines. Results: Among the 169 EGFR-mutated patients, compliance was 76.4%. The most common noncompliance criterion was chemotherapy given in first-line treatment instead of EGFR-TKI. No dedicated multidisciplinary meeting and type of institutions were independent unfavorable predictors for compliance. Compliance to guidelines was significantly correlated with time-to-first subsequent treatment improvement (2.5 vs 9.1 months; p < 0.0001). Conclusion: Implementation of new standards of care is challenging. Our results reinforce the role of multidisciplinary meetings to provide a better access to innovating therapeutics.
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Affiliation(s)
- Aurélie Swalduz
- Department of Chest Diseases & Thoracic Oncology, University Hospital of Saint-Étienne, 42270, Saint Priest en Jarez, France
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Maurice Pérol
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Denis Moro-Sibilot
- Pulmonology & Thoracic Oncology Department, Grenoble University Hospital, 38700, Grenoble, France
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
| | - Camille Schiffler
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Sylvie Chabaud
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Yohan Fayet
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | - Muriel Rogasik
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | | | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, 69008, Lyon, France
| | - Philippe Brun
- Department of Respiratory Medicine, Valence Hospital, 26953, Valence, France
| | - Chantal Decroisette
- Department of Respiratory Medicine, Annecy Genevois Hospital, 74370, Metz-Tessy, France
| | - Pierre Bombaron
- Department of Respiratory Medicine, Mermoz Private Hospital, 69008, Lyon, France
| | - Pierre-Paul Bringuier
- Molecular Diagnostics Laboratory, Edouard-Herriot Hospital, Hospices Civils de Lyon, 69003, Lyon, France
| | - Véronique Haddad
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Michel Peoc’h
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Sylvie Lantuejoul
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Florence de Fraipont
- Institue of Biology & Pathology, Grenoble University Hospital, 38043, Grenoble, France
| | - Isabelle Ray-Coquard
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
- Université Claude Bernard Lyon 1, 69008, Lyon, France
| | - Pierre Fournel
- Department of Medical Oncology, Institut Lucien Neuwirth, 42270, Saint-Priest-en-Jarez, France
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Bouleftour W, Mery B, Chanal E, Rowinski E, Viard A, Forges F, Fournel P, Rivoirard R. Obesity and chemotherapy administration: between empiric and mathematic method review. Acta Oncol 2019; 58:880-887. [PMID: 30907190 DOI: 10.1080/0284186x.2019.1585942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Obesity is a major risk factor for chronic disease and cancer development. Therapeutic management of obese patients with cancer is a real challenge for physician because of the alteration of antineoplastic pharmacokinetics parameters in this population. In routine clinical practices, chemotherapy doses in obese patients are arbitrarily capped or adjusted to an ideal weight to minimize excessive toxicities. Material and methods: The main goal of this review is to describe the current state of knowledge concerning the correlation between the adjustment of BSA (capping or ideal weight) and the rates of global toxicities and survival outcomes in obese patients under chemotherapy in different types of cancer. We searched in the Medline database (via PubMed) in order to identify all publications of literature reviews whose subject chemotherapy dosing in obese population. Results: Only a single study was pointing toward increased of global toxicities of full weight dosing. Furthermore, some studies suggests that the practice of limiting doses in overweight and obese patients may negatively influence the quality of care and outcomes in a constantly increasing population. Conclusion: This review highlights the lack of prospective studies focusing on chemotherapy methods of administration in obese patients. At this time, there is no prospective study comparing capping and full weight dose chemotherapy administration in obese patient population.
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Affiliation(s)
- W. Bouleftour
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - B. Mery
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - E. Chanal
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - E. Rowinski
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - A. Viard
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - F. Forges
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - P. Fournel
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | - R. Rivoirard
- Département d’oncologie médicale, Institut de cancérologie Lucien Newirth, Saint Priest en Jarez, France
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Gras M, Vallard A, Brosse C, Beneton A, Sotton S, Guyotat D, Fournel P, Daguenet E, Magné N, Morisson S. Use of Complementary and Alternative Medicines among Cancer Patients: A Single-Center Study. Oncology 2019; 97:18-25. [DOI: 10.1159/000499629] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
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Mezquita L, Swalduz A, Jovelet C, Ortiz-Cuaran S, Planchard D, Recondo G, Benitez JC, Howarth K, Morris CD, Green E, Lacroix L, Odier L, Rouleau E, Fournel P, Caramella C, Tissot C, Perol M, Friboulet L, Besse B, Saintigny P. Efficacy of tyrosine kinase inhibitors (TKIs) based on the ALK resistance mutations on amplicon-based liquid biopsy in ALK positive non-small cell lung cancer (NSCLC) patients (pts). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3055] [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
3055 Background: Acquired ALK resistance mutations (mut.) are the main mechanism of tyrosine kinase inhibitor (TKI) resistance (30-50%). While next-generation TKIs are more active on mut. than earlier TKIs, compound ALK resistance are associated with failure to next-generation TKIs. We evaluated the clinical utility of detecting ALK resistance mutations in blood to predict TKI efficacy. Methods: ALK positive advanced NSCLC pts were prospectively enrolled between Oct. 2015 and Aug. 2018 in 8 French institutions. Prospective samples were collected; ctDNA was analyzed by amplicon-based Inivata InVisionFirst-Lung. Results: A total of 101 pts with advanced ALK positive NSCLC were enrolled and 328 samples collected. In samples collected at TKI failure (N=74), we detected 9 single and 7 complex (≥2) ALK resistance mut. (22%), associated with EML4-ALK variant 3 (38%) vs. variant 2 (13%) vs. variant 1 (none); 30% had other somatic mut. (mainly TP53 and KRAS, PI3KCA, MET, etc.). No mutations were detected in 48% of samples (ctDNA neg). ALK mut. were more frequent after 2nd/3rd generation TKI (43% post-lorlatinib (7), 29% post-2nd gen. (31), 11% post-crizotinib (36)). ALKG1202R was the most common, as single (n=3) or complex mut. (n=4). The median overall survival (mOS) was 100.4 mo. (95% CI 41.9-158.9) and the median progression free-survival (mPFS) to subsequent line was 2.8 mo. (0.7-4.9). Patients with ctDNA neg had mOS of 105 mo. (39.3-172.1) vs. 58.5 mo. (33.1-84.0) if ≥1 ALK mut. vs. 44.1 mo. (20.0-68.2) if others ( P=0.001). Pts with the complex ALK mut. had worse OS compared to singles ALK mut. (mOS 26.9 mo. vs. 58.5 mo., P=0.001); ALK complex mut. were associated with poor efficacy to subsequent therapy (PFS <3 mo. in 57%; no cases with PFS >6 mo.) vs. single mut., with longer PFS (PFS >6 mo. in 56%). Detectable ALKG1202R mut. were associated with shorter median OS (58.3 mo.; 7.9-109.1) vs. overall population; 86% of cases developed rapid PD (PFS <3mo.) to subsequent therapy with only one durable response to lorlatinib (PFS >6mo.). Conclusions: The absence of ctDNA mutations at TKI failure was associated with prolonged OS, whereas complex ALK mutations at TKI failure may predict resistance to subsequent therapy. Larger and specifically designed studies should be performed to validate these findings.
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Affiliation(s)
- Laura Mezquita
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Cecile Jovelet
- Translational Reseach Laboratory, Gustave Roussy, Villejuif, France
| | - Sandra Ortiz-Cuaran
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
| | - David Planchard
- Medical Oncology Department, Thoracic Group, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | - Claire Tissot
- Acute Respiratory Medicine and Thoracic Oncology Department Lyon Sud Hospital and Lyon University Cancer Institute, International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Pierre Benite, France
| | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | | | - Benjamin Besse
- Paris-Sud University, Orsay and Gustave Roussy, Villejuif, France
| | - Pierre Saintigny
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
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Pelissier C, Kalecinski J, Brochaye S, Tissot C, Vergnon JM, Fournel P, Chauvin F. Implementation of a self-administered questionnaire to detect lung carcinogens. Occup Med (Lond) 2019; 69:266-271. [DOI: 10.1093/occmed/kqz065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Pelissier
- Univ Lyon, Univ Lyon 1, IFSTTAR, UMRESTTE, Lyon, France
| | - J Kalecinski
- Centre HYGÉE, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint Etienne, France
| | - S Brochaye
- Centre HYGÉE, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint Etienne, France
| | - C Tissot
- Service de Pneumologie et d’Oncologie Thoracique, CHU de Saint-Etienne, Saint Etienne, France
| | - J M Vergnon
- Service de Pneumologie et d’Oncologie Thoracique, CHU de Saint-Etienne, Saint Etienne, France
| | - P Fournel
- Département d’Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, France
| | - F Chauvin
- Centre HYGÉE, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint Etienne, France
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Bylicki O, Guisier F, Monnet I, Doubre H, Radj G, Janicot H, Perol M, Fournel P, Le Treut J, Lamy R, Le Caer H, Auliac J, Chouaid C. Efficacité et tolérance des inhibiteurs des immuno-checkpoints (anti-PD-1/PD-L1) chez les patients atteint de CBNPC avec mutation EFGR, ALK/ROS : étude IMAD GFPC 03-2016. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saboundji K, Auliac J, Fraboulet G, Andre M, Madelaine J, Quéré G, Masson P, Vergnenegre A, Lamy R, Raymond S, Chiappa A, Hauss P, Fournel P, Corre R, Chouaid C. Tolérance et efficacité de l’osimertinib chez les patients (pts) octogénaires atteints de cancer du poumon non à petites cellules (CPNPC) porteurs d’une mutation T790M de l’Epidermal Growth Factor Receptor (EGFR) pré-traités par inhibiteurs de tyrosine-kinase (ITK) de l’EGFR. Étude Explore T790M, cohorte octogénaire. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swalduz A, Mezquita L, Ortiz-Cuaran S, Jovelet C, Avrillon V, Planchard D, Marteau S, Recondo G, Martinez S, Howarth K, Plagnol V, Morris C, Green E, Odier L, Lacroix L, Hominal S, Rouleau E, Tissot C, Caramella C, Fournel P, Friboulet L, Pérol M, Besse B, Saintigny P. MA16.09 Feasibility, Clinical Relevance of ALK/ROS1 Fusion Variant Detection by Liquid Biopsy in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.454] [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: 10/28/2022]
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Pérol M, Fournel P, Le Treut J, Lamy R, Vieillot S, Le Caer H, Auliac J, Chouaid C. P1.04-31 Efficacy and Tolerance of Immune-Checkpoint Inhibitors in EGFR, ALK/ROS 1 Non-Small-Cell-Lung-Cancer (NSCLC): GFPC 03-2016 IMAD Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Merveilleux du Vignaux C, Dansin E, Mhanna L, Greillier L, Pichon E, Kerjouan M, Clément-Duchêne C, Mennecier B, Westeel V, Robert M, Quantin X, Zalcman G, Thiberville L, Lena H, Molina T, Calcagno F, Fournel P, Mazières J, Besse B, Girard N. Systemic Therapy in Advanced Thymic Epithelial Tumors: Insights from the RYTHMIC Prospective Cohort. J Thorac Oncol 2018; 13:1762-1770. [PMID: 30138763 DOI: 10.1016/j.jtho.2018.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 04/10/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are rare malignancies that may be aggressive and difficult to treat. In the advanced setting, systemic treatments may be delivered as primary therapy before surgery or definitive radiotherapy, as exclusive treatment when no focal treatment is feasible, or in the setting of recurrences. Réseau tumeurs THYMIques et Cancer (RYTHMIC) is the nationwide network for TETs in France. The objective of the study was to describe the modalities and analyze the efficacy of systemic treatments for patients with advanced TETs included in the RYTHMIC prospective database hosted by the French Thoracic Cancer Intergroup. METHODS All consecutive patients for whom systemic treatment was discussed at the RYTHMIC multidisciplinary tumor board from 2012 to 2015 and who received at least one cycle of treatment were included. The main end points were objective response and progression-free survival (PFS). RESULTS A total of 236 patients were included in this analysis. Of those 236 patients, 91 received primary chemotherapy, leading to response rates of 83% for thymomas and 75% for thymic carcinomas and a median PFS of 23.2 months. A strong predictor of longer PFS was histologic type of thymoma (p < 0.001). Exclusive chemotherapy was delivered to 54 patients. The response rates were 31% for thymomas and 37% for thymic carcinomas. The median PFS was 6.2 months, and it was correlated to response rate (p = 0.001). Systemic therapy for a first, second, third, and fourth recurrence was delivered to 114, 81, 51, and 27 patients, respectively. The response rates ranged between 15% and 39% for thymomas and 4% to 21% for thymic carcinomas. The median PFS times were 7.7, 6.2, 5.9, and 6.5 months, respectively. CONCLUSION Patients with advanced thymic malignancies may receive multiple lines of systemic therapy, with an opportunity for clinically relevant PFS rates for which objective response may be a surrogate. Our real-life study provides landmark efficacy data that are needed when designing clinical trials to assess innovative agents.
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Affiliation(s)
- Claire Merveilleux du Vignaux
- Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France; University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Eric Dansin
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Laurent Mhanna
- Respiratory Medicine Department, University Hospital, Toulouse, France
| | - Laurent Greillier
- Respiratory Medicine Department, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Eric Pichon
- Respiratory Medicine Department, University Hospital, Tours, France
| | - Mallorie Kerjouan
- Respiratory Medicine Department, University Hospital, Rennes, France
| | | | - Bertrand Mennecier
- Respiratory Medicine Department, University Hospital, Strasbourg, France
| | - Virginie Westeel
- Respiratory Medicine Department, University Hospital, Besançon, France
| | - Marie Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Xavier Quantin
- Respiratory Medicine Department, University Hospital, Montpellier, France
| | - Gérard Zalcman
- Respiratory Medicine Department, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Thiberville
- Respiratory Medicine Department, University Hospital, Rouen, France
| | - Hervé Lena
- Respiratory Medicine Department, University Hospital, Rennes, France
| | - Thierry Molina
- Pathology Department, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fabien Calcagno
- Respiratory Medicine Department, University Hospital, Besançon, France
| | - Pierre Fournel
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Etienne, France
| | - Julien Mazières
- Respiratory Medicine Department, University Hospital, Toulouse, France
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Nicolas Girard
- University of Lyon, University Claude Bernard Lyon 1, Lyon, France; Thorax Institute Curie-Montsouris, Curie Institute, Paris, France.
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Ortiz-Cuaran S, Swalduz A, Léonce C, Marteau S, Martinez S, Clapisson G, Avrillon V, Odier L, Falchero L, Fournel P, Green E, Morris C, Pérol M, Saintingy P. Abstract 937: Longitudinal circulating-tumor DNA profiling of EGFR-mutated non-small cell lung cancer patients treated with EGFR-tyrosine kinase inhibitors. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-937] [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: In EGFR-mutant non-small cell lung cancer (NSCLC), progression disease (PD) under 1st-generation EGFR tyrosine kinase inhibitors (EGFR-TKIs) is driven by the EGFR T790M mutation in about 50% of cases. This mutation is targeted with osimertinib, a specific and potent inhibitor that also showed superior efficacy to that of 1st-generation EGFR-TKIs in the 1st-line treatment EGFR+ NSCLC.
Strategy: We performed a longitudinal circulating-tumor DNA (ctDNA) analysis to evaluate 1) the dynamics of sensitizing or resistant mutations over time and 2) the genomic alterations associated with EGFR-TKI resistance, in NSCLC patients treated with either 1st-generation EGFR-TKIs (n=24) or with osimertinib (n=20). ctDNA sequencing was performed using InVisionSeq™, an amplicon-based NGS (36-gene panel) assay.
Results: Sensitivity was 80% and 100% for the detection of EGFR-activating mutations and the EGFR T790M mutation, respectively, at PD in ctDNA vs tissue biopsies. The type of progression appears to influence the detection of EGFR mutations in plasma. Patients (pts) with exclusively brain or thoracic PD had significantly lower allelic fractions (AFs) of EGFR-activating mutations than pts with systemic PD (P=0.006). AFs of both EGFR-activating and EGFR T790M mutations were highest in patients with progressive metastases in liver or bone. High cell-free DNA load was associated with the presence of TP53 mutations regardless of the time under treatment (n=248 samples). The total number of mutations detected in ctDNA was higher in pts treated with osimertinib vs. 1st-generation EGFR-TKIs (P=0.004), suggesting a potential increase of tumor heterogeneity over time. We observed that the AFs of mutant ctDNA were correlated with response to treatment. Complete clearance of EGFR T790M (AF detection limit: 0.01%) was observed in pts who presented a partial response to osimertinib (n=17), of these, EGFR-activating mutations were found in 4/17 pts (AF:0.05-1.03%). PD was evidenced in 36/44 pts. Emergence of mechanisms of resistance, before the confirmation of clinical PD, was evidenced in 5 and 3 pts under erlotinib and osimertinib, respectively. PD to 1st-generation EGFR-TKIs was mainly driven by EGFR T790M (86%), followed by mutations in PIK3CA or PTEN. We detected the emergence of heterogeneous potential mechanisms of resistance to osimertinib in 3/9 cases, including mutations in EGFR, KRAS, BRAF as well as HER2 and MET amplification. We did not identify genomic drivers of resistance in 16/36 pts, despite evidence of clinical PD. These pts had either exclusive brain or thoracic progression. ctDNA WES will be performed in these samples.
Conclusion: Our results suggest that ctDNA sequencing might be a complementary, noninvasive tool to monitor response to treatment and heterogeneous mechanisms of resistance in NSCLC pts treated with EGFR inhibitors.
Citation Format: Sandra Ortiz-Cuaran, Aurélie Swalduz, Camille Léonce, Solène Marteau, Séverine Martinez, Gilles Clapisson, Virginie Avrillon, Luc Odier, Lionel Falchero, Pierre Fournel, Emma Green, Clive Morris, Maurice Pérol, Pierre Saintingy. Longitudinal circulating-tumor DNA profiling of EGFR-mutated non-small cell lung cancer patients treated with EGFR-tyrosine kinase inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 937.
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Affiliation(s)
| | | | - Camille Léonce
- 1Centre Léon Bérard / Cancer Research Center of Lyon, Lyon, France
| | - Solène Marteau
- 1Centre Léon Bérard / Cancer Research Center of Lyon, Lyon, France
| | | | | | | | - Luc Odier
- 3Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | | | - Pierre Fournel
- 4Institut de Cancérologie Lucien Neuwirth, Saint-Étienne, France
| | - Emma Green
- 5Inivata Ltd., Cambridge, United Kingdom
| | | | | | - Pierre Saintingy
- 1Centre Léon Bérard / Cancer Research Center of Lyon, Lyon, France
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Perol M, Fournel P, Le Treut JH, Lamy R, Le Caer H, Falchero L, Vieillot S, Descourt R, Decroisette C, Urban T, Locher C, Marcq M, Auliac JB, Chouaid C. Efficacy and tolerance of immune-checkpoint inhibitors in EGR, ALK/ROS 1 non-small-cell-lung-cancer (NSCLC): GFPC 03-2016 IMAD study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | - Régine Lamy
- Centre Hospitalier Bretagne Sud-Lorient, Lorient, France
| | - Hervé Le Caer
- Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | | | | | | | | | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
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Decousus H, Bertoletti L, Fournel P, Bourmaud A, Labruyère C, Presles E, Merah A, Laporte S, Stefani L, Landry G, Chauvin F, Meyer G. In patients with cancer, prognostic factors of catheter-related thrombosis (CRT) are different than prognostic factors of VTE. A prospective cohort study in 3032 cancer patients with central venous catheter (ONCOCIP). Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garcia MA, Kalecinski J, Oriol M, Bonne A, Lofti M, Espenel S, Tinquaut F, Fournel P, Collard O, Vassal C, Rivoirard R, Regnier V, Chauvin F, Bourmaud A. Cancer patients treated with intravenous chemotherapy for the first time. What are their needs? What do they lack? A qualitative-quantitative mixed approach. Patient Prefer Adherence 2018; 12:1853-1861. [PMID: 30288026 PMCID: PMC6159784 DOI: 10.2147/ppa.s169810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The announcement of cancer coupled with initiation of its treatment impacts patients' psychological and physical states as well as their lifestyles. The objective of this study was to identify and confirm the needs of patients starting off on anticancer chemotherapy treatment. METHODS This study was based on a qualitative-quantitative mixed method. In 2009, a qualitative study was conducted at the Lucien Neuwirth Cancer Institut for cancer patients undergoing intravenous chemotherapy for the first time. Exploratory and semi-directed interviews were carried out by a sociologist. In 2014, a questionnaire was hetero-administered to 100 patients starting off on chemotherapy. RESULTS Forty patients were interviewed in 2009. Ninety-seven patients answered the questionnaire in 2014. Food was a theme that was identified by a majority of patients in 2009 (13/40) and confirmed in 2014: 63% needed help in identifying favorable food and 67% in identifying those that had to be avoided. The other needs identified were those linked to better understanding of the treatment, of how it may affect the couple, its side effects, hygiene and beauty, and knowledge about other treatments. These needs were confirmed in 2014. New needs were elicited in 2014: activities and leisure (33%), psychological needs (32.6%), and family relations (29.9%). CONCLUSION This study enabled us to identify, confirm, and enrich our knowledge of the needs of cancer patients starting off on intravenous chemotherapy. These results led to the modification of an existing patient education program for these patients, in order to fulfill their needs in an updated and tailored manner.
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Affiliation(s)
- Max-Adrien Garcia
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Julie Kalecinski
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Mathieu Oriol
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Jean Monnet University, Saint Etienne, France
| | - Armand Bonne
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Mohamed Lofti
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Sophie Espenel
- Radiotherapy Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Fabien Tinquaut
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Pierre Fournel
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Olivier Collard
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Cécile Vassal
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Romain Rivoirard
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Véronique Regnier
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
| | - Franck Chauvin
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Jean Monnet University, Saint Etienne, France
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
| | - Aurélie Bourmaud
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
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Paleiron N, Gervais R, Rousseau Bussac G, Bigay-Game L, Chiappa A, Lamy R, Guisier F, Le Caer H, Robinet G, Fournel P, Chouaid C. Étude Synchron GFPC 15.04 : épidémiologie et prise en charge des patients présentant un cancer des voies aérodigestives supérieures et un cancer bronchique synchrone découvert lors du bilan d’extension initial. Une cohorte de 132 patients. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.035] [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]
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Tardy-Poncet B, Fournel P, Venet C, Jospe R, Dacosta A, Tardy B. Lower Limb Veins Should be Systematically Explored in Patients with Isolated Heparin-induced Thrombocytopenia. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Karpathiou G, Casteillo F, Giroult JB, Forest F, Fournel P, Monaya A, Froudarakis M, Dumollard JM, Prades JM, Peoc'h M. Prognostic impact of immune microenvironment in laryngeal and pharyngeal squamous cell carcinoma: Immune cell subtypes, immuno-suppressive pathways and clinicopathologic characteristics. Oncotarget 2017; 8:19310-19322. [PMID: 28038471 PMCID: PMC5386686 DOI: 10.18632/oncotarget.14242] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/02/2016] [Indexed: 01/01/2023] Open
Abstract
Background Immune system affects prognosis of various malignancies. Anti-immune pathways like PD-L1 and CTLA4 are used by the tumor to overcome immune system and they serve as immunotherapy targets. The immune microenvironment of head-and-neck squamous cell carcinoma (SCCHN) has not been sufficiently studied. Patients and Methods 152 SCCHN were immunohistochemically studied for the expression of CD3, CD8, CD57, CD4, granzyme b, CD20, CD163, S100, PD-L1, CTLA4 and CXCR4. Results CD3, CD8, CD57 and stromal S100 higher density is a good prognostic factor (p=0.02, 0.01, 0.02, 0.03 respectively). CTLA4 tumor expression is a poor prognostic factor (p=0.05). The rest immune cells do not affect prognosis. CD3 and CD8 density does not correlate with clinicopathological factors or p16/p53 expression, while CD57 and CD4 higher density is associated with the absence of distant metastases (p=0.03 and 0.07, respectively). Higher CD20 and S100 density is associated with lower T stage (p=0.04 and 0.03, respectively). PD-L1 expression is higher in CD3, CD8, and CD163 infiltrated tumors and in histologically more aggressive tumors. Response to neoadjuvant chemotherapy is better in highly CD3 infiltrated tumors and in tumors with less intraepithelial macrophages. Conclusion Rich T-lympocytic and dendritic cell response is a good prognostic factor in SCCHN, whereas tumors expressing CTLA4 show poor prognosis. PDL1 expression does not affect prognosis, but it is expressed in histologically more aggressive tumors and in T-cells rich tumors. Response to induction chemotherapy is better in tumors less infiltrated by macrophages and mostly infiltrated by T cells.
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Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Francois Casteillo
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Jean-Baptiste Giroult
- Department of Head and Neck Surgery, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Fabien Forest
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | | | - Alessandra Monaya
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Marios Froudarakis
- Department of Pneumonology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Jean Marc Dumollard
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Jean Michel Prades
- Department of Head and Neck Surgery, North Hospital, University Hospital of St-Etienne, St-Etienne, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France
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