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Vendrely V, Ronchin P, Minsat M, Le Malicot K, Lemanski C, Mirabel X, Etienne PL, Lièvre A, Darut-Jouve A, de la Fouchardière C, Giraud N, Breysacher G, Argo-Leignel D, Thimonnier E, Magné N, Abdelghani MB, Lepage C, Aparicio T. Panitumumab in combination with chemoradiotherapy for the treatment of locally-advanced anal canal carcinoma: Results of the FFCD 0904 phase II trial. Radiother Oncol 2023; 186:109742. [PMID: 37315583 DOI: 10.1016/j.radonc.2023.109742] [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: 01/26/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND PURPOSE Standard treatment of squamous cell carcinoma of the anus (SCCA)is 5-fluorouracil (5FU) and mitomycin C (MMC) based chemoradiotherapy (CRT). This phase II study (EudraCT: 2011-005436-26) assessed the tolerance and complete response (CR) rate at 8 weeks of panitumumab (Pmab) combined with MMC-5FU-based CRT. METHODS Patients with locally advanced tumors without metastases (T2 > 3 cm, T3-T4, or N + whatever T stage) were treated with IMRT up to 65 Gy and concomitant CT according to the doses defined by a previous phase I study (MMC: 10 mg/m2; 5FU: 400 mg/m2; Pmab: 3 mg/kg). The expected CR rate was 80%. RESULTS Forty-five patients (male: 9, female: 36; median age: 60.1 [41.5-81]) were enrolled in 15 French centers. The most common related grade 3-4 toxicities observed were digestive (51.1%), hematologic (lymphopenia: 73.4%; neutropenia: 11.1%), radiation dermatitis (13.3%), and asthenia (11.1%) with RT interruption in 14 patients. One patient died because of mesenteric ischemia during the CRT, possibly related to treatment. In ITT analysis, the CR rate at 8 weeks after CRT was 66.7% [90%CI: 53.4-78.2]. Median follow-up was 43.6 months [IC 95%: 38.61-47.01]. Overall survival, recurrence-free and colostomy-free survival at 3 years were 80% [95%CI: 65.1-89], 62.2% [IC95%: 46.5-74.6] and 68.8 % [IC95%: 53.1-80.2] respectively. CONCLUSION Panitumumab in combination with CRT for locally advanced SCCA failed to meet the expected CR rate and exhibited a poor tolerance. Furthermore, late RFS, CFS, and OS did not suggest any outcome improvement to justify further clinical trials. CLINICALTRIALS gov identifier: NCT01581840.
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Affiliation(s)
- Véronique Vendrely
- Radiation Oncology Department, CHU Bordeaux, Bordeaux, France; BRIC (BoRdeaux Institute of OnCology), UMR1312, INSERM, University of Bordeaux, F-33000 Bordeaux, France.
| | | | | | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, University of Burgundy, Biostatistics, Dijon, France, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Xavier Mirabel
- Radiotherapy Department, Centre Oscar Lambret, Lille, France
| | | | - Astrid Lièvre
- Gastroenterology Department, Rennes University Hospital, Rennes 1 University, Inserm U1242 COSS (Chemistry Oncogenesis Stress Signaling), Rennes, France
| | | | | | - Nicolas Giraud
- Radiation Oncology Department, CHU Bordeaux, Bordeaux, France
| | | | | | | | - Nicolas Magné
- Radiotherapy and Oncology Department, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | | | - Côme Lepage
- Department of Hepato-gastroenterology, University Hospital of Dijon, Dijon, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, AP-HP, Paris, France
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Bascoul-Mollevi C, Gourgou S, Borg C, Etienne PL, Rio E, Rullier E, Juzyna B, Castan F, Conroy T. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER PRODIGE 23): Health-related quality of life longitudinal analysis. Eur J Cancer 2023; 186:151-165. [PMID: 37068407 DOI: 10.1016/j.ejca.2023.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Results from the phase 3 PRODIGE 23 study showed that neoadjuvant chemotherapy (NAC) with mFOLFIRINOX and preoperative chemoradiotherapy improved disease-free survival compared with preoperative chemoradiotherapy in patients with locally advanced rectal cancer. We aimed to assess the health-related quality of life (HRQOL) outcomes from this study. PATIENTS AND METHODS A total of 461 patients (231 versus 230 patients) from 35 French hospitals were randomly assigned to either NAC with FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, fluorouracil 2400 mg/m2 over 46 h intravenously every 2 weeks for 6 cycles) followed by preoperative chemoradiotherapy or chemoradiotherapy only. HRQOL was assessed at baseline, during treatments and at 2-year follow-up using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. RESULTS Compared to baseline, HRQOL scores during NAC were better for tumour symptoms but worse for global health status, functional domains, fatigue, nausea/vomiting and appetite loss. During follow-up, improved emotional functioning was observed, but deterioration of body image, increased urinary incontinence, and lower male sexual function were observed. Linear mixed model exhibited a treatment-by-time interaction effect for nausea/vomiting and insomnia symptoms showing a greater deterioration in the standard-of-care group. Only treatment arm and baseline physical functioning were independent significant favourable prognostic factors. CONCLUSION NAC improved tumour-related symptoms and transitorily reduced most functional scores. Adding NAC before chemoradiotherapy and increased physical functioning at baseline were independent significant prognostic factors for longer disease-free survival.
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Affiliation(s)
- Caroline Bascoul-Mollevi
- Biometrics Unit, Institut du Cancer Montpellier, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique, Université de Montpellier, Inserm, Montpellier, France; French National Platform Quality of Life and Cancer, France.
| | - Sophie Gourgou
- Biometrics Unit, Institut du Cancer Montpellier, Montpellier, France; French National Platform Quality of Life and Cancer, France
| | - Christophe Borg
- University Hospital of Besançon, CIC-BT1431, Besançon, France
| | | | - Emmanuel Rio
- Institut de Cancérologie de l'Ouest - Site René Gauducheau, Saint-Herblain, France
| | - Eric Rullier
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | | | - Florence Castan
- Biometrics Unit, Institut du Cancer Montpellier, Montpellier, France; French National Platform Quality of Life and Cancer, France
| | - Thierry Conroy
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France; Université de Lorraine, APEMAC, Equipe MICS, Nancy, France
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Aparicio T, Bouché O, Etienne PL, Barbier E, Mineur L, Desgrippes R, Guérin-Meyer V, Hocine F, Martin J, Le Brun-Ly V, Cretin J, Desramé J, Rinaldi Y, Cany L, Falandry C, Lefevre LB, Marous M, Terrebonne E, Mosser L, Turpin J, Turpin A, Bauguion L, Reichling C, Van den Eynde M, Carola E, Hiret S. Preliminary tolerance analysis of adjuvant chemotherapy in older patients after resection of stage III colon cancer from the PRODIGE 34-FFCD randomized trial. Dig Liver Dis 2022; 55:541-548. [PMID: 36115817 DOI: 10.1016/j.dld.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colon adenocarcinoma mainly occurs in older patients. Oxaliplatin-based adjuvant chemotherapy improved disease-free survival after stage III colon cancer resection, but this improvement was not demonstrated in older patients. METHODS The purpose of ADAGE-PRODIGE 34, randomized open phase III trial is to compare in patients over 70 years oxaliplatin plus fluoropyrimidine with fluoropyrimidine alone in fit patients (Group 1) and fluoropyrimidine with observation in frail patients (Group 2) after resection of stage III colon adenocarcinoma. We report a preliminary tolerance analysis on 50% of the first patients enrolled. RESULTS The analysis was conducted on 491 patients (378 in Group 1 and 113 in Group 2). Patients in Group 2 were older and showed more frailty criteria than those in Group 1. Cumulative grade 3-5 toxicities were more frequent in patients treated with oxaliplatin in Group 1 or with fluoropyrimidine in Group 2 than in patients treated with fluoropyrimidine in Group 1. At least one course was deferred in more than half of the patients in all groups. Early treatment cessation was more frequent in Group 2. CONCLUSION No safety concerns were raised for the continuation of accrual. The frailty criteria distribution suggests that the investigator's evaluation for group allocation was accurate.
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Affiliation(s)
- Thomas Aparicio
- Gastroenterology and Digestive Oncology department, CHU Saint Louis, APHP, Université de Paris Cité, Paris, France.
| | - Olivier Bouché
- Gastroenterology and Digestive Oncology department, Reims, France
| | - Pierre-Luc Etienne
- Centre Armoricain de Radiothérapie, Imagerie, Oncologie, et Hôpital Privé des Côtes d'Armor, Plérin, France
| | - Emilie Barbier
- Biostatistic department, Burgundy University, INSERM U866, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Laurent Mineur
- Oncology department, Clinique Saint Catherine, Avignon, France
| | - Romain Desgrippes
- Hepatogastroenterology and Digestive Oncology department, CH Saint-Malo, Saint-Malo, France
| | | | | | - Jean Martin
- Oncology department, Clinique François Chenieux, Limoges, France
| | | | | | | | - Yves Rinaldi
- Hepato Gastroenterology department, Hôpital Européen de Marseille, Marseille, France
| | - Laurent Cany
- Radiotherapy and Oncology department, Polyclinique Francheville, Perigueux, France
| | - Claire Falandry
- Geriatry department CHU Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Laboratoire CarMeN de l'Université de Lyon, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, UCOGIR- Auvergne-Rhône-Alpes Ouest - Guyane
| | | | | | - Eric Terrebonne
- Gastroenterology department, CHU Haut Lévèque, Pessac, France
| | | | | | | | | | | | - Marc Van den Eynde
- Gastroenterology and Digestive Oncology department, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | | | - Sandrine Hiret
- Medical Oncology department, Institut Cancérologique de l'Ouest, Saint Herblain, France
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Chibaudel B, Dourthe LM, Andre T, Henriques J, Bourgeois V, Etienne PL, Desrame J, Carola E, Dupuis O, Baba-Hamed N, Auby D, Louvet C, Maillard E, Romano O, Tournigand C, Garcia-Larnicol ML, Shmueli ES, Healey Bird B, Ghiringhelli F, De Gramont A. STRATEGIC-1: Multi-line therapy trial in unresectable wild-type KRAS/NRAS/BRAF metastatic colorectal cancer—A GERCOR-PRODIGE randomized open-label phase III study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3504 Background: The management of unresectable metastatic colorectal cancer (mCRC) is a comprehensive treatment strategy involving several lines of therapy, maintenance, salvage surgery, and treatment-free intervals. Besides chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan), anti-angiogenic and anti-epidermal growth factor receptor (EGFR) agents have become available. Ultimately, strategy trials are needed to define the optimal use and the best sequencing of these agents. Methods: Patients with previously untreated RAS/BRAF wild-type unresectable mCRC were randomly assigned (1:1 ratio) to receive either FOLFIRI-cetuximab followed by mFOLFOX6-bevacizumab (arm A) or OPTIMOX-bevacizumab followed by FOLFIRI-bevacizumab followed by EGFR mab +/- irinotecan (arm B). This trial was designed as a superiority study (hypothesis arm B > arm A) with Duration of Disease Control (DDC) as primary endpoint, defined as the sum of PFS of each active sequence of treatment (Chibaudel B, J Clin Oncol, 2011). Secondary endpoints were overall survival (OS), Time to Failure of Strategy (TFS), Progression-free survival (PFS) and response rate (RECIST version 1.1) per sequence, salvage surgery rate, safety, and Quality of life (QoL). Results: Between October 2013 and May 2019, 263 eligible patients were randomized (arm A, n = 131; arm B, N = 132). After a median follow-up of 51.2 months (95% CI 43.3-57.4), 188 events for DDC were observed. Efficacy outcomes are presented in table. Median DDC was similar in both arms (HR 0.97, 95% CI 0.72-1.29; P = 0.805). Salvage surgery for metastasis (+/- radiofrequency ablation) was done in 36 (27.5%) patients in arm A and 28 (21.2%) in arm B. Median time until definitive deterioration of QoL (global health status) were 18.3 and 18.0 months (P = 0.628). The safety profiles were consistent with the established safety profiles of each treatment regimen. Conclusions: STRATEGIC-1 is the first randomized phase III study comparing multi-line standard treatment strategies in patients with KRAS/NRAS/BRAF wild-type mCRC. This study did not meet its primary endpoint of DDC. The treatment strategy starting with FOLFIRI-cetuximab followed by mFOLFOX6-bevacizumab led to higher response rates and to a trend for better median OS exceeding 3 years. These findings may add to our understanding of treatment sequencing in mCRC. Clinical trial information: NCT01910610. [Table: see text]
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Affiliation(s)
- Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Thierry Andre
- Department of Medical Oncology, Hopital Saint-Antoine, APHP, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | | | - Pierre-Luc Etienne
- Medical Oncology Department, Hôpital Privé des Côtes d'Armor, Plerin, France
| | - Jérôme Desrame
- Cancerology Institute, Hôpital Privé Jean Mermoz, Lyon, France
| | - Elisabeth Carola
- Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
| | | | - Nabil Baba-Hamed
- Medical Oncology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Dominique Auby
- Department of Medical Oncology, CH de Mont-de-Marsan, Hospital Layné, Mont-De-Marsan, France
| | - Christophe Louvet
- Medical Oncology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Olivier Romano
- Medical Oncology Department, Lille Metropole Cancer Institute, Villeneuve D'ascq, France
| | | | | | - Einat Shacham Shmueli
- Cancer center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Brian Healey Bird
- Bon Secours Hospital Cork, Cancer Trials Ireland, and University College Cork, Cork, Ireland
| | - François Ghiringhelli
- Medical Oncology Department, Centre Georges-François Leclerc, University of Bourgogne Franche-Comté, Dijon, France
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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Adenis A, Ghiringhelli F, Gauthier L, Mazard T, Evesque L, Etienne PL, Evrard A, Chalbos P, Bleuse JP, Tosi D, Gourgou S, Ychou M. Regorafenib (REGO) plus FOLFIRINOX as frontline treatment in patients (pts) with RAS-mutated metastatic colorectal cancer (mCRC): A phase I/II, dose-escalation and dose-expansion study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3561] [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
3561 Background: Standard treatment options for RAS-mutated mCRC pts include the combination of bevacizumab with FOLFIRINOX, a three-drug chemotherapy regimen. Unlike bevacizumab, REGO – an oral multi-tyrosine kinase agent - exhibits not only antiangiogenic properties with cytostatic effects but also true cytotoxic effects. We report the preliminary results of the FOLFIRINOX-R trial (NCT03828799), in which we evaluated the safety and the efficacy of REGO in combination with FOLFIRINOX in pts with RAS-mutated mCRC. Methods: FOLFIRINOX-R trial is a prospective, dose-finding, phase I/II study whose dose-escalation part has been completed. Dose escalation was implemented following a 3 + 3 design and included three dose levels (DL). FOLFIRINOX regimen includes oxaliplatin (85 mg/m²), folinic acid (400 mg/m²), irinotecan (150–180 mg/m²), 5-fluorouracil (400 mg/m² in bolus then 2400 mg/m² over 46h), and was administered every 14 days. REGO (80 to 160 mg per day, as per DL) was administered on days 4 to 10 of each cycle. Treatment was continued up to 12 cycles or until progression or unacceptable toxicity. The primary objectives of the dose-finding part of the study were to determine the maximum tolerated dose (MTD) using as endpoint the incidence of DLTs during the three first cycles of treatment, and to select the recommended phase 2 dose (RP2D). Key eligibility criteria include ECOG PS ≤1 and RAS-mutated mCRC not amenable to surgery with curative intent and not previously treated for metastatic disease. Patients with the 7/7 variant of the UGT1A1*28 polymorphism were not eligible. Prophylactic G-CSF was administered from Day-7 to Day-12. Results: Thirteen pts were enrolled across the 3 DL (DL 1: 3 pts, DL 2: 6 pts, DL 3: 4 pts); 46% of pts were female, the median age was 65 yo [range: 40 ; 76]. One pt (at DL 3) was not evaluable for DLT because of poor observance during the first 2 cycles. At data cut-off, median treatment duration and median follow-up were 4.6 mo. (range: 2.3; 10) and 13.4 mo. (range: 3.8; 18.0), respectively. One DLT (a grade 3 hypokalaemia related to grade 2 diarrhoea) occurred at DL 2. MTD was not reached at DL 3 (REGO 160 mg/day). The most common grade ≥3 TRAE per patient were grade 3 neutropenia (n = 1), grade 4 neutropenia (n = 1), grade 3 neuropathy (n = 2) and grade 3 diarrhoea (n = 7). Dose reductions/discontinuations due to grade ≥3 TRAE were necessary in 12/13 (92%) pts. The ORR was 62% (95% CI 32%-86%) and median PFS was 9.1 mo (range: 3.1; 15.4). Conclusions: Full-dose FOLFIRINOX plus full-dose REGO (160mg/day, days 4 to 10) can be administered safely. Due to the manageable toxicity profile and the promising efficacy observed in the dose-escalation stage, this regimen deserves to be evaluated in the dose-expansion stage. Clinical trial information: NCT03828799.
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Affiliation(s)
| | | | | | - Thibault Mazard
- Institut régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Patrick Chalbos
- Institut régional du Cancer de Montpellier, Montpellier, France
| | | | - Diego Tosi
- Medical Oncology Departement, Institut du Cancer de Montpellier Inserm U1194, Montpellier University, Montpellier, France
| | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Marc Ychou
- Montpellier Cancer Institute, Montpellier, France
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Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22:702-715. [PMID: 33862000 DOI: 10.1016/s1470-2045(21)00079-6] [Citation(s) in RCA: 423] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of locally advanced rectal cancer with chemoradiotherapy, surgery, and adjuvant chemotherapy controls local disease, but distant metastases remain common. We aimed to assess whether administering neoadjuvant chemotherapy before preoperative chemoradiotherapy could reduce the risk of distant recurrences. METHODS We did a phase 3, open-label, multicentre, randomised trial at 35 hospitals in France. Eligible patients were adults aged 18-75 years and had newly diagnosed, biopsy-proven, rectal adenocarcinoma staged cT3 or cT4 M0, with a WHO performance status of 0-1. Patients were randomly assigned (1:1) to either the neoadjuvant chemotherapy group or standard-of-care group, using an independent web-based system by minimisation method stratified by centre, extramural extension of the tumour into perirectal fat according to MRI, tumour location, and stage. Investigators and participants were not masked to treatment allocation. The neoadjuvant chemotherapy group received neoadjuvant chemotherapy with FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 intravenously every 14 days for 6 cycles), chemoradiotherapy (50 Gy during 5 weeks and 800 mg/m2 concurrent oral capecitabine twice daily for 5 days per week), total mesorectal excision, and adjuvant chemotherapy (3 months of modified FOLFOX6 [intravenous oxaliplatin 85 mg/m2 and leucovorin 400 mg/m2, followed by intravenous 400 mg/m2 fluorouracil bolus and then continuous infusion at a dose of 2400 mg/m2 over 46 h every 14 days for six cycles] or capecitabine [1250 mg/m2 orally twice daily on days 1-14 every 21 days]). The standard-of-care group received chemoradiotherapy, total mesorectal excision, and adjuvant chemotherapy (for 6 months). The primary endpoint was disease-free survival assessed in the intention-to-treat population at 3 years. Safety analyses were done on treated patients. This trial was registered with EudraCT (2011-004406-25) and ClinicalTrials.gov (NCT01804790) and is now complete. FINDINGS Between June 5, 2012, and June 26, 2017, 461 patients were randomly assigned to either the neoadjuvant chemotherapy group (n=231) or the standard-of-care group (n=230). At a median follow-up of 46·5 months (IQR 35·4-61·6), 3-year disease-free survival rates were 76% (95% CI 69-81) in the neoadjuvant chemotherapy group and 69% (62-74) in the standard-of-care group (stratified hazard ratio 0·69, 95% CI 0·49-0·97; p=0·034). During neoadjuvant chemotherapy, the most common grade 3-4 adverse events were neutropenia (38 [17%] of 225 patients) and diarrhoea (25 [11%] of 226). During chemoradiotherapy, the most common grade 3-4 adverse event was lymphopenia (59 [28%] of 212 in the neoadjuvant chemotherapy group vs 67 [30%] of 226 patients in the standard-of-care group). During adjuvant chemotherapy, the most common grade 3-4 adverse events were lymphopenia (18 [11%] of 161 in the neoadjuvant chemotherapy group vs 42 [27%] of 155 in the standard-of-care group), neutropenia (nine [6%] of 161 vs 28 [18%] of 155), and peripheral sensory neuropathy (19 [12%] of 162 vs 32 [21%] of 155). Serious adverse events occurred in 63 (27%) of 231 participants in the neoadjuvant chemotherapy group and 50 (22%) of 230 patients in the standard-of-care group (p=0·167), during the whole treatment period. During adjuvant therapy, serious adverse events occurred in 18 (11%) of 163 participants in the neoadjuvant chemotherapy group and 36 (23%) of 158 patients in the standard-of-care group (p=0·0049). Treatment-related deaths occurred in one (<1%) of 226 patients in the neoadjuvant chemotherapy group (sudden death) and two (1%) of 227 patients in the standard-of-care group (one sudden death and one myocardial infarction). INTERPRETATION Intensification of chemotherapy using FOLFIRINOX before preoperative chemoradiotherapy significantly improved outcomes compared with preoperative chemoradiotherapy in patients with cT3 or cT4 M0 rectal cancer. The significantly improved disease-free survival in the neoadjuvant chemotherapy group and the decreased neurotoxicity indicates that the perioperative approach is more efficient and better tolerated than adjuvant chemotherapy. Therefore, the PRODIGE 23 results might change clinical practice. FUNDING Institut National du Cancer, Ligue Nationale Contre le Cancer, and R&D Unicancer.
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Affiliation(s)
- Thierry Conroy
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France; APEMAC, Université de Lorraine, Nancy, France.
| | - Jean-François Bosset
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
| | | | - Emmanuel Rio
- Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint-Herblain, France
| | | | | | - Véronique Vendrely
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Xavier Artignan
- Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | | | | | | | - Clotilde Morand
- Centre Hospitalier Départemental, Site de la Roche-sur-Yon, La Roche-sur-Yon, France
| | | | | | | | | | - Eric Rullier
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France
| | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Florence Castan
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Christophe Borg
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
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Niogret J, Limagne E, Thibaudin M, Blanc J, Bertaut A, Le Malicot K, Rinaldi Y, Caroli-Bosc FX, Audemar F, Nguyen S, Sarda C, Lombard-Bohas C, Locher C, Carreiro M, Legoux JL, Etienne PL, Baconnier M, Porneuf M, Aparicio T, Ghiringhelli F. Baseline Splenic Volume as a Prognostic Biomarker of FOLFIRI Efficacy and a Surrogate Marker of MDSC Accumulation in Metastatic Colorectal Carcinoma. Cancers (Basel) 2020; 12:cancers12061429. [PMID: 32486421 PMCID: PMC7352427 DOI: 10.3390/cancers12061429] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Predictive biomarkers of response to chemotherapy plus antiangiogenic for metastatic colorectal cancer (mCRC) are lacking. The objective of this study was to test the prognostic role of splenomegaly on baseline CT scan. Methods: This study is a sub-study of PRODIGE-9 study, which included 488 mCRC patients treated by 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) and bevacizumab in first line. The association between splenic volume, and PFS and OS was evaluated by univariate and multivariable Cox analyses. The relation between circulating monocytic Myeloid derived suppressor cells (mMDSC) and splenomegaly was also determined. Results: Baseline splenic volume > 180 mL was associated with poor PFS (median PFS = 9.2 versus 11.1 months; log-rank p = 0.0125), but was not statistically associated with OS (median OS = 22.6 versus 28.5 months; log-rank p = 0.1643). The increase in splenic volume at 3 months had no impact on PFS (HR 0.928; log-rank p = 0.56) or on OS (HR 0.843; log-rank p = 0.21). Baseline splenic volume was positively correlated with the level of baseline circulating mMDSC (r = 0.48, p-value = 0.031). Conclusion: Baseline splenomegaly is a prognostic biomarker in patients with mCRC treated with FOLFIRI and bevacizumab, and a surrogate marker of MDSC accumulation.
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Affiliation(s)
- Julie Niogret
- Department of Medical Oncology, Georges François Leclerc Cancer Center-UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France;
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Emeric Limagne
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Marion Thibaudin
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Julie Blanc
- Methodology, Data-Management, and Biostatistics Unit, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (J.B.); (A.B.)
| | - Aurelie Bertaut
- Methodology, Data-Management, and Biostatistics Unit, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (J.B.); (A.B.)
| | - Karine Le Malicot
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
| | - Yves Rinaldi
- Department of Hepato-Gastroenterology, European Hospital, 6 Rue Désirée Clary, 13003 Marseille, France;
| | | | - Franck Audemar
- Department of Gastroenterology, Côte Basque Hospital Center, 13 Avenue de l’Interne Jacques Loeb, 64100 Bayonne, France;
| | - Suzanne Nguyen
- Department of Medical Oncology, Hospital Center, 4 Boulevard Hauterive, 64000 Pau, France;
| | - Corinne Sarda
- Department of Medical Oncology, Saintonge Hospital Center, 11 Boulevard Ambroise Paré, 17100 Saintes, France;
| | - Catherine Lombard-Bohas
- Department of Medical Oncology, Edouard Herriot Hospital, HCL, 5 Place d’Arsonval, 69003 Lyon, France;
| | - Christophe Locher
- Department of Gastroenterology, Est-Francilien Great Hospital, 6-8 Rue Saint-Fiacre, 77100 Meaux, France;
| | - Miguel Carreiro
- Department of Medical Oncology and Internal medicine, Hospital Center, 100 Rue Léon Cladel, 82000 Montauban, France;
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, Regional Hospital Center, 14 Avenue de l’Hôpital, 45100 Orléans, France;
| | - Pierre-Luc Etienne
- Department of Medical Oncology, CARIO, Côtes d’Armor Private Hospital, 10 Rue François Jacob, 22190 Plerin, France;
| | - Mathieu Baconnier
- Department of Hepato-Gastroenterology, Annecy Genevois Hospital Center, 1 Avenue de l’Hôpital, 74374 Pringy, France;
| | - Marc Porneuf
- Department of Medical Oncology and Hematology, Yves Le Foll Hospital Center, 10 Rue Marcel Proust, 22000 Saint-Brieuc, France;
| | - Thomas Aparicio
- Department of Gastroenterology, University Hospital Center Saint Louis, APHP, 1 Avenue Claude Vellefaux, 75010 Paris, France;
| | - Francois Ghiringhelli
- Department of Medical Oncology, Georges François Leclerc Cancer Center-UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France;
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
- Correspondence:
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8
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Conroy T, Lamfichekh N, Etienne PL, Rio E, FRANCOIS E, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, De La Fouchardiere C, Juzyna B, Rullier E, Marchal F, Castan F, Borg C. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: Final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4007] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
4007 Background: PRODIGE 23 investigated the role of neoadjuvant mFOLFIRINOX before preoperative (preop) chemoradiation (CRT), with TME-surgery and adjuvant chemotherapy (CT) in resectable locally advanced rectal cancer. Methods: PRODIGE 23 is a phase III multicenter randomized clinical trial. Eligible pts had cT3 or cT4, M0 rectal adenocarcinomas <15 cm from the anal verge, age 18-75 years, and WHO PS ≤1. Randomization was stratified by center, T stage, N status, tumor location, and perirectal fat extramural extension. Primary endpoint was 3-yr disease-free survival (DFS). Main secondary endpoints were ypT0N0 rate, overall survival (OS) and metastasis-free survival (MFS). 460 pts were required to observe 136 events to show a gain in 3-year DFS from 75% to 85% (HR=0.56) with a 2-sided α=0.05 and 90% power. HR and 95% CI were estimated by a stratified Cox proportional hazard model. Arm A pts received preop CRT (50 Gy, 2 Gy/fraction [fr]; 25 fr + capecitabine), surgery, then adjuvant CT for 6 months (mos). Arm B pts received 6 cycles of mFOLFIRINOX (oxaliplatin 85 mg/m², leucovorin 400 mg/m², irinotecan 180 mg/m² D1, and 5-FU 2.4 g/m² over 46 h) every 14 days, followed by the same preop CRT, surgery and 3 mos of adjuvant CT. Adjuvant CT consisted of mFOLFOX6 or capecitabine, depending on the centre’s choice for all pts. Imaging work-up, operative and pathology reports were centrally reviewed. Results: (ITT) Between 6/2012 and 6/2017, 230 and 231 pts were randomly assigned in Arm A/B, respectively by 35 participating centers. Pts characteristics were well balanced. Neoadjuvant mFOLFIRINOX and CRT in both arms were well tolerated. Compliance to CRT and to adjuvant CT was not hampered by neoadjuvant CT. Surgical morbidity did not differ between the 2 arms. The ypT0N0 rate was 11.7 vs 27.5% in Arm A/B (p<0.001). Median follow-up was 46.5 mos. 136 DFS events was reported. 3-yr DFS was significantly increased in arm B (HR 0.69, 95% CI 0.49-0.97, p=0.034): 68.5% (CI: 61.9-74.2) vs 75.7% (CI: 69.4-80.8) in arm A/B. The subgroup analysis showed no evidence of heterogeneity of the effect size of treatment on DFS. 3-yr MFS was also significantly higher in arm B: 71.7 in arm A vs 78.8% (HR 0.64, CI 0.44-0.93, p<0.02) in arm B. 3-yr OS was 87.7 vs 90.8% (HR 0.65, CI 0.40-1.05, p=0.077) in arm A/B, with 54.2% of the pts with recurrence being alive. Conclusions: Neoadjuvant mFOLFIRINOX plus CRT is safe, and significantly increased ypCR rate, DFS and MFS. OS data are not mature. Clinical trial information: NCT01804790 .
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Affiliation(s)
- Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Najib Lamfichekh
- Centre Hospitalier Belfort Monbéliard - Site du Mittan, Montbéliard, France
| | | | - Emmanuel Rio
- ICO-Site René Gauducheau, Saint-Herblain, France
| | - Eric FRANCOIS
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | | | | | | | - Valerie Boige
- Digestive Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Clotilde Morand
- CHD de la Roche-sur-Yon-les Oudairies, La Roche-sur-Yon, France
| | | | | | | | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Florence Castan
- Biometrics Department, Institut du Cancer de Montpellier, Montpellier, France
| | - Christophe Borg
- Department of Medical Oncology, Besancon University Hospital, Besancon, France
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9
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Reichling C, Taieb J, Derangere V, Klopfenstein Q, Le Malicot K, Gornet JM, Becheur H, Fein F, Cojocarasu O, Kaminsky MC, Lagasse JP, Luet D, Nguyen S, Etienne PL, Gasmi M, Vanoli A, Perrier H, Puig PL, Emile JF, Lepage C, Ghiringhelli F. Artificial intelligence-guided tissue analysis combined with immune infiltrate assessment predicts stage III colon cancer outcomes in PETACC08 study. Gut 2020; 69:681-690. [PMID: 31780575 PMCID: PMC7063404 DOI: 10.1136/gutjnl-2019-319292] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diagnostic tests, such as Immunoscore, predict prognosis in patients with colon cancer. However, additional prognostic markers could be detected on pathological slides using artificial intelligence tools. DESIGN We have developed a software to detect colon tumour, healthy mucosa, stroma and immune cells on CD3 and CD8 stained slides. The lymphocyte density and surface area were quantified automatically in the tumour core (TC) and invasive margin (IM). Using a LASSO algorithm, DGMate (DiGital tuMor pArameTErs), we detected digital parameters within the tumour cells related to patient outcomes. RESULTS Within the dataset of 1018 patients, we observed that a poorer relapse-free survival (RFS) was associated with high IM stromal area (HR 5.65; 95% CI 2.34 to 13.67; p<0.0001) and high DGMate (HR 2.72; 95% CI 1.92 to 3.85; p<0.001). Higher CD3+ TC, CD3+ IM and CD8+ TC densities were significantly associated with a longer RFS. Analysis of variance showed that CD3+ TC yielded a similar prognostic value to the classical CD3/CD8 Immunoscore (p=0.44). A combination of the IM stromal area, DGMate and CD3, designated 'DGMuneS', outperformed Immunoscore when used in estimating patients' prognosis (C-index=0.601 vs 0.578, p=0.04) and was independently associated with patient outcomes following Cox multivariate analysis. A predictive nomogram based on DGMuneS and clinical variables identified a group of patients with less than 10% relapse risk and another group with a 50% relapse risk. CONCLUSION These findings suggest that artificial intelligence can potentially improve patient care by assisting pathologists in better defining stage III colon cancer patients' prognosis.
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Affiliation(s)
- Cynthia Reichling
- Département d'hépato-gastroentérologie et en oncologie digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - Julien Taieb
- Service d'hépato-gastroentérologie, Hopital Europeen Georges Pompidou, Paris, France
| | - Valentin Derangere
- Plateforme de recherche biologique en oncologie, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
| | - Quentin Klopfenstein
- Plateforme de recherche biologique en oncologie, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - Jean-Marc Gornet
- Département d'hépato-gastroentérologie, Hospital Saint-Louis, Paris, Île-de-France, France
| | - Hakim Becheur
- Département d'hépato-gastroentérologie, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France
| | - Francis Fein
- Département d'hépato-gastroentérologie, CHU Besancon, Besancon, France
| | - Oana Cojocarasu
- Département d'onco-hématologie, Le Mans Universite, Le Mans, Pays de la Loire, France
| | - Marie Christine Kaminsky
- Département d'oncologie médicale, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
| | - Jean Paul Lagasse
- Département d'hépato-gastroentérologie et en oncologie digestive, Orleans University, Orleans, France
| | - Dominique Luet
- Département d'hépato-gastroentérologie et en oncologie digestive, CHU Angers, Angers, Pays de la Loire, France
| | - Suzanne Nguyen
- Service d'Oncologie Médicale, CH Pau, Pau, Aquitaine-Limousin-Poitou, France
| | - Pierre-Luc Etienne
- Service d'Oncologie Médicale, Hospital Centre Saint Brieuc, Saint Brieuc, Bretagne, France
| | - Mohamed Gasmi
- Département d'hépato-gastroentérologie, Assistance Publique Hopitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Andre Vanoli
- Département d'oncologie médicale, Clinique Sainte Marthe, Dijon, Bourgogne, France
| | - Hervé Perrier
- service d'oncologie, Hopital Saint Joseph, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Pierre-Laurent Puig
- pole biologie, Hospital European George Pompidou, Paris, Île-de-France, France
| | | | - Come Lepage
- Département d'hépato-gastroentérologie et en oncologie digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - François Ghiringhelli
- Département d'oncologie médicale, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
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10
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Aparicio T, Ronchin P, Bazire L, Le Malicot K, Lemanski C, Mirabel X, Etienne PL, Lièvre A, Cacheux W, Darut-Jouve A, De La Fouchardiere C, Breysacher G, Argo Leignel D, Tessier A, Magne N, Ben Abdelghani M, Lepage C, Vendrely V. Anti-epidermal growth factor receptor therapy in combination with chemoradiotherapy for the treatment of locally advanced anal canal carcinoma: Results of a phase II study with panitumumab (FFCD 0904). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3570] [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: 11/20/2022] Open
Abstract
3570 Background: Standard treatment of anal squamous cell carcinoma is 5-fluorouracil (5FU) and mitomycin C (MMC) based chemoradiotherapy (CRT). This phase II study studied the tolerance and complete response (CR) rate at 8 weeks of panitumumab (Pmab) combined with MMC-5FU based CRT. Methods: Patients with locally advanced tumor without metastases (Stage T2, T3 or T4, whatever N stage; Stage N1-N3 whatever T stage) were treated with two RT periods (45Gy in 5 weeks and a boost of 20Gy in 2 weeks) with concomitant CT sessions of 5FU/MMC at RT weeks 1 and 5. Pmab was administered on RT weeks 1, 3, 5 and 7 according to the doses defined by a previous phase 1.study (MMC: 10 mg/m² at J1 and J29; 5FU: 400 mg/m² from J1 to J4 and from J29 to J32, Pmab: 3mg/kg). The expected rate of CR at 8 weeks to continue in phase III was 80%. Results: Forty-five patients (male: 9 (20%), female: 36 (80%); median age: 60.1 [41.5-81]) were enrolled in 15 French centers. All patients but one completed the CRT. Median duration of CRT was 52 days [30-76].Fourteen patients had a RT interruption because of toxicity. Most common related grade 3-4 toxicities observed were digestive (51.1%), hematologic (lymphopenia: 73.4%; neutropenia: 11.1%), radiation dermatitis (28.8%) and asthenia (11.1%). On patient died because of mesenteric ischemia during the CRT (total dose: 36 Gy). In ITT analysis, the CR rate at 8 weeks after CRT was 66.7% [90%CI: 53.4-78.2]. Median follow-up was 16.2 months [14.1-18.2]. Overall survival, recurrence-free and colostomy-free survival at one year were 94.6% [95%CI: 75.8-98.7], 72.2% [95%CI: 55.0-83.7] and 78.2% [95%CI: 60.6 – 88.6] respectively. Six (13%) patients had a colostomy with abdomino-perineal amputation due to a tumour recurrence. Conclusions: Despite an acceptable tolerance, panitumumab in combination with CRT for locally advanced anal cancer failed to meet the expected CR rate to justify further clinical trials. Clinical trial information: NCT01581840.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | - Louis Bazire
- Institut Curie-Radiotherapy Department, Paris, France
| | | | - Claire Lemanski
- Radiation Oncology, Montpellier Val d'Aurelle Cancer Institute, Montpellier, France
| | | | | | | | - Wulfran Cacheux
- Institut Curie-Medical Oncology Department, Saint-Cloud, France
| | | | | | | | | | | | - Nicolas Magne
- Lucien Neuwirth Cancer Institute, Saint-Priest-En-Jarez, France
| | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
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11
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Reichling C, Taieb J, Derangere V, Le Malicot K, Emile JF, Gornet JM, Becheur H, Fein F, Cojocarasu O, Kaminsky MC, Lagasse JP, Luet D, Nguyen S, Etienne PL, Gasmi M, Vanoli A, Perrier H, Klopfenstein Q, Lepage C, Ghiringhelli F. Combination of tissues analysis and immune infiltrate in localized colon cancer using artificial intelligence in PETACC8 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3574] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3574 Background: We used artificial intelligence to perform tissue classification and count CD3 and CD8 in each subclass and determined their role in outcome prediction in PETACC8 cohort of stage III colon cancer treated with FOLFOX or FOLFOX plus cetuximab. Methods: We developed artificial intelligence aimed to detect tumor, healthy mucosa, stroma and immune cells on whole slide of CD3 and CD8 staining. The invasive margin (IM) was also automatically determined. Using a lasso algorithm, the software was able to detect digital parameters within the tumor core (TC) which were related to patients’ outcome (variable called DGMate for DiGital tuMor pArameTErs). CD3 and CD8 lymphocytes density were also quantified automatically by the software in TC and at IM. Associations with disease-free survival (DFS) were evaluated by multivariable Cox regression adjusting for age, T/N stage, sidedness, KRAS/BRAF, DNA mismatch repair (MMR). Results: On 1220 samples collected, data could be generated for 1018 patients. We observed that a high IM stromal area and a high DGMate were associated with a poorer DFS [HR 5.65 (95% CI, 2.34, 13.67), p < 0.0001; HR 2.72 (95% IC, 1.92, 3.85), p<0.001 respectively for the continuous variable]. A higher density of CD3+ TC, CD3+ IM and CD8+ TC were significantly associated with a longer DFS (HR 0.75 (95% IC, .66, .87), p<0.0001; HR 0.78 (95% IC, .68, .88), p<0.0001; HR 0.83 (95% IC, .71, .96), p=0.01). All these immune variables were significantly correlated with each other. ANOVA test demonstrated that CD3+ TC gave a similar prognostic value compared to the classical CD3/CD8 immunoscore (p=0.44). The combination of IM stromal area, DGMate and CD3 outperformed the classical CD3/CD8 immunoscore to estimate patients’ prognosis (C-index= 0.601 vs 0.578, p-value=0.04). Adding this new variable to classical clinical prognostic parameters we generated a nomogram which predicted the risk of relapse of stage III colon cancer with a stronger predictive value compared to clinical parameters or the immunoscore. Conclusions: We propose a new fully automated method of whole slide analysis using a software based on artificial intelligence which classify tissue and determine tumor and immune parameters on one single slide stained with CD3 antibody. This valuable strategy outperforms immunoscore and clinical outcome prediction models.
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Affiliation(s)
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | - Valentin Derangere
- Research Platform in Biological Oncology, Center GF Leclerc, Dijon, France
| | | | - Jean Francois Emile
- Service d’Anatomie Pathologique Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | | | | | | | | | | | | | | | | | | | - Andr Vanoli
- Clinique Sainte Marie, Chalons Sur Saone, France
| | | | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
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12
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Touchefeu Y, Guimbaud R, Louvet C, Dahan L, Samalin E, Barbier E, Le Malicot K, Cohen R, Gornet JM, Aparicio T, Nguyen S, Azzedine A, Etienne PL, Phelip JM, Hammel P, Chapelle N, Sefrioui D, Mineur L, Lepage C, Bouche O. Prognostic factors in patients treated with second-line chemotherapy for advanced gastric cancer: results from the randomized prospective phase III FFCD-0307 trial. Gastric Cancer 2019; 22:577-586. [PMID: 30311042 DOI: 10.1007/s10120-018-0885-z] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to determine prognostic factors in patients treated with second-line therapy (L2) for locally advanced or metastatic gastric and gastro-esophageal junction (GEJ) adenocarcinoma in a randomized phase III study with predefined L2. METHODS In the FFCD-0307 study, patients were randomly assigned to receive in L1 either epirubicin, cisplatin, and capecitabine (ECX arm) or fluorouracil, leucovorin, and irinotecan (FOLFIRI arm). L2 treatment was predefined (FOLFIRI for the ECX arm and ECX for the FOLFIRI arm). Chi square tests were used to compare the characteristics of patients treated in L2 with those of patients who did not receive L2. Prognostic factors in L2 for progression-free survival (PFS) and overall survival (OS) were analyzed using a Cox model. RESULTS Among 416 patients included, 101/209 (48.3%) patients in the ECX arm received FOLFIRI in L2, and 81/207 (39.1%) patients in the FOLFIRI arm received ECX in L2. Patients treated in L2, compared with those who only received L1 had : a better ECOG score (0-1: 90.4% versus 79.7%; p = 0.0002), more frequent GEJ localization (40.8% versus 27.6%; p = 0.005), and lower platelet count (median: 298000 versus 335000/mm3; p = 0.02). In multivariate analyses, age < 60 years at diagnosis (HR 1.49, 95% CI 1.09-2.03, p = 0.013) and ECOG score 2 before L2 (HR 2.62, 95% CI 1.41-4.84, p = 0.005) were the only significant poor prognostic factors for OS. CONCLUSION Age ≥ 60 years at diagnosis and ECOG score 0/1 before L2 were the only favorable prognostic factors for OS.
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Affiliation(s)
- Y Touchefeu
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - R Guimbaud
- Digestive Medical Oncology IUCT Rangueil, CHU de Toulouse, Toulouse, France
| | - C Louvet
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - L Dahan
- Digestive Oncology Unit, AP-HM, La Timone Hospital, Aix-Marseille Université, Marseille, France
| | - E Samalin
- Digestive Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - E Barbier
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - K Le Malicot
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - R Cohen
- Department of Oncology, Sorbonne Université, AP-HP, hôpital Saint-Antoine, 75012, Paris, France
| | - J M Gornet
- Department of Gastroenterology, AP-HP Hôpital Saint Louis, Paris, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, University Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - S Nguyen
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - A Azzedine
- Department of oncology, CH Montélimar, Montélimar, France
| | - P L Etienne
- Oncology Department, CARIO, HPCA, Plérin, France
| | - J M Phelip
- Service HGE et Oncologie Digestive, CHU de Saint Etienne, Unité HESPER EA-7425 Université Jean Monnet/Claude Bernard Lyon 1, Villeurbanne, France
| | - P Hammel
- Digestive Oncology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - N Chapelle
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - D Sefrioui
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, UNIROUEN, Inserm U1245, IRON group, Normandie University, 76000, Rouen, France
| | - L Mineur
- Institut Sainte Catherine, Avignon, France
| | - C Lepage
- Gastroenterology Department, INSERM UMR1231, CHU de Dijon, University Bourgogne Franche-Comté, Dijon, France
| | - O Bouche
- Digestive Oncology, CHU REIMS, Reims, France
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Lacas B, Bouché O, Etienne PL, Gasmi M, Texereau P, Gargot D, Lombard-Bohas C, Azzedine A, Denis B, Geoffroy P, Auby D, Michel P, Pignon JP, Lepage C, Ducreux M, Borget I. Quality of life and cost of strategies of two chemotherapy lines in metastatic colorectal cancer: results of the FFCD 2000-05 trial. Expert Rev Pharmacoecon Outcomes Res 2019; 19:601-608. [PMID: 30739558 DOI: 10.1080/14737167.2019.1580573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: This study compared the cost and quality of life (QoL) of 407 advanced colorectal cancer patients, randomly assigned to receive LV5FU2 followed by FOLFOX6 (sequential strategy) or FOLFOX6 followed by FOLFIRI (combination strategy). Methods: Costs were compared from the French health insurance perspective, until the end of the second line of treatment. Consumed resources, collected during the trial, included medicines, hospitalizations, examinations, and transportation. Valuations were made using 2009 and 2016 tariffs. QoL was assessed using the QLQ-C30 questionnaire and clinically significant variations were searched. Results: In 2009, the mean cost per patient was significantly lower for the sequential strategy compared to the combination strategy (18,061€ and 23,119€, p = 0.001). In 2016, the difference was no longer significant (16,876€ and 18,090€, p = 0.41) because oxaliplatin and irinotecan became generics. The QoL analysis (292 patients) showed that there was significantly less improvement of global health status in the sequential strategy than in the combination strategy (29% and 42%; p = 0.02) during first-line therapy. No significant differences were observed for emotional functioning (p = 0.45) and physical functioning (p = 0.07) or during second-line therapy. Conclusion: The choice to treat patients with advanced colorectal cancer using one or the other strategy cannot be based on costs or QoL.
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Affiliation(s)
- Benjamin Lacas
- Department of Biostatistic and Epidemiology, Gustave Roussy , Villejuif , France
| | - Olivier Bouché
- Department of Digestive Oncology, Centre Hospitalier Universitaire , Reims , France
| | | | - Mohamed Gasmi
- Department of Gastroenterology, Hôpital Nord , Marseille , France
| | - Patrick Texereau
- Department of Oncology, Centre Hospitalier , Mont de Marsan , France
| | - Dany Gargot
- Department of Gastroenterology, Centre Hospitalier , Blois , France
| | | | - Ahmed Azzedine
- Department of Gastroenterology, Centre Hospitalier , Avignon , France
| | - Bernard Denis
- Department of Gastroenterology, Hôpital Louis Pasteur , Colmar , France
| | - Patrick Geoffroy
- Department of Gastroenterology, Clinique St-Vincent , Epernay , France
| | - Dominique Auby
- Department of Medical Oncology, Centre Hospitalier , Libourne , France
| | - Pierre Michel
- Department of Gastroenterology, Hôpital Charles Nicolle , Rouen , France
| | - Jean-Pierre Pignon
- Department of Biostatistic and Epidemiology, Gustave Roussy , Villejuif , France
| | - Côme Lepage
- Department of Gastroenterology, Centre Hospitalier Universitaire , Dijon , France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif et Université Paris-Saclay , France
| | - Isabelle Borget
- Department of Biostatistic and Epidemiology, Gustave Roussy , Villejuif , France
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Aparicio T, Ducreux M, Faroux R, Barbier E, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, François E, Michel P, Legoux JL, Gasmi M, Breysacher G, Rougier P, De Gramont A, Lepage C, Bouché O, Seitz JF, Adenis A, Alessio A, Aouakli A, Azzedine A, Bedjaoui A, Bidault A, Blanchi A, Botton A, Cadier-Lagnes A, Fatisse A, Gagnaire A, Gilbert A, Gueye A, Hollebecque A, Lemaire A, Mahamat A, Marre A, Patenotte A, Rotenberg A, Roussel A, Thirot-Bidault A, Votte A, Weber A, Zaanan A, Dupont-Gossart A, Villing A, Queuniet A, Coudert B, Denis B, Garcia B, Lafforgue B, Landi B, Leduc B, Linot B, Paillot B, Rhein B, Winkfield B, Barberis C, Becht C, Belletier C, Berger C, Bineau C, Borel C, Brezault C, Buffet C, Cornila C, Couffon C, De La Fouchardière C, Giraud C, Lecaille C, Lepere C, Lobry C, Locher C, Lombard-Bohas C, Paoletti C, Platini C, Rebischung C, Sarda C, Vilain C, Briac-Levaché C, Auby D, Baudet-Klepping D, Bechade D, Besson D, Cleau D, Festin D, Gargot D, Genet D, Goldfain D, Luet D, Malka D, Peré-Vergé D, Pillon D, Sevin-Robiche D, Smith D, Soubrane D, Tougeron D, Zylberait D, Carola E, Cuillerier E, Dorval Danquechin E, Echinard E, Janssen E, Maillard E, Mitry E, Norguet-Monnereau E, Suc E, Terrebonne E, Zrihen E, Pariente E, Almaric F, Audemar F, Bonnetain F, Desseigne F, Dewaele F, Di Fiore F, Ghiringhelli F, Husseini F, Khemissa F, Kikolski F, Morvan F, Petit-Laurent F, Riot F, Subtil F, Zerouala-Boussaha F, Caroli-Bosc F, Boilleau-Jolimoy G, Bordes G, Cavaglione G, Coulanjon G, Deplanque G, Gatineau-Saillant G, Goujon G, Medinger G, Roquin G, Brixi-Benmansour H, Castanie H, Lacroix H, Maechel H, Perrier H, Salloum H, Senellart H, Baumgaertner I, Cumin I, Graber I, Trouilloud I, Boutin J, Butel J, Charneau J, Cretin J, Dauba J, Deguiral J, Egreteau J, Ezenfis J, Forestier J, Goineau J, Lacourt J, Lafon J, Martin J, Meunier J, Moreau J, Provencal J, Taieb J, Thaury J, Tuaillon J, Vergniol J, Villand J, Vincent J, Volet J, Bachet J, Barbare J, Souquet J, Grangé J, Dor J, Paitel J, Jouve J, Raoul J, Cheula J, Gornet J, Sabate J, Vantelon J, Vaillant J, Aucouturier J, Barbieux J, Herr J, Lafargue J, Lagasse J, Latrive J, Plachot J, Ramain J, Robin J, Spano J, Douillard J, Beerblock K, Bouhier-Leporrier K, Slimane Fawzi K, Cany L, Chone L, Dahan L, Gasnault L, Rob L, Stefani L, Wander L, Baconnier M, Ben Abdelghani M, Benchalal M, Blasquez M, Carreiro M, Charbit M, Combe M, Duluc M, Fayolle M, Gignoux M, Giovannini M, Glikmanas M, Mabro M, Mignot M, Mornet M, Mousseau M, Mozer M, Pauwels M, Pelletier M, Porneuf M, Ramdani M, Schnee M, Tissot M, Zawadi M, Clavero-Fabri M, Gouttebel M, Kaminsky M, Galais M, Abdelli N, Barrière N, Bouaria N, Bouarioua N, Delas N, Gérardin N, Hess-Laurens N, Stremsdoerfer N, Berthelet O, Boulat O, Capitain O, Favre O, Amoyal P, Bergerault P, Burtin P, Cassan P, Chatrenet P, Chiappa P, Claudé P, Couzigou P, Feydy P, Follana P, Geoffroy P, Godeau P, Hammel P, Laplaige P, Lehair P, Martin P, Novello P, Pantioni P, Pienkowski P, Pouderoux P, Prost P, Ruszniewski P, Souillac P, Texereau P, Thévenet P, Haineaux P, Benoit R, Coriat R, Lamy R, Mackiewicz R, Beorchia S, Chaussade S, Hiret S, Jacquot S, Lavau Denes S, Montembault S, Nahon S, Nasca S, Nguyen S, Oddou-Lagraniere S, Pesque-Penaud S, Fratte S, Chatellier T, Mansourbakht T, Morin T, Walter T, Boige V, Bourgeois V, Derias V, Guérin-Meyer V, Hautefeuille V, Jestin Le Tallec V, Lorgis V, Quentin V, Sebbagh V, Veuillez V, Adhoute X, Coulaud X, Becouarn Y, Coscas Y, Courouble Y, Le Bricquir Y, Molin Y, Rinaldi Y, Lam Y, Ladhib Z. Overweight is associated to a better prognosis in metastatic colorectal cancer: A pooled analysis of FFCD trials. Eur J Cancer 2018; 98:1-9. [DOI: 10.1016/j.ejca.2018.03.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
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Moehler MH, Janjigian YY, Adenis A, Aucoin JS, Boku N, Chau I, Cleary JM, Feeney K, Franke FA, Mendez GA, Schenker M, Li M, Hitre E, Couture F, Karamouzis M, Etienne PL, Ajani JA. CheckMate 649: A randomized, multicenter, open-label, phase III study of nivolumab (NIVO) + ipilimumab (IPI) or nivo + chemotherapy (CTX) versus CTX alone in patients with previously untreated advanced (Adv) gastric (G) or gastroesophageal junction (GEJ) cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS192 Background: Pts with adv G/GEJ cancer have an OS of ≈ 1 y, indicating an unmet medical need for new first-line treatments. Expression of PD-L1 is observed in up to 40% of pts with G/GEJ cancer and is associated with poor prognosis. In the randomized phase 3 ATTRACTION-2 study, NIVO demonstrated superior overall survival vs placebo with a 38% reduction of the risk of death (median OS, 5.3 vs 4.1 mo; HR, 0.62 P< 0.0001) and increased the OS rate at 12 mo (27% vs 12%; Boku N et al ESMO 2017) in pts with adv CTX-R (≥ 2 lines) G/GEJ cancer. In the phase 1/2 CheckMate-032 study in pts with CTX-R G/GEJ/esophageal cancer (79% ≥ 2 prior Tx lines), NIVO 1 mg/kg + IPI 3 mg/kg had a manageable safety profile and resulted in 24% ORR (40% ORR in pts with PD-L1+ tumors), a median OS of 6.9 mo, and a 35% OS rate at 12 mo (Janjigian Y et al ASCO 2017). In the phase 1 CheckMate-012 trial, NIVO + CTX had clinical activity and manageable safety in pts with NSCLC (Rizvi NA et al J Clin Oncol 2016). These positive results support investigation of NIVO, NIVO + IPI, and NIVO + CTX in earlier lines of treatment for G/GEJ cancer. The open-label, phase 3 CheckMate 649 trial will evaluate NIVO + IPI and NIVO + CTX vs CTX alone as first-line treatment for pts with adv G/GEJ cancer (NCT02872116). Methods: 1266 pts aged ≥ 18 y with untreated, inoperable adv/metastatic G/GEJ cancer (histologically confirmed adenocarcinoma) regardless of PD-L1 status will be randomized to receive either NIVO + IPI, NIVO + CTX (capecitabine/oxaliplatin [XELOX] or fluorouracil/leucovorin/oxaliplatin [FOLFOX]), or investigator choice of XELOX or FOLFOX. Tumor tissue for determination of PD-L1 status (Dako assay) must be provided from ≤ 6 mo before study treatment. No prior systemic treatment, including HER2 inhibitors, are allowed. Pts with known HER2+ status, suspected autoimmune disease, grade > 1 peripheral neuropathy, or active infection are excluded. Primary endpoint is OS in pts with PD-L1+ (≥ 1%) tumors. Other endpoints include OS in all pts; PFS and time to symptom deterioration in all pts and in pts with PD-L1+ tumors; and safety. Clinical trial information: NCT02872116.
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Affiliation(s)
| | | | | | | | | | - Ian Chau
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Fabio A. Franke
- Hospital de Caridade de Ijuí Avenida David José Martins, Ijui-RS, Brazil
| | | | - Michael Schenker
- S.C Centrul de Oncologie, Policlinica Sf. Nectarie, Craiova, Romania
| | | | - Erika Hitre
- Orszagos Onkologiai Intezet, Budapest, Hungary
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Emile JF, Julié C, Le Malicot K, Lepage C, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Dimet S, Boulagnon-Rombi C, Allard MA, Penault-Llorca F, Bennouna J, Laurent-Puig P, Taieb J, Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Keil F, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Jagdt B, Lang A, Fridrik M, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, Kalantari HR, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, Budnik TM, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, Derigs HG, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ciuffreda L, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, Ayerbes MV, Batlle JF, Gil S, Esteve AA, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, Nogueras LC, Merino BQ, Castro CG, de Prado PM, Pericay CP, Figueiras MC, Jordan IG, Gome Reina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, Gaspar EM, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, Morales MG, Muñoz ML, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, Busquier IH, Ruiz TC, Muñoa AL, Aliguer MN, de Taranco AVO, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, Brotons AG, Rodriguez SA, Martinez JA, Ruiz LC, Ruiz MC, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prospective validation of a lymphocyte infiltration prognostic test in stage III colon cancer patients treated with adjuvant FOLFOX. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Aparicio T, Etienne PL, Bouche O, Mineur L, Hiret S, Martin J, Desgrippes R, Maillard E, Breysacher G, Faroux R, Cany L, Francois E, Cristol-Dalstein L, Carola E, Paillaud E, Retornaz F, Seitz JF. PRODIGE 34 ADAGE: Adjuvant chemotherapy in elderly patients with resected stage III colon cancer—A randomized phase III trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps3628] [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
TPS3628 Background: Colon cancer (CC) occurs in around 50% of the patients after 70 years. Adjuvant chemotherapy (CT) has demonstrated a benefit on disease-free survival (DFS) and overall survival after a stage III CC resection. Nevertheless, adjuvant CT is poorly used in elderly patients. There is still concern about the efficacy of doublet CT with oxaliplatin in fit elderly patients and the usefulness of fluoropyrimidine monotherapy in unfit elderly patients. The selection of patients that should be treated remains a challenge. Geriatric evaluation and tumor biology should be explored to help for patient selection. Methods: ADAGE is a multicenter, randomized phase III study comparing 3-years DFS of 2 therapeutic strategies in 2 groups of patients aged over 70 with completely resected stage III CC. Patients are included in one of the 2 groups after a multidisciplinary team evaluation; Group 1 (arm A and B) is defined as “able” to be treated with doublet CT; Group 2 (arm C and D) is defined as “unable” to be treated with doublet CT. In each group, patients are randomized according to a 1:1 ratio. Randomization is stratified according to center, gender, stage (IIIA vs IIIB vs IIIC), occlusion and/or perforation (yes vs no) and independent activity of daily living score (IADL: normal vs abnormal). Arm A and D receive LV5FU2 or capecitabine, arm B FOLFOX4 or XELOX and arm C is an observation arm. The treatment is planned for 6 months. Adjuvant CT should start within 12 weeks after surgery. Geriatric questionnaires and Lee score must be completed before randomization. Radiological assessment is performed every 6 months for 3 years after randomization and then annually for 2 years. Hypotheses (α two-sided = 5%, power = 80%) are to improve 3-years DFS from 65% (arm A) to 72% (arm B) in group 1 (756 patients required) and from 40% (arm C) to 55% (arm D) in group 2 (226 patients required). Safety is evaluated based on laboratory and clinical tests before each cycle. Exploratory analysis are planned to determine geriatric prognostic factors for DFS. A biological ancillary study is planned to allow prognostic evaluation of mismatch repair status and other molecular signatures. At the 1stof February 2017 the accrual was 246 patients. Clinical trial information: NCT02355379.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | | | | | | | | | | | | | | | - Roger Faroux
- Centre Hospitalier Departemental Les Oudairies, La Roche-Sur-Yon, France
| | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Crehange G, Bertaut A, Peiffert D, Le Prise E, Etienne PL, Rio E, Pereira R, Noel G, Benezery K, Bonnetain F, Seitz JF. Exclusive chemoradiotherapy with or without dose escalation in locally advanced esophageal carcinoma: The CONCORDE study (PRODIGE 26). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4037 Background: In esophageal cancer (EC), 20 to 45% of patients suffer from local failure after 50Gy concomitant chemoradiation (cCRT). Improvements in staging together with target definitions led us to test dose escalation in the modern era of new technologies. Methods: Patients were randomly assigned cCRT to 40Gy elective nodal irradiation with either a 10Gy boost (Arm A) or 26Gy boost (Arm B) combined with FOLFOX-4. The primary endpoint of this phase II was acute toxicity according to the NCIC-CTCAE (version 4.0). Quality of life according to the EORTC QLQ-C30 and OG25 was a secondary endpoint. All analyses were performed in intent-to-treat. Results: 160 patients were randomized between Jun 2011 and Feb 2016: 81 patients in arm A and 79 patients in arm B. The mean age at diagnosis was 61.9 (7.9) years and 62.1 (7.8) years, respectively. Seventy patients in each arm had squamous cell carcinoma (86.4% in arm A and 88.6% in arm B) and 59 patients (72.8%) and 58 patients (73.4%) had stage III disease in arms A and B, respectively. IMRT was performed in 57 (70.4%) and 55 (69.6%) patients in arms A and B. The rates of grade ≥3 (G3+) non-hematological toxicity were not significantly different between arms A and B (76.5% vs 86.0%, p = 0.12). The rates of G3+ hematological toxicity were not significantly different between arms A and B (82.7% vs 88.6%, p = 0.29). The rates of G3+ non-hematological toxicity were not significantly different between patients treated with 3DRT (83.3%) and IMRT (81.3%) (p = 0.77). The mean global health scores at baseline and 3 months were 63.9 (sd = 21.4) vs 69.6 (sd = 23.1) in arm A (p = 0.10) and 65.27 (sd = 19.54) vs 58.8 (sd = 19.9) in arm B (p = 0.16). The presence of dysphagia was neither significantly different between arm A (89.23%) and arm B (86.21%) (p = 0.61) at baseline nor at 3 months (77.78% vs 86.84%, p = 0.29). Odynophagia was present at baseline in 78.46% in arm A and 75.86% in arm B (p = 0.73) while the rates observed at 3 months were 68.18% and 73.68%, respectively (p = 0.59). Conclusions: Dose escalated cCRT in patients with EC is feasible with no increased acute toxicity and no deterioration of QOL. A phase III trial is on-going to conclusively address the issue of local control with cCRT. Clinical trial information: NCT01348217.
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Affiliation(s)
| | | | - Didier Peiffert
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, Vandoeuvre-Les-Nancy, France
| | | | | | - Emmanuel Rio
- Institut de Cancerologie de l'Ouest, Nantes, France
| | | | | | | | | | - Jean Francois Seitz
- Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France
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Moehler MH, Janjigian YY, Adenis A, Aucoin JS, Boku N, Chau I, Cleary JM, Feeney KT, Franke FA, Mendez GA, Schenker M, Li M, Hitre E, Couture F, Karamouzis M, Etienne PL, Ajani JA. CheckMate 649: A randomized, multicenter, open-label, phase 3 study of nivolumab (nivo) + ipilimumab (ipi) or nivo + chemotherapy (CTX) vs CTX alone in pts with previously untreated advanced (adv) gastric (G) or gastroesophageal junction (GEJ) cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps4132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4132 Background: Pts with adv G/GEJ cancer have an OS of ≈ 1 y, indicating an unmet medical need for new first-line treatments (Tx). Expression of the PD-1 ligands PD-L1/PD-L2 is observed in up to 40% of pts with G/GEJ cancer and is associated with poor prognosis. In a phase 3 study of the PD-1 inhibitor nivo vs placebo in pts with adv CTX-refractory (CTX-R; ≥ 2 lines) G/GEJ cancer, nivo reduced the risk of death by 37% (HR, 0.63; P < 0.0001) and increased the OS rate at 12 mo (27% vs 11%; Kang YK, et al. J Clin Oncol. 2017;35 (suppl 4S) [abstract 2]). In a phase 1/2 study in pts with CTX-R G/GEJ/esophageal cancer (79% ≥ 2 prior Tx lines), nivo 1 mg/kg + ipi 3 mg/kg had a manageable safety profile and resulted in 26% ORR (44% ORR in pts with PD-L1+ tumors), a median OS of 6.9 mo, and a 34% OS rate at 12 mo (Janjigian Y, et al. ASCO, 2016 [abstract 4010]). In the phase 1 CheckMate 012 trial, nivo + CTX had clinical activity and manageable safety in pts with NSCLC (Rizvi NA, et al. J Clin Oncol. 2016;34:2969-2979). These positive results support investigation of nivo, nivo + ipi, and nivo + CTX in earlier lines of Tx for G/GEJ cancer. The open-label, phase 3 CheckMate 649 trial will evaluate nivo + ipi and nivo + CTX vs CTX alone as first-line Tx for pts with adv G/GEJ cancer (NCT02872116). Methods: 1266 pts aged ≥ 18 y with untreated, inoperable adv/metastatic G/GEJ cancer (histologically confirmed adenocarcinoma) regardless of PD-L1 status will be randomized to receive either nivo + ipi, nivo + CTX (capecitabine/oxaliplatin [XELOX] or fluorouracil/leucovorin/oxaliplatin [FOLFOX]), or investigator choice of XELOX or FOLFOX. Tumor tissue for determination of PD-L1 status (Dako assay) must be provided from ≤ 6 mo before study Tx. No prior systemic Tx, including HER2 inhibitors, are allowed. Pts with known HER2+ status, suspected autoimmune disease, grade > 1 peripheral neuropathy, or active infection are excluded. Primary endpoint is OS in pts with PD-L1+ (≥ 1%) tumors. Other endpoints include OS in all pts; PFS and time to symptom deterioration in all pts and in pts with PD-L1+ tumors; and safety. Clinical trial information: NCT02872116.
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Affiliation(s)
| | | | | | - Jean-Sebastien Aucoin
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Quebec, QC, Canada
| | | | - Ian Chau
- Royal Marsden Hospital, London, United Kingdom
| | | | - Kynan Tadao Feeney
- University of Notre Dame, Fremantle, and Edith Cowan University, Joondalup, WA, Australia
| | | | | | | | | | - Erika Hitre
- Orszagos Onkologiai Intezet, Budapest, Hungary
| | | | | | | | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Adenis A, de la Fouchardiere C, Paule B, Burtin P, Tougeron D, Wallet J, Dourthe LM, Etienne PL, Mineur L, Clisant S, Phelip JM, Kramar A, Andre T. Erratum to: Survival, safety, and prognostic factors for outcome with Regorafenib in patients with metastatic colorectal cancer refractory to standard therapies: results from a multicenter study (REBECCA) nested within a compassionate use program. BMC Cancer 2016; 16:518. [PMID: 27457763 PMCID: PMC4959046 DOI: 10.1186/s12885-016-2559-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antoine Adenis
- Medical Oncology, Centre Oscar Lambret and Catholic University, Lille, France. .,Department of Medical Oncology, Centre Oscar Lambret, 3, rue F Combemale, 59000, Lille, France.
| | | | - Bernard Paule
- Medical Oncology, Paul Brousse University Hospital, Villejuif, France
| | | | | | - Jennifer Wallet
- Methodology and Biostatistics, Centre Oscar Lambret, Lille, France
| | | | | | - Laurent Mineur
- Radiation and Medical Oncology, Institut Sainte-Catherine, Avignon, France
| | | | | | - Andrew Kramar
- Methodology and Biostatistics, Centre Oscar Lambret, Lille, France
| | - Thierry Andre
- Medical Oncology, Saint Antoine Hospital, and University Pierre et Marie Curie (UMPC), Paris VI, Paris, France
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Etienne PL, Francois E, Gourgou S, Jarlier M, Azria D, Rouanet P, Conroy T, Bouche O, Mineur L, Vendrely V, Doyen J, Seitz JF, Stanbury T, Gerard JP. PRODIGE 2 phase III trial neoadjuvant in rectal cancer: Quality of life and results at 5 years. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Marta Jarlier
- Biostatistic Unit - CTD INCa, ICM - Montpellier Cancer Institute, Montpellier, France
| | - David Azria
- Institut Régional du Cancer, Montpellier, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les Nancy, France
| | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
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Bachet JB, Lucidarme O, Taïeb J, Maillard E, Levache CB, Raoul JL, Lecomte T, Hebbar M, Brocard F, Pernot S, Breysacher G, Lagasse JP, Di Fiore F, Etienne PL, Dupuis OJM, Aleba A, Lepage C, Rougier P. FOLFIRINOX as induction treatment in rectal cancer patients with synchronous metastases (RCSM): Results of the FFCD 1102 phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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)
| | | | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
| | | | - Charles-Briac Levache
- Department of Radiotherapy and Medical Oncology, Polyclinique Francheville, Périgueux, France
| | | | | | | | | | - Simon Pernot
- Hôpital Européen Georges-Pompidou, Paris, France
| | | | | | - Frédéric Di Fiore
- Digestive Oncology Unit, IRON group, Rouen Hospital, University of Normandy, Rouen, France
| | | | | | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
| | - Philippe Rougier
- Paris Descartes University, Georges Pompidou European Hospital, Paris, France
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Aparicio T, Maillard E, Ducreux M, Bouche O, Rougier P, De Gramont A, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, Francois E, Michel P, Legoux JL, Gasmi M, Faroux R, Breysacher G, Lepage C, Seitz JF. Obesity in metastatic colorectal cancer: Pooled analysis of FFCD trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | | | | | | | | | | | | | | | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, IRON group, CHU Rouen, University of Normandy, Rouen, France
| | | | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche Sur Yon, France
| | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
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Adenis A, Bennouna J, Etienne PL, Bogart E, Francois E, Galais MP, Ben Abdelghani M, Kotecki N, Michel P, Metges JP, Dahan L, Piessen G, Conroy T, Ghiringhelli F, Bedenne L, El Hajbi F, Samalin E, Delaine SC, Penel N, Mariette C. Discontinuation of first-line chemotherapy (CT) after 6 weeks of CT in patients (pts) with metastatic squamous-cell esophageal cancer (MSEC): A randomized phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | | | - Pierre Michel
- Digestive Oncology Unit, IRON group, CHU Rouen, University of Normandy, Rouen, France
| | - Jean-Philippe Metges
- Cancer Institute University Hospital Morvan and Observatory of Cancer Inserm 1078 - Mission 8.1 Canceropole Grand Ouest, Brest, France
| | - Laetitia Dahan
- La Timone, Marseille University Hospital, Marseille, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les Nancy, France
| | | | | | | | | | | | | | - Christophe Mariette
- Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, Lille, France
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Francois E, Gourgou-Bourgade S, Azria D, Conroy T, Bouche O, Doyen J, Seitz JF, Mineur L, Etienne PL, Gerard JP. ACCORD12/0405-Prodige 2 phase III trial neoadjuvant treatment in rectal cancer: Results after 5 years of follow-up. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
490 Background: The ACCORD 12 randomized trial was aiming at improving ypCR by increasing the radiation dose and adding oxaliplatin (OX) to a standard RT 45 Gy with concurrent capecitabine. On short term benefit of OX was not demonstrated (Gérard JP et al. J Clin Oncol. 2010;28:1638-44) at 3 years no significant difference in clinical outcome was achieved (Gérard JP et al. J Clin Oncol. 2012;30:4558-65. François E et al. Radiother Oncol. 2014;110:144-9). This is an update of results at 5 years. Methods: Between 11/2005 and 07/2008, 598 patients were randomized. Inclusion criteria: adenocarcinoma of rectum accessible to digital examination, T3 Nx M0 (or T2 distal anterior rectum). Randomization was between two neoadjuvant treatments chemo radiotherapy: Cap45 (45 Gy + capecitabine) and Capox50 (50 Gy + cape. and oxaliplatin). Main end point was sterilization of the operative specimen. Bowel function for patients treated with anterior resection was analyzed with a global score (1 very poor to 7 excellent). A total of 253 patients received adjuvant chemotherapy usually with FOLFOX: 133 in Cap45, 120 in Capox50. Results: In the ITT population, with a median follow-up of 60 months, updated carcinologic results were calculated using the Kaplan-Meier method. Out of 299 pts randomized in CAP45 and 299 pts in CAPOX50 results were respectively the following 1) 5y-cumulative incidence of Loc. Recurrence : 8.8% vs 7.8% (p = 0.78 HR = 0.92 [0.51-1.66]) 2) 5y-cumulative incidence of dist metastasis : 29.3% vs 27.1% (p = 0.48 HR = 0.89 [0.62-1.54]) 3) 5y-disease free survival rate : 60.4% vs 64.7% (p = 0.25 HR = 0.86 [0.66-1.11]) 4) 5y-overall survival rate : 76.4% vs 81.9% (p = 0.06 HR = 0.71 [0.50-1.01]) 5) bowel function median score : 5.2 [1-7] vs 4.9 [1-7]. Conclusions: At 5 years there was no significant difference in terms of local recurrence or distant metastases rates between both regimens. The new finding is a trend for improved overall survival in the Capox 50 groups may be related to subsequent salvage secondary treatments. At time of meeting the prognostic factors will be available in details and these results put in perspective with other phase III trial testing the role of oxaliplatin in Europe and the US. Clinical trial information: NCT00227747.
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Affiliation(s)
- Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | - David Azria
- Montpellier Cancer Institute, Montpellier, France
| | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les Nancy, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
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Crehange G, Bonnetain F, Peiffert D, Le Prise E, Etienne PL, Rio E, Pereira R, Noel G, Benezery K, Seitz JF. Phase II/III randomized trial of exclusive chemoradiotherapy with or without dose escalation in locally advanced esophageal carcinoma: The CONCORDE study (PRODIGE 26). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.tps190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS190 Background: INT 0123 failed to demonstrate an overall survival benefit with chemoradiotherapy dose escalation in locally advanced esophageal cancer. Nearly 45% of the patients had local persistent or recurrent disease. Several drawbacks surround the interpretation of the results of INT 0123. Improvements in target definitions with planning CT and 18F FDG PET/CT in keeping with improvements in radiation dose delivery that better protect healthy tissues with 3D conformal radiation therapy and/or IMRT should lead to the retesting of dose escalation in the modern era of new technologies. Methods: Patients are randomized into two groups: Experimental group: 40Gy ENI followed by a 26-Gy boost to the primary tumor and involved nodes (i.e. 33 daily fractions of 2Gy) with concomitant and adjuvant FOLFOX-4 weeks 1, 3, 5, 7, 9 and 11. Control group: 40Gy ENI followed by a 10-Gy boost to the primary tumor and involved nodes (in 25 daily fractions of 2Gy) with concomitant and adjuvant FOLFOX-4 weeks 1, 3, 5, 7, 9 and 11. Randomization using minimization to ensure balanced allocation across: Center / Adeno vs Squamous cell carcinoma / stage III vs I-II / weight loss / 3D-CRT vs IMRT. The principal hypothesis is that the rate of survival without locoregional relapse at 2 years will reach 50% in the reference arm and 65% in the experimental arm (Hazard ratio = 0.62). With a risk α = 0.05 (bilateral test) and β = 0.15 (power 85%). If we use a rate of 5% for lost to follow-up, it will be necessary to recruit 266 patients. The main inclusion criteria are: age < 75 years, WHO Status 0, 1 and 2, Enteral or parenteral feeding planned before the start of treatment if oral calorie intake < 1500 kcal, Histologically proven carcinoma of the esophagus, adenocarcinoma or squamous cell, T3, N0-N3, M0 (UICC 7thedition), T1-T2, N0-N3, M0 with a contra-indication for surgery, Absence of tracheo-esophageal fistula, Absence of thoracic or upper abdominal irradiation for another tumor, Written informed consent. 141 of the 160 patients required in phase II of the trial were included by September 22nd 2015. (ClinicalTrials.gov Identifier: NCT01348217). Clinical trial information: NCT01348217.
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Affiliation(s)
| | | | - Didier Peiffert
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, Vandoeuvre Les Nancy, France
| | | | | | - Emmanuel Rio
- Institut de Cancérologie de l'Ouest, Nantes, France
| | | | - Georges Noel
- Radiotherapy, Centre P. Strauss, Strasbourg, France
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Kotecki N, Hiret S, Etienne PL, Penel N, Tresch E, François E, Galais MP, Ben Abdelghani M, Michel P, Dahan L, Ghiringelli F, Bedenne L, Samalin E, Piessen G, Bennouna J, Peugniez C, El Hajbi F, Clisant S, Kramar A, Mariette C, Adenis A. First-Line Chemotherapy for Metastatic Esophageal Squamous Cell Carcinoma: Clinico-Biological Predictors of Disease Control. Oncology 2016; 90:88-96. [PMID: 26784946 DOI: 10.1159/000442947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of tumor control (TC) in metastatic esophageal squamous cell carcinoma patients receiving first-line chemotherapy. METHODS A development cohort of 68 patients from a prospective multicenter trial (NCT01248299) was used to identify predictors of TC at first radiological tumor assessment and to generate a predictive score for TC. That score was applied in an independent retrospective single-center validation cohort of 60 consecutive patients. RESULTS Multivariate analysis identified three predictors of TC: body mass index ≥18.5 (OR 4.5, 95% CI 0.91-22.5), absence of bone metastasis (OR 4.6, 95% CI 0.91-23.2) and albumin ≥35 g/l (OR 3.5, 95% CI 1.0-12.1). Based on the presence or absence of these three independent prognosticators, we built a predictive model using a score from 0 to 3. In the development cohort, the TC rates were 14.3 and 78.0% and in the validation cohort 12.5 and 44.2%, for scores of 0-1 and 2-3, respectively. With negative predictive values of 85 and 88% in the development and validation cohorts, respectively, we were able to identify patients with a very low probability of TC. CONCLUSION We have developed and validated a score that can be easily determined at the bedside to predict TC in metastatic esophageal squamous cell carcinoma patients.
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Aparicio T, Bouche O, Francois E, Maillard E, Kirscher S, Taïeb J, Etienne PL, Faroux R, Khemissa F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, Bedenne L. PRODIGE 20: Bevacizumab + chemotherapy (BEV-CT) versus chemotherapy alone (CT) in elderly patients (pts) with untreated metastatic colorectal cancer (mCRC)—A randomized phase II trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
- Thomas Aparicio
- Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Emilie Maillard
- Biostatistic Unit, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | | | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
| | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | | | | | | | | | - Alice Oden-Gangloff
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University, Rouen, France
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Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Lang A, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, Van Laethem JL, Van Cutsem E, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, RezaieKalantari H, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Ychou M, Zawadi A, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche, Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, MatysiakBudnik T, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, GuenterDerigs H, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Labianca R, Colucci G, Amadori D, Mini E, Falcone A, Boni C, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Tabernero J, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, ValladaresAyerbes M, FeliuBatlle J, Gil S, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, CireraNogueras L, Merino B, Castro CG, de Prado PM, PijaumePericay C, ConstenlaFigueiras M, Jordan I, GomeReina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, MarcuelloGaspar E, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, GuillotMorales M, LlanosMuñoz M, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, HernandezBusquier I, Ruiz TC, LacastaMuñoa A, Aliguer M, Ortiz de Taranco AV, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, GalanBrotons A, AlbiolRodriguez S, Martinez JA, Ruiz LC, CentellesRuiz M, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prognostic value of KRAS mutations in stage III colon cancer: post hoc analysis of the PETACC8 phase III trial dataset. Ann Oncol 2015; 26:822-825. [DOI: 10.1093/annonc/mdv070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Guimbaud R, Louvet C, Ries P, Ychou M, Maillard E, André T, Gornet JM, Aparicio T, Nguyen S, Azzedine A, Etienne PL, Boucher E, Rebischung C, Hammel P, Rougier P, Bedenne L, Bouché O. Prospective, Randomized, Multicenter, Phase III Study of Fluorouracil, Leucovorin, and Irinotecan Versus Epirubicin, Cisplatin, and Capecitabine in Advanced Gastric Adenocarcinoma: A French Intergroup (Fédération Francophone de Cancérologie Digestive, Fédération Nationale des Centres de Lutte Contre le Cancer, and Groupe Coopérateur Multidisciplinaire en Oncologie) Study. J Clin Oncol 2014; 32:3520-6. [DOI: 10.1200/jco.2013.54.1011] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare epirubicin, cisplatin, and capecitabine (ECX) with fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatments in patients with advanced gastric or esophagogastric junction (EGJ) adenocarcinoma. Patients and Methods This open, randomized, phase III study was carried out in 71 centers. Patients with locally advanced or metastatic gastric or EGJ cancer were randomly assigned to receive either ECX as first-line treatment (ECX arm) or FOLFIRI (FOLFIRI arm). Second-line treatment was predefined (FOLFIRI for the ECX arm and ECX for the FOLFIRI arm). The primary criterion was time-to-treatment failure (TTF) of the first-line therapy. Secondary criteria were progression-free survival (PFS), overall survival (OS), toxicity, and quality of life. Results In all, 416 patients were included (median age, 61.4 years; 74% male). After a median follow-up of 31 months, median TTF was significantly longer with FOLFIRI than with ECX (5.1 v 4.2 months; P = .008). There was no significant difference between the two groups in median PFS (5.3 v 5.8 months; P = .96), median OS (9.5 v 9.7 months; P = .95), or response rate (39.2% v 37.8%). First-line FOLFIRI was better tolerated (overall rate of grade 3 to 4 toxicity, 69% v 84%; P < .001; hematologic adverse events [AEs], 38% v 64.5%; P < .001; nonhematologic AEs: 53% v 53.5%; P = .81). Conclusion FOLFIRI as first-line treatment for advanced gastric and EGJ cancer demonstrated significantly better TTF than did ECX. Other outcome results indicate that FOLFIRI is an acceptable first-line regimen in this setting and should be explored as a backbone regimen for targeted agents.
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Affiliation(s)
- Rosine Guimbaud
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Christophe Louvet
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pauline Ries
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Marc Ychou
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Emilie Maillard
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Thierry André
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Jean-Marc Gornet
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Thomas Aparicio
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Suzanne Nguyen
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Ahmed Azzedine
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pierre-Luc Etienne
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Eveline Boucher
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Christine Rebischung
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pascal Hammel
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Philippe Rougier
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Laurent Bedenne
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Olivier Bouché
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
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Adenis A, Dourthe LM, Mineur L, Tougeron D, Tournigand C, Etienne PL, Paule B, Laplaige P, Tresch E, Morère JF, Hollebecque A, Ferru A, Desseigne F, Malka D, Michel P, Arvis P, Clisant S, Phelip JM, De La Fouchardiere C, André T. Regorafenib (REG) in the real-life setting: First results from a large French compassionate-use program in patients (pts) with previously treated metastatic colorectal cancer (mCRC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antoine Adenis
- Medical Oncology Dpt, Centre Oscar Lambret, Lille, France
| | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | | | | | | | | | | | | | | | - Aurelie Ferru
- Department of Oncology, Poitiers University Hospital, Poitiers, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
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Metges JP, Ramée JF, Faroux R, Douillard JY, Porneuf M, Cumin I, Etienne PL, Gourlaouen A, Geslin G, Achour N, Soulie P, Le Bihan G, Le Roux C, Miglianico L, Deguiral P, Riche C, Marhuenda F, Deniel Lagadec D, Campion L, Grude F. FOLFIRINOX in first-line metastatic pancreatic cancer regimen (FLMPC): What profile of patients take a real advantage? Real world cohort from cancer observatory from Brittany and Pays de la Loire areas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christian Riche
- Observatory of Cancer Bretagne Pays de la Loire, Brest, France
| | - Fanny Marhuenda
- Observatoire dédié au Cancer Bretagne Pays de la Loire, Angers, France
| | | | - Loic Campion
- Institut de Cancérologie de l'Ouest René Gauducheau, Nantes Saint Herblain, France
| | - Francoise Grude
- Observatoire dédié au Cancer Bretagne Pays de Loire, Angers, France
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Mitry E, Lombard-Bohas C, Caroli-Bosc FX, Legoux JL, Ruszniewski PB, Seitz JF, Terrebonne E, Etienne PL, Rougier P, Brixi Benmansour H, Manfredi S, Michel P, Naman HL, Bouhier K, Dominguez S, Locher C, Abakar AM, Le Malicot K, Lepage C, Choukroun G. Renal effects of streptozocin: Preliminary results of the STREPTOTOX prospective study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | | | | | | | | | | | | | | | | | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | | | | | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | | | - Karine Le Malicot
- Fédération Francophone de la Cancérologie Digestive Faculté de Médecine, Dijon, France
| | - Come Lepage
- Centre Hospitalier Universitaire Bocage, Dijon, France
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Conroy T, Galais MP, Raoul JL, Bouché O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, François E, Créhange G, Abdelghani MB, Juzyna B, Bedenne L, Adenis A. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 2014; 15:305-14. [PMID: 24556041 DOI: 10.1016/s1470-2045(14)70028-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Definitive chemoradiotherapy is a curative treatment option for oesophageal carcinoma, especially in patients unsuitable for surgery. The PRODIGE5/ACCORD17 trial aimed to assess the efficacy and safety of the FOLFOX treatment regimen (fluorouracil plus leucovorin and oxaliplatin) versus fluorouracil and cisplatin as part of chemoradiotherapy in patients with localised oesophageal cancer. METHODS We did a multicentre, randomised, open-label, parallel-group, phase 2/3 trial of patients aged 18 years or older enrolled from 24 centres in France between Oct 15, 2004, and Aug 25, 2011. Eligible participants had confirmed stage I-IVA oesophageal carcinoma (adenocarcinoma, squamous-cell, or adenosquamous), Eastern Cooperative Oncology Group (ECOG) status 0-2, sufficient caloric intake, adequate haematological, renal, and hepatic function, and had been selected to receive definitive chemoradiotherapy. Patients were randomly assigned (1:1) to receive either six cycles (three concomitant to radiotherapy) of oxaliplatin 85 mg/m(2), leucovorin 200 mg/m(2), bolus fluorouracil 400 mg/m(2), and infusional fluorouracil 1600 mg/m(2) (FOLFOX) over 46 h, or four cycles (two concomitant to radiotherapy) of fluorouracil 1000 mg/m(2) per day for 4 days and cisplatin 75 mg/m(2) on day 1. Both groups also received 50 Gy radiotherapy in 25 fractions (five fractions per week). Random allocation to treatment groups was done by a central computerised randomisation procedure by minimisation, stratified by centre, histology, weight loss, and ECOG status, and was achieved independently from the study investigators. The primary endpoint was progression-free survival. Data analysis was primarily done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00861094. FINDINGS 134 participants were randomly allocated to the FOLFOX group and 133 to the fluorouracil and cisplatin group (intention-to-treat population), and 131 patients in the FOLFOX group and 128 in the fluorouracil and cisplatin group actually received the study drugs (safety population). Median follow-up was 25·3 months (IQR 15·9-36·4). Median progression-free survival was 9·7 months (95% CI 8·1-14·5) in the FOLFOX group and 9·4 months (8·1-10·6) in the fluorouracil and cisplatin group (HR 0·93, 95% CI 0·70-1·24; p=0·64). One toxic death occurred in the FOLFOX group and six in the fluorouracil-cisplatin group (p=0·066). No significant differences were recorded in the rates of most frequent grade 3 or 4 adverse events between the treatment groups. Of all-grade adverse events that occurred in 5% or more of patients, paraesthesia (61 [47%] events in 131 patients in the FOLFOX group vs three [2%] in 128 patients in the cisplatin-fluorouracil group, p<0·0001), sensory neuropathy (24 [18%] vs one [1%], p<0·0001), increases in aspartate aminotransferase concentrations (14 [11%] vs two [2%], p=0·002), and increases in alanine aminotransferase concentrations (11 [8%] vs two [2%], p=0·012) were more common in the FOLFOX group, whereas serum creatinine increases (four [3%] vs 15 [12%], p=0·007), mucositis (35 [27%] vs 41 [32%], p=0·011), and alopecia (two [2%] vs 12 [9%], p=0·005) were more common in the fluorouracil and cisplatin group. INTERPRETATION Although chemoradiotherapy with FOLFOX did not increase progression-free survival compared with chemoradiotherapy with fluorouracil and cisplatin, FOLFOX might be a more convenient option for patients with localised oesophageal cancer unsuitable for surgery. FUNDING UNICANCER, French Health Ministry, Sanofi-Aventis, and National League Against Cancer.
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Affiliation(s)
- Thierry Conroy
- Département d'Oncologie Médicale, Institut de Cancérologie de Lorraine and Lorraine University, Vandoeuvre-lès-Nancy, France.
| | | | - Jean-Luc Raoul
- Service d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Olivier Bouché
- Service d'Hépatogastroentérologie et de Cancérologie Digestive, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Sophie Gourgou-Bourgade
- Unité de Biométrie, Institut régional du Cancer de Montpellier - Val d'Aurelle, Montpellier, France
| | - Jean-Yves Douillard
- Institut de Cancérologie de l'Ouest - Centre René Gauducheau, Nantes Saint-Herblain, France
| | | | - Valérie Boige
- Service de Gastroentérologie, Institut Gustave Roussy, Villejuif, France
| | | | - Pierre Michel
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | | | - Eric François
- Pôle de Médecine, Centre Antoine Lacassagne, Nice, France
| | - Gilles Créhange
- Département de Radiothérapie, Centre Georges François Leclerc, Dijon, France
| | | | - Beata Juzyna
- R&D UNICANCER, Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France
| | - Laurent Bedenne
- Service Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire du Bocage, Dijon, France
| | - Antoine Adenis
- Département de Cancérologie Digestive et Urologique, Centre Oscar Lambret, Lille, France
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Adenis A, Bennouna J, Galais MP, Tresch E, Francois E, Etienne PL, Ben Abdelghani M, Michel P, Seitz JF, Conroy T, Ghiringhelli F, Bedenne L, Samalin E, Piessen G, Hiret S, Peugniez C, Herin H, Clisant S, Kramar A, Mariette C. Predictors of disease control in patients treated with platinum-based chemotherapies for metastatic squamous-cell esophageal cancer: First results of the e-DIS trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.95] [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
95 Background: There is little evidence that chemotherapy (CT) impacts on outcome of patients with MSEC. We designed an ongoing randomized phase 2 trial to detect a progression-free survival benefit of CT continuation over CT discontinuation in disease-controlled and ECOG≤2 patients at 6 weeks after an initial CT treatment. The aim of the present study was to identify predictors of disease control at 6 weeks (DC6wkx) in MSEC patients receiving platinum-based CTs as first-line treatment for metastatic disease. Methods: Among 68/70 evaluable patients included between 1/2011 and 7/2013 who received at least 1 CT cycle, 58 were evaluable for disease assessment at 6 weeks. Ten patients were not evaluable (early death: 4, patient’s decision: 2, concomitant disease 1, early progressive disease 1, other reasons: 2). Baseline demographic, clinical, biological, and tumor characteristics were tested for prediction of DC6wkx. Significant variables for DC6wkx were identified with the chi-squared test and logistic regression. Results: Baseline patients characteristics were as follows: median age: 61.5yo; male: 57/68; ECOG 0/1/2: 13/42/13; metachronous/synchronous MSEC: 38/30; number of metastatic sites 1/2/>2: 35/20/13; metastatic location: lung 36, liver 23, bone 11, nodes 37, other 11; prior exposure to CT: 37/68; time from previous CT exposure: ≤ 6m 6/37, 6-12m 14/37, > 12m 17/37; gr>2 dysphagia (Atkinson) 19/67; BMI<18.5kg/m²: 13/68. Current CTs were FU-CDDPq3w 2/68, LV5FU2-CDDPq2w 15/68, FOLFOX 51/68, and patients received the following number of cycles 1/2/>2: 5/7/54. DC6wkx rate was 65.7%, with 16/68 PR (23.5%) and 28/68 SD (42.2%). Albumin (p<0.01), BMI (p<0.02), bone metastases (p<0.005), gender (p<0.047) and ECOG status (p<0.05) were predictive of DC6wkx. Normal or overweight BMI, grade 0 albumin, and no bone metastases, were predictive of DC6wkx in multivariate analysis. Conclusions: DC at 6 wks was 65.7% in MSEC receiving platinum-based CTs as first line treatment for metastatic disease. Normal or overweight BMI, normal albumin, and the absence of bone metastasis were significant predictors of DC6wkx in this prospective phase 2 trial. Clinical trial information: NCT01248299.
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Affiliation(s)
| | - Jaafar Bennouna
- Institut de Cancerologie de l’Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | | | | | | | - Laurent Bedenne
- Federation Francophone de Cancerologie Digestive, Dijon, France
| | | | - Guillaume Piessen
- Department of Surgical Oncology, University Hospital of Lille, Lille, France
| | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | | | | | | | - Andrew Kramar
- Unite de Methodologie et Biostatistique, Centre Oscar Lambret, Lille, France
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Metges JP, Ramée JF, Douillard JY, Boucher E, Faroux R, Guerin-Meyer V, Cumin I, Miglianico L, Le Roux C, Dupuis O, Porneuf M, Lam YH, Achour N, Etienne PL, Cojocarasu O, Corbinais S, Deguiral P, Geslin G, Campion L, Grude F. Efficacy and safety of FOLFIRINOX in patients with metastatic pancreatic cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
305 Background: FOLFIRINOX, one of the gold standard in metastatic pancreatic cancer as first-line therapy for patients under 76 years with PS 0-1, good haematological and renal function and a subnormal bilirubin level (Prodige 4 criteria), was analysed in Brittany (B) and Pays de la Loire (PL) in routine clinical practice. Methods: Our aim is to evaluate the use of Folfirinox between July 2010 and December 2012 in B/PL. Results: Data of 340 patients have been studied (198 men, median age 63 years [29-81]). 208 patients were metastatic at diagnosis (liver 67%). 62 primary tumors were resected and 51 patients had received previous adjuvant chemotherapy (gemcitabine, n=48). The median progression free survival PFS and overall survival OS were respectively 6.80 months IC95% [6.18-7.43] and 10.97 months IC 95% [9.56-11.83]. Patients could be divided into 4 groups : Group 1 composed of patients treated according to Prodige 4 trial (n=242), Group 2 1st line metastatic patients with at least one Prodige 4 non-eligibility criterion (n=25), Group 3 locally advanced patients (n=59) and Group 4 by Folfirinox in 2ndline (n=14). The median number of cycles was 9 [1-27] in Group 1 and 6 [1-12] in Group 2. Clinical benefit was 65% (group 1) vs 56% (group 2). During treatment, 81% of patients had a dose adjustment (Group 1) vs 72% (Group 2) and 32% vs 40% presented grade III/IV toxicity (mostly neuro- or haematotoxicity). Median PFS were respectively in Group 1 vs Group 2 : 6.54 months IC95% [5.98-7.29] vs 4.14 [1.68-6.21] (p=0.0107) and median OS :10.91 months IC 95% [8.94-12.02] vs 7.0 IC95% [4.01-11.20] (p=0.0166). For Group 3 and 4, median OS were respectively 11.24 months [10.0-15.01] vs 11.50 [4.83-14.09]. Others results will be shown at the meeting. For Group 1, stopping treatment before progression induced significatively better median PFS and OS than going on treatment until progression : PFS : 8.25 IC95[7.52-8.74] vs 3.48. IC95 [3.09-4.44] (p<0.0001) and OS : 12.78 months IC95 [11.60-15.54] vs 7.62 IC95 [6.44-9.49] (p<0.0001). Conclusions: Our results for Group 1 are relatively consistent with those of Prodige 4: objective response rate (39% vs 32%), PFS (6.5 vs 6.4 months) and OS (10.9 vs 11.1 months). Non eligibity for Prodige 4’s criteria decreases PFS and OS significantly.
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Affiliation(s)
| | | | - Jean-Yves Douillard
- L'Institut de Cancérologie de l'Ouest Centre René Gauducheau, Saint-Herblain, France
| | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | | | | | | | - Olivier Dupuis
- Service de Radiothérapie, Clinique Victor Hugo, Le Mans, France
| | | | | | | | | | | | | | | | | | - Loic Campion
- L'Institut de Cancérologie de l'Ouest René Gauducheau, Nantes Saint Herblain, France
| | - Francoise Grude
- Observatoire dédié au Cancer B PL - ICO Centre Paul Papin, Angers, France
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Metges JP, Ramée JF, Faroux R, Douillard JY, Porneuf M, Cumin I, Etienne PL, Gourlaouen A, Geslin G, Achour N, Delalande AH, Soulie P, Le Bihan G, Le Roux C, Miglianico L, Deguiral P, Campion L, Riche C, Grude F. Efficacy and safety of FOLFIRINOX in patients with pancreatic metastatic cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
248 Background: Efficacy and safety of a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) is one of the gold standard in metastatic pancreatic cancer as first-line therapy for patients with PS 0-1, good haematological and renal function and a subnormal bilirubin level. Pending approval, this treatment has been allowed in Brittany (B) and Pays de la Loire (PL) respecting these criteria. Methods: Observatory of Cancer B/PL is a network of 50 private/public cancer centers focused on good practice for cancer drugs use. Our aim is to evaluate the use of FOLFIRINOX between July 2010 and June 2013 in B/PL. Sex, age, successive chemotherapeutic regimens, toxicities, response rate, progression free survival (PFS) and overall survival (OS) have been studied. Results: Data of 79 patients, treated in 2010 (37%), in 2011 (54%) or early 2012 (9%) have been studied (44 men, median age 62 years [37-74]). 64 patients were metastatic when cancer was diagnosed. Principal site of metastases was liver (73%). 17 primary tumors were resected and 15 patients received an adjuvant chemotherapy (gemcitabine (n=14)).The median number of treatment cycles was 9 [1-24]. Objective response was observed in 29 patients (37%), disease stabilization in 18 patients (23%) and progression in 18 patients (23%). During treatment, 75% of patients had a dose adjustment and 30 % had one or more dose delays. 22 patients presented grade III/IV toxicity (almost neurotoxicity or haematologic). 42 patients had a second line of treatment (mainly gemcitabine) and 7 patients a third line. The median PFS and OS were respectively 174 days IC95% [125-216] and 309 days IC 95% [229-376]. Conclusions: Our preliminary results are relatively convenient with those of Conroy et al in 2011. A higher rate of response (37% vs 32%) has been found. Concerning PFS and OS, our results are clearly worst with 174 vs 195 days and 309 vs 338 days. Our results confirm the aggressiveness of this schedule with 75% of the patients requiring a dose adjustement. Analysis of all pancreatic metastatic patients treated by FOLFIRINOX in B/PL by the Observatory of Cancer allows to assess its good use in the real life.
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Affiliation(s)
| | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Loic Campion
- ICO René Gauducheau, Nantes Saint Herblain, France
| | - Christian Riche
- Observatory of Cancer Bretagne Pays de la Loire, Brest, France
| | - Francoise Grude
- Observatory of Cancer Bretagne Pays de la Loire, Angers, France
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Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Lafay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Seitz JF, Bedenne L, Juzyna B, Conroy T. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol 2012; 30:4558-65. [PMID: 23109696 DOI: 10.1200/jco.2012.42.8771] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The ACCORD 12 trial investigated the value of two different preoperative chemoradiotherapy (CT-RT) regimens in T3-4 Nx M0 resectable rectal cancer. Clinical results are reported after follow-up of 3 years. PATIENTS AND METHODS Between November 2005 and July 2008, a total of 598 patients were randomly assigned to preoperative CT-RT with CAP45 (45-Gy RT for 5 weeks with concurrent capecitabine) or CAPOX50 (50-Gy RT for 5 weeks with concurrent capecitabine and oxaliplatin). Total mesorectal excision was planned 6 weeks after CT-RT. The primary end point was sterilization of the operative specimen, which was achieved in 13.9% versus 19.2% of patients, respectively (P = .09). Clinical results were analyzed for all randomly assigned patients according to the intention-to-treat principle. RESULTS At 3 years, there was no significant difference between CAP45 and CAPOX50 (cumulative incidence of local recurrence, 6.1% v 4.4%; overall survival, 87.6% v 88.3%; disease-free survival, 67.9% v 72.7%). Grade 3 to 4 toxicity was reported in four patients in the CAP45 group and in two patients in the CAPOX50 group. Bowel continence, erectile dysfunction, and social life disturbance were not different between groups. In multivariate analysis, the sterilization rate (Dworak score) of the operative specimen was the main significant prognostic factor (hazard ratio, 0.32; 95% CI, 0.21 to 0.50). CONCLUSION At 3 years, no significant difference in clinical outcome was achieved with the intensified CAPOX regimen. When compared with other recent randomized trials, these results indicate that concurrent administration of oxaliplatin and RT is not recommended.
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Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, Berille J, Bedenne L, Adenis A. Phase III randomized trial of definitive chemoradiotherapy (CRT) with FOLFOX or cisplatin and fluorouracil in esophageal cancer (EC): Final results of the PRODIGE 5/ACCORD 17 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba4003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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
LBA4003 Background: CRT is one of the best treatment options for localized EC. As new combinations are required to improve safety and survival, we launched a randomized phase II study to assess the complete response (CR) rate of CRT with FOLFOX versus 5FU/cisplatin in 97 pts with localized EC (Conroy 2010). The trial having met its objectives, it has been pursued as a phase III trial. Stratified randomization was performed centrally in a 1:1 ratio according to histological type, pretreatment weight loss in the prior 6 months (<10% vs ≥10%), ECOG PS (0 vs 1 vs 2), and center. Methods: Pts with technically unresectable cancer or those with surgical contraindications or who refused to undergo surgery were eligible. Eligibility criteria also included age >18 years (y), PS ≤ 2, previously untreated adenocarcinoma or squamous cell EC (any T, N0 or N1, M0 or M1a). The radiation dose was 50 Gy (2Gy/fr) 5 d/wk for 5 wks in both arms. In Arm A, pts received 6 bimonthly cycles (cy): oxaliplatin 85 mg/m2 d1 and leucovorin 200 mg/m2 followed by 5-FU 400 mg/m2 bolus d1 then 1,600 mg/m2 46h continuous infusion (ci) ; the first 3 cy were delivered during RT, the 3 other after. In Arm B, pts received 4 cy: cisplatin 75 mg/m2 d1 followed by 5FU 1,000 mg/m2/d ci d1-4, the first 2 cy during RT and 2 other after. The primary endpoint was PFS. Main secondary endpoints were OS, grade 3-4 toxicities, and quality of life. A total of 266 pts would provide 90% power to detect a 20% 3y-PFS difference (α=0.05). Results: 267 pts were enrolled between 10/2004 and 08/2011. Treatment cohorts were well balanced: male 81%; median age 61 y; PS 0 53%, squamous cell 85.8%, stage III 52%, IVA 6.0% and IVB 3.0%. Full treatment was delivered to 67.9% and 72.2% of pts in arms A/B, respectively. 7 toxic deaths occurred in each arm. Grade 3/4 toxicities per pt (%) in arms A/B were neutropenia 30.6/31.3, febrile neutropenia 5.3/7.0, anemia 5.4/11.0, asthenia 17.6/10.2, respectively. The median FU time was 25.3 mos. 3y-PFS was 18.2/17.4 % (HR=1.07; 95%CI =0.80-1.43) and median OS was 20.2 /17.5 m (HR=1.06; 95%CI =0.77-1.46). Conclusions: CRT with FOLFOX does not improve PFS compared to cisplatin and 5-FU and has similar toxicities.
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Affiliation(s)
| | | | | | | | | | | | | | - Valérie Boige
- Service de Gastro-Enterologie, Institut Gustave Roussy, Villejuif, France
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Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, Berille J, Bedenne L, Adenis A. Phase III randomized trial of definitive chemoradiotherapy (CRT) with FOLFOX or cisplatin and fluorouracil in esophageal cancer (EC): Final results of the PRODIGE 5/ACCORD 17 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba4003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4003 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Saturday, June 2, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | | | | | | | - Valérie Boige
- Service de Gastro-Enterologie, Institut Gustave Roussy, Villejuif, France
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Francois E, Azria D, Gourgou-Bourgade S, Martel-Lafay I, Hennequin C, Etienne PL, Vendrely V, Seitz JF, Conroy T, Juzyna B, Gerard JP. Influence of age on chemoradiotherapy outcome in patients with rectal cancer: Exploratory analysis from the phase III study ACCORD 12/0405 PRODIGE 2. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.550] [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
550 Background: Preoperative radiochemotherapy (RCT) is the standard of care for patients (pts) with locally advanced rectal adenocarcinoma. However elderly pts may have an increased risk of adverse events after combined modality treatment. The randomized trial ACCORD 12/0405 PRODIGE 2 compared 5 weeks of treatment with radiotherapy 45 Gy/25 fractions (f) with concurrent capecitabine 800 mg/m² twice daily 5 days per week (Cap 45) or radiotherapy 50 Gy/25 f with capecitabine 800 mg/m2 twice daily, 5 days per week and oxaliplatin 50 mg/m2 once weekly (Capox 50), results of efficacy (complete pathologic response) were not different between the two arms. We analyzed the results of RCT according to pts age. Methods: All eligible pts (n=584) were included in this exploratory analysis. Pts were divided in 2 groups: <70 y and ≥70 y. Toxicity and tumor regression scores were compared between the 2 groups. Results: 442 pts were <70 y and 142 were ≥70 y. Pts characteristics were well balanced between groups (gender, ECOG performance status, primary tumor, histology). Tolerance was worse in pts ≥70 y as shown in the table. Surgical procedures were not different between the 2 groups. Results on histological response were similar between the 2 groups: complete pathologic response was 16.9% (95% CI 13.1 to 20.2%) for pts <70 y and 14.7% (95% CI 9.2 to 21.8%) for pts ≥70 y, (p=0.55) and rates of R0 surgery for pts < 70 y and pts ≥ 70 y were respectively: 90.6% and 88.2%, (p=0.54). Conclusions: As tolerance of elderly pts treated with preoperative RTCT is worse than in younger pts, appropriate therapeutic schedule are warranted for these pts. [Table: see text]
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Affiliation(s)
- Eric Francois
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - David Azria
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Sophie Gourgou-Bourgade
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Isabelle Martel-Lafay
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Christophe Hennequin
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Pierre-Luc Etienne
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Veronique Vendrely
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Jean Francois Seitz
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Thierry Conroy
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Beata Juzyna
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
| | - Jean-Pierce Gerard
- Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Léon Bérard, Lyon, France; Hopital Saint-Louis, Paris, France; Clinique Armoricaine de Radiologie, Saint Brieuc, France; CHU Bordeaux, Bordeaux, France; La Timone University Hospital, Marseille, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; UNICANCER, Paris, France
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Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Montoto-Grillot C, Conroy T. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 2010; 28:1638-44. [PMID: 20194850 DOI: 10.1200/jco.2009.25.8376] [Citation(s) in RCA: 552] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Neoadjuvant chemoradiotherapy is considered a standard approach for T3-4 M0 rectal cancer. In this situation, we compared neoadjuvant radiotherapy plus capecitabine with dose-intensified radiotherapy plus capecitabine and oxaliplatin. PATIENTS AND METHODS We randomly assigned patients to receive 5 weeks of treatment with radiotherapy 45 Gy/25 fractions with concurrent capecitabine 800 mg/m(2) twice daily 5 days per week (Cap 45) or radiotherapy 50 Gy/25 fractions with capecitabine 800 mg/m(2) twice daily 5 days per week and oxaliplatin 50 mg/m(2) once weekly (Capox 50). The primary end point was complete sterilization of the operative specimen (ypCR). RESULTS Five hundred ninety-eight patients were randomly assigned to receive Cap 45 (n = 299) or Capox 50 (n = 299). More preoperative grade 3 to 4 toxicity occurred in the Capox 50 group (25 v 1%; P < .001). Surgery was performed in 98% of patients in both groups. There were no differences between groups in the rate of conservative surgery (75%) or postoperative deaths at 60 days (0.3%). The ypCR rate was 13.9% with Cap 45 and 19.2% with Capox 50 (P = .09). When ypCR was combined with yp few residual cells, the rate was respectively 28.9% with Cap 45 and 39.4% with Capox 50 (P = .008). The rate of positive circumferential rectal margins (between 0 and 2 mm) was 19.3% with Cap 45 and 9.9% with Capox 50 (P = .02). CONCLUSION The benefit of oxaliplatin was not demonstrated and this drug should not be used with concurrent irradiation. Cap 50 merits investigation for T3-4 rectal cancers.
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Dahan L, Bonnetain F, Rougier P, Raoul JL, Gamelin E, Etienne PL, Cadiot G, Mitry E, Smith D, Cvitkovic F, Coudert B, Ricard F, Bedenne L, Seitz JF. Phase III trial of chemotherapy using 5-fluorouracil and streptozotocin compared with interferon alpha for advanced carcinoid tumors: FNCLCC-FFCD 9710. Endocr Relat Cancer 2009; 16:1351-61. [PMID: 19726540 DOI: 10.1677/erc-09-0104] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this randomized multicenter phase III trial was to compare chemotherapy and interferon (IFN) in patients with metastatic carcinoid tumors. Patients with documented progressive, unresectable, metastatic carcinoid tumors were randomized between 5-fluorouracil plus streptozotocin (day 1-5) and recombinant IFN-alpha-2a (3 MU x 3 per week). Primary endpoint was progression-free survival (PFS). From February 1998 to June 2004, 64 patients were included. The two arms were well matched for median age, sex ratio, PS 0-1, previous chemotherapy, surgery, or radiotherapy. The median PFS for chemotherapy was 5.5 months versus 14.1 for IFN (hazard ratio=0.75 (0.41-1.36)). Overall survival (OS), tolerance, and effects on carcinoid symptoms were not significantly different. Despite a trend in favor of IFN, there was no difference in PFS and OS in advanced metastatic carcinoid tumors and therapeutic effect of both treatments was mild.
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Affiliation(s)
- Laetitia Dahan
- Assistance Publique, Hôpitaux de Marseille, Hôpital Timone, Université de la Méditerranée, CHU Timone, Marseille Cedex 5, France.
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Lombard-Bohas C, Mitry E, O'Toole D, Louvet C, Pillon D, Cadiot G, Borson-Chazot F, Aparicio T, Ducreux M, Lecomte T, Etienne PL, Cacheux W, Legoux JL, Seitz JF, Ruszniewski P, Chayvialle JA, Rougier P. Thirteen-month registration of patients with gastroenteropancreatic endocrine tumours in France. Neuroendocrinology 2009; 89:217-22. [PMID: 18719344 DOI: 10.1159/000151562] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 05/09/2008] [Indexed: 11/19/2022]
Abstract
The prevalence, clinical profiles and management of gastroenteropancreatic endocrine tumours (GEP) in France are not known. From August 1, 2001 to September 1, 2002, standardized records on patients with GEP were prospectively completed in 87 participating centres. The total group amounted to 668 patients (median age: 56 years, range: 12-89). WHO performance status was 0/1 for 80.2% of patients. The primary sites were the small bowel and colon (288), pancreas (211), unknown (77), stomach (33), non-digestive primary sites (24), appendix (20), rectum-anus (12), and oesophagus or cardia (3). GEP were functional in 260 patients (39%). Most pancreatic tumours were non-functional (72%). Metastatic disease was observed in 73.4% of cases. Most tumours (85.8%) were well or moderately differentiated. Somatostatin receptor scintigraphy was performed in only 55% of patients. The following treatment modalities were employed: resection of primary tumour: 66%; systemic chemotherapy: 41%; somatostatin analogues: 44 and 26% for GEP of small intestine and pancreas, respectively; interferon: 12%, and intra-arterial hepatic (chemo)embolization in 23 and 15% of GEP arising from the midgut and pancreas, respectively. Despite their low prevalence, well-differentiated GEP represent a significant and heterogeneous clinical group, which warrants improved medical education, referral to expert centres at an early stage, and the design of prospective therapeutic trials.
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de Gramont A, Buyse M, Abrahantes JC, Burzykowski T, Quinaux E, Cervantes A, Figer A, Lledo G, Flesch M, Mineur L, Carola E, Etienne PL, Rivera F, Chirivella I, Perez-Staub N, Louvet C, André T, Tabah-Fisch I, Tournigand C. Reintroduction of oxaliplatin is associated with improved survival in advanced colorectal cancer. J Clin Oncol 2007; 25:3224-9. [PMID: 17664470 DOI: 10.1200/jco.2006.10.4380] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE In the OPTIMOX1 trial, previously untreated patients with advanced colorectal cancer were randomly assigned to two different schedules of leucovorin, fluorouracil, and oxaliplatin that were administered until progression in the control arm or in a stop-and-go fashion in the experimental arm. The randomly assigned treatment groups did not differ significantly in terms of response rate, progression-free survival, and overall survival (OS). However, the impact of oxaliplatin reintroduction on OS was potentially masked by the fact that a large number of patients did not receive the planned oxaliplatin reintroduction or received oxaliplatin after second-line therapy in both treatment groups. PATIENTS AND METHODS A Cox model was fitted with all significant baseline factors plus time-dependent variables reflecting tumor progression, reintroduction of oxaliplatin, and use of second-line irinotecan. A shared frailty model was fitted with all significant baseline factors plus the number of lines of chemotherapy received by the patient and the percentage of patients with oxaliplatin reintroduction in the center. An adjusted hazard ratio (HR) was calculated for three reintroduction classes (1% to 20%, 21% to 40%, and > 40%), using centers with no reintroduction (0%) as the reference group. RESULTS Oxaliplatin reintroduction had an independent and significant impact on OS (HR = 0.56, P = .009). The percentage of patients with oxaliplatin reintroductions also had a significant impact on OS. Centers in which more than 40% of the patients were reintroduced had an adjusted HR for OS of 0.59 compared with centers in which no patient was reintroduced. CONCLUSION Oxaliplatin reintroduction is associated with improved survival in patients with advanced colorectal cancer.
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Mitry E, Ducreux M, Ould-Kaci M, Boige V, Seitz JF, Bugat R, Breau JL, Bouché O, Etienne PL, Tigaud JM, Morvan F, Cvitkovic E, Rougier P. Oxaliplatin combined with 5-FU in second line treatment of advanced pancreatic adenocarcinoma. Results of a phase II trial. ACTA ACUST UNITED AC 2006; 30:357-63. [PMID: 16633299 DOI: 10.1016/s0399-8320(06)73188-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy and benefit of second-line chemotherapy in advanced pancreatic adenocarcinoma has never been demonstrated although it is regularly used. PATIENTS AND METHODS A randomized phase II study evaluating oxaliplatin alone (OXA), infusional 5-fluorouracil alone (5-FU) and an oxaliplatin/infusional 5-FU combination (OXFU) in untreated advanced pancreatic adenocarcinoma has been conducted. In this trial, a second-line treatment with the OXFU regimen (OXA 130 mg/m2 2-h intravenous (i.v.) infusion combined with 5-FU (1000 mg/m2/day, continuous i.v., days 1-4), every 3 weeks) was offered to patients progressing after single agent treatment. RESULTS Eighteen out of 32 patients (12 males, median age 57 years) treated in the single agent arms received the OXFU combination in second-line treatment. WHO performance status was at least 2 in 61% of the patients. There was no objective response and 3 patients (17%) had a disease stabilisation. Median time to progression from the start of second-line treatment was 0.9 months. Median overall survival was 4.9 months from the start of front-line therapy and 1.3 months from the start of second-line therapy. CONCLUSION The results of this trial bring arguments to support a modest value of second-line chemotherapy for advanced pancreatic adenocarcinoma.
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Tournigand C, Cervantes A, Figer A, Lledo G, Flesch M, Buyse M, Mineur L, Carola E, Etienne PL, Rivera F, Chirivella I, Perez-Staub N, Louvet C, André T, Tabah-Fisch I, de Gramont A. OPTIMOX1: a randomized study of FOLFOX4 or FOLFOX7 with oxaliplatin in a stop-and-Go fashion in advanced colorectal cancer--a GERCOR study. J Clin Oncol 2006; 24:394-400. [PMID: 16421419 DOI: 10.1200/jco.2005.03.0106] [Citation(s) in RCA: 574] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In metastatic colorectal cancer, a combination of leucovorin (LV) and fluorouracil (FU) with oxaliplatin (FOLFOX) 4 is a standard first-line regimen. The cumulative neurotoxicity of oxaliplatin often requires therapy to be stopped in patients who are still responding. This study evaluates a new strategy of intermittent oxaliplatin treatment that is based on FOLFOX7, a simplified leucovorin and fluorouracil regimen with high-dose oxaliplatin. PATIENTS AND METHODS Previously untreated patients were randomly assigned to either FOLFOX4 administered every 2 weeks until progression (arm A) or FOLFOX7 for six cycles, maintenance without oxaliplatin for 12 cycles, and reintroduction of FOLFOX7 (arm B). RESULTS Six hundred twenty patients were enrolled, including an exploratory cohort of 95 elderly or poor prognosis patients. Median progression-free survival and survival times were 9.0 and 19.3 months, respectively, in patients allocated to arm A compared with 8.7 and 21.2 months, respectively, in patients allocated to arm B (P = not significant). Response rates were 58.5% with arm A and 59.2% with arm B. National Cancer Institute Common Toxicity Criteria grade 3 or 4 toxicity was observed in 54.4% of the patients in arm A v 48.7% of patients in arm B. From cycle 7, fewer patients experienced grade 3 or 4 toxicity in arm B. Grade 3 sensory neuropathy was observed in 17.9% of the patients in arm A v 13.3% of patients in arm B (P = .12). In arm B, oxaliplatin was reintroduced in only 40.1% of the patients but achieved responses or stabilizations in 69.4% of these patients. CONCLUSION Oxaliplatin can be safely stopped after six cycles in a FOLFOX regimen. Further study is needed to fully evaluate oxaliplatin reintroduction.
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Lutz MP, Van Cutsem E, Wagener T, Van Laethem JL, Vanhoefer U, Wils JA, Gamelin E, Koehne CH, Arnaud JP, Mitry E, Husseini F, Reichardt P, El-Serafi M, Etienne PL, Lingenfelser T, Praet M, Genicot B, Debois M, Nordlinger B, Ducreux MP. Docetaxel plus gemcitabine or docetaxel plus cisplatin in advanced pancreatic carcinoma: randomized phase II study 40984 of the European Organisation for Research and Treatment of Cancer Gastrointestinal Group. J Clin Oncol 2006; 23:9250-6. [PMID: 16361622 DOI: 10.1200/jco.2005.02.1980] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To define the efficacy and toxicity of docetaxel plus gemcitabine or docetaxel plus cisplatin for advanced pancreatic carcinoma. PATIENTS AND METHODS Chemotherapy-naive patients with measurable disease and WHO performance status less than 2 were randomly assigned to receive 21-day cycles of gemcitabine 800 mg/m2 on days 1 and 8 plus docetaxel 85 mg/m2 on day 8 (arm A) or docetaxel 75 mg/m2 on day 1 plus cisplatin 75 mg/m2 on day 1 (arm B). Primary end points were tumor response and rate of febrile neutropenia grade. RESULTS Of 96 randomly assigned patients (49 patients in arm A and 47 patients in arm B), 70 patients were analyzed for response (36 in arm A and 34 in arm B) and 89 patients were analyzed for safety (45 in arm A and 44 in arm B). Confirmed responses were observed in 19.4% (95% CI, 8.2% to 36.0%) of patients in arm A and 23.5% (95% CI, 10.7% to 41.2%) in arm B. In arm A, the median progression-free survival (PFS) was 3.9 months (95% CI, 3.0 to 4.7 months), median survival was 7.4 months (95% CI, 5.6 to 11.0 months), and 1-year survival was 30%. In arm B, the median PFS was 2.8 months (95% CI, 2.6 to 4.6 months), median survival was 7.1 months (95% CI, 4.8 to 8.7 months), and 1-year survival was 16%. Febrile neutropenia occurred in 9% and 16% of patients in arms A and B, respectively. CONCLUSION Both regimens are well tolerated and show activity in advanced pancreatic carcinoma. The safety profile and survival analyses favor docetaxel plus gemcitabine for further evaluation.
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Conroy T, Gory-Delabaere G, Adenis A, Bosquet L, Bouché O, Louvet C, Mitry E, Bécouarn Y, Bosset JF, Ducreux M, Etienne PL, Merrouche Y, Monges G, Rougier P. [Clinical practice guideline: 2003 update of Standards, Options et Recommendations for first line palliative chemotherapy in patients with metastatic colorectal cancer (summary report)]. Bull Cancer 2004; 91:759-68. [PMID: 15556876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES To update clinical practice guidelines for first line palliative chemotherapy in patients with metastatic colorectal cancer previously validated in 1995, then updated in 1997 and published again in 1998. These recommendations do not cover second line treatment. METHODS The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers. RESULTS This article is a summary version of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concerned (1) Which patients should be treated? (2) What is the best treatment duration? (3) Which treatment should be administered? The new data identified concerning which patients to treat and the duration of treatment were consistent with the data presented in the initial report and did not modify the original recommendations from 1997. The new data available represent stronger evidence than those in the original report (Two good-quality meta-analyses published since 1997). A new guideline concerning patients who are 75 years old or more has been added. Concerning, the new evidence identified has modified the guidelines for the therapeutic schema to adopt from 1997. These modifications concern irinotecan, oxaliplatin, oral fluoropyrimidines and methotrexate. Treatment with irinotecan or oxaliplatin associated with continuous 5FU infusion, modulated with folinic acid (LV5FU2-like) has become a standard. The use of oral fluoropyrimidines has become an option for patients who refuse hospitalisation or treatment by infusion. The use of methotrexate combined with 5FU is no longer recommended.
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Ducreux M, Mitry E, Ould-Kaci M, Boige V, Seitz JF, Bugat R, Breau JL, Bouché O, Etienne PL, Tigaud JM, Morvan F, Cvitkovic E, Rougier P. Randomized phase II study evaluating oxaliplatin alone, oxaliplatin combined with infusional 5-FU, and infusional 5-FU alone in advanced pancreatic carcinoma patients. Ann Oncol 2004; 15:467-73. [PMID: 14998850 DOI: 10.1093/annonc/mdh098] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A randomized phase II, open-label multicenter study evaluating oxaliplatin alone (OXA), infusional 5-fluorouracil alone (5-FU) and an oxaliplatin/infusional 5-FU combination (OXFU) in untreated, advanced pancreatic carcinoma (APC). PATIENTS AND METHODS Chemotherapy-naïve patients with advanced or metastatic, histologically/cytologically proven pancreatic carcinoma with measurable disease, received OXA [130 mg/m2, 2-h intravenous (i.v.) infusion] alone, OXA combined with 5-FU (1000 mg/m2/day, continuous i.v., days 1-4), or 5-FU alone, every 3 weeks. RESULTS Sixty-three patients (42 males/21 females) were treated: 17 patients/52 cycles OXA, 31 patients/ 175 cycles OXFU, 15 patients/41 cycles 5-FU, with a median of three, six and two cycles/patient, respectively. Patient characteristics were similar in all arms. Median age was 57 years (range 21-75), and 83% of patients had PS 0-1. Most patients (62%) had moderate to well-differentiated tumors, 90% had metastatic disease, 81% with liver metastases. All responses (three partial responses; WHO) occurred in the OXFU arm (10% response rate). Five of 32 patients evaluable for clinical benefit were responders (OXA, 14%; OXFU, 21%). Median time to progression and overall survival were higher in the combination arm (4.2 and 9.0 months, respectively) than either single-agent arm (OXA, 2.0 and 3.4 months; 5-FU, 1.5 and 2.4 months, respectively). Moderate hematotoxicity without morbidity was seen in all arms. Two OXFU patients had grade 3 oxaliplatin neurosensory toxicity. CONCLUSIONS With a 10% response rate, median overall survival of 9 months and an encouraging safety profile, the OXFU combination is effective, appears superior to infusional 5-FU and warrants further studies in APC patients.
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Affiliation(s)
- M Ducreux
- Institut Gustave Roussy, Villejuif, France
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