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Sterlé M, Puszkiel A, Burlot C, Pereira E, Bellesoeur A, De Percin S, Beinse G, Fumet JD, Favier L, Niogret J, Blanchet B, Royer B, Bengrine-Lefevre L, Schmitt A. Improving olaparib exposure to optimize adverse effects management. Ther Adv Med Oncol 2024; 16:17588359241248328. [PMID: 38665845 PMCID: PMC11044803 DOI: 10.1177/17588359241248328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Background Olaparib is an inhibitor of the human poly-(ADP-ribose)-polymerase enzymes (PARP1/2) needed to repair single-strand DNA breaks. It is used in breast, ovarian, prostate and pancreatic cancer. Objectives This work aimed to describe the pharmacokinetics/pharmacodynamics (PK/PD) relationship between olaparib plasma concentrations and common adverse effects (i.e. anaemia and hypercreatininaemia), in a real-life setting, to propose a target concentration for therapeutic drug monitoring. Methods Two PK/PD models describing the evolution of haemoglobinaemia and creatininaemia as a function of time were developed, based on data from, respectively, 38 and 37 patients receiving olaparib. The final model estimates were used to calculate the incidence of anaemia and creatinine increase according to plasma trough concentrations for 1000 virtual subjects to define target exposure. Results The final models correctly described the temporal evolution of haemoglobinaemia and creatininaemia for all patients. The haemoglobinaemia PK/PD model is inspired by Friberg's model, and the creatininaemia PK/PD model is an indirect response model. Model parameters were in agreement with physiological values and close to literature values for similar models. The mean (population) plasma haemoglobin concentration at treatment initiation, as estimated by the model, was 11.62 g/dL, while creatinine concentration was 71.91 µmol/L. Using simulations, we have identified a target trough concentration of 3500-4000 ng/mL, above which more than 20% of patients would report grade ≥3 anaemia. Conclusion Based on real-world data, we were able to properly describe the time course of haemoglobinaemia and plasma creatininaemia during olaparib treatment.
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Affiliation(s)
- Marylise Sterlé
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Alicja Puszkiel
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, UMR-S1144, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Chloé Burlot
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Eva Pereira
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Bellesoeur
- Institut Curie, Département d’Oncologie Médicale, Paris, France
- Institut Curie, Département de Radio-Pharmacologie, Saint-Cloud, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | | | - Guillaume Beinse
- Oncology Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Cordeliers Research Center, Paris-Sorbonne University, INSERM, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization, Paris, France
| | - Jean-David Fumet
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Laure Favier
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Julie Niogret
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Benoit Blanchet
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Bernard Royer
- Pharmacology and Toxicology Laboratory, CHRU Besançon, Besançon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Leïla Bengrine-Lefevre
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, 1 rue Pr Marion, Dijon 21079, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, France
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Tardy C, Puszkiel A, Boudou-Rouquette P, De Percin S, Alexandre J, Berge M, Ulmann G, Blanchet B, Batista R, Goldwasser F, Thomas Schoemann A. Pazopanib pharmacokinetically guided dose optimization in three cancer patients with gastrointestinal resection. Cancer Chemother Pharmacol 2024; 93:169-175. [PMID: 37620675 DOI: 10.1007/s00280-023-04574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Pazopanib is approved in advanced renal cell carcinoma (RCC) and soft-tissue sarcoma at a flat-fixed dose despite a large pharmacokinetics interindividual variability and a narrow therapeutic index. To our knowledge, pazopanib exposure in patients with gastrointestinal resections (GIR) has not been described. This report focuses on feasibility of pharmacokinetics-guided dose escalation in these patients and clinical implications for their management. METHOD A retrospective data collection was performed for three patients with GIR treated with pazopanib, including pazopanib plasma concentrations (high-performance liquid chromatography with UV detection) and treatment adherence (Girerd score). CASE PRESENTATION First patient (55-year-old man, RCC, gastric bypass surgery) pazopanib Cmin,ss at day 39 was 4.1 mg/L. Dose escalation to 1800 mg/day fractionated allowed to reach Cmin,ss of 18.5 mg/L (target threshold in RCC patients: 20.5 mg/L). Patient 2 (50-year-old woman, metastatic myxofibrosarcoma, gastric band) showed Cmin,ss of 4.0 mg/L at day 13. In patient 3 (49-year-old man, gastric malignant peripheral nerve sheath tumor, gastrectomy), Cmin,ss at day 13 was 2.7 mg/L. For these two patients, intake with food and dose fractioning only slightly increased pazopanib Cmin,ss to 12.0 mg/L and 6.5 mg/L, respectively (therapeutic threshold in sarcoma patients: 27 mg/L). Treatment adherence was good in all patients. CONCLUSION Optimal pazopanib exposure cannot be achieved in patients with GIR, and thus, other therapeutic strategies should be encouraged. Pretherapeutic assessment seems crucial to evaluate factors as bariatric surgery that may impact pazopanib concentrations. Therapeutic drug monitoring could be helpful to optimize pazopanib response in these patients.
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Affiliation(s)
- Cléa Tardy
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France.
| | - Alicja Puszkiel
- Biologie du Médicament-Toxicologie, Cochin Hospital (AP-HP), Paris, France
- INSERM UMR-S1144, Université Paris Cité, Paris, France
| | | | | | - Jérôme Alexandre
- Oncology Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Centre de Recherche des Cordeliers, Université Paris-Sorbonne, INSERM, 75005, Paris, France
| | - Marion Berge
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
| | | | - Benoit Blanchet
- Biologie du Médicament-Toxicologie, Cochin Hospital (AP-HP), Paris, France
| | - Rui Batista
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
| | | | - Audrey Thomas Schoemann
- Pharmacy Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Université Paris Cité, UMR 8038 CNRS, CiTCom, INSERM U1268, 75006, Paris, France
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Tlemsani C, Larousserie F, De Percin S, Audard V, Hadjadj D, Chen J, Biau D, Anract P, Terris B, Goldwasser F, Pasmant E, Boudou-Rouquette P. Biology and Management of High-Grade Chondrosarcoma: An Update on Targets and Treatment Options. Int J Mol Sci 2023; 24:ijms24021361. [PMID: 36674874 PMCID: PMC9862566 DOI: 10.3390/ijms24021361] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
This review provides an overview of histopathology, clinical presentation, molecular pathways, and potential new systemic treatments of high-grade chondrosarcomas (CS), including grade 2−3 conventional, dedifferentiated, and mesenchymal CS. The diagnosis of CS combines radiological and histological data in conjunction with patient clinical presentations. Conventional CS is the most frequent subtype of CS (85%) and represents about 25% of primary bone tumors in adults; they can be categorized according to their bone location into central, peripheral, and periosteal chondrosarcomas. Central and peripheral CS differ at the molecular level with either IDH1/2 mutations or EXT1/2 mutations, respectively. CDKN2A/B deletions are also frequent in conventional CS, as well as COL2A1 mutations. Dedifferentiated CS develops when low-grade conventional CS transforms into a high-grade sarcoma and most frequently exhibits features of osteosarcoma, fibrosarcoma, or undifferentiated pleomorphic sarcoma. Their molecular characteristics are similar to conventional CS. Mesenchymal CS is a totally different pathological entity exhibiting recurrent translocations. Their clinical presentation and management are different too. The standard treatment of CSs is wide en-bloc resection. CS are relatively radiotherapy resistant; therefore, doses >60 Gy are needed in an attempt to achieve local control in unresectable tumors. Chemotherapy is possibly effective in mesenchymal chondrosarcoma and is of uncertain value in dedifferentiated chondrosarcoma. Due to resistance to standard anticancer agents, the prognosis is poor in patients with metastatic or unresectable chondrosarcomas. Recently, the refined characterization of the molecular profile, as well as the development of new treatments, allow new therapeutic options for these rare tumors. The efficiency of IDH1 inhibitors in other malignancies suggests that these inhibitors will be part of IDH1/2 mutated conventional CS management soon. Other treatment approaches, such as PIK3-AKT-mTOR inhibitors, cell cycle inhibitors, and epigenetic or immune modulators based on improving our understanding of CS molecular biology, are emerging.
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Affiliation(s)
- Camille Tlemsani
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Frédérique Larousserie
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Sixtine De Percin
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Virginie Audard
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Djihad Hadjadj
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Jeanne Chen
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - David Biau
- Department of Orthopedic Surgery, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Philippe Anract
- Department of Orthopedic Surgery, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Eric Pasmant
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- Department of Genetics, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Université Paris Cité, APHP.Centre, 75014 Paris, France
- Correspondence: ; Tel.: +33-1-58-41-23-30; Fax: +33-1-58-41-14-34
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Boudou-Rouquette P, Arrondeau J, Gervais C, Durand JP, Fabre E, De Percin S, Villeminey CV, Piketty AC, Rassy N, Ulmann G, Damotte D, Mansuet-Lupo A, Giraud F, Alifano M, Wislez M, Alexandre J, Jouinot A, Goldwasser F. Development and validation of a host-dependent, PDL1-independent, biomarker to predict 6-month progression-free survival in metastatic non-small cell lung cancer (mNSCLC) patients treated with anti-PD1 immune checkpoint inhibitors (ICI) in the CERTIM Cohort: The ELY study. EBioMedicine 2021; 73:103630. [PMID: 34688030 PMCID: PMC8536532 DOI: 10.1016/j.ebiom.2021.103630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICI) are dramatically active in a minority of non-small cell lung cancer (NSCLC) patients. We studied here the relationship between patients's metabolism and outcome under ICI. Methods Metastatic NSCLC patients underwent a nutritional assessment prior to initiating immunotherapy. Resting energy expenditure (REE) was measured (mREE) using ambulatory indirect calorimetry and compared with the theoretical value (tREE) provided by the Harris and Benedict formula. The primary endpoint was 6-month progression-free survival (PFS). Secondary endpoints included objective response rate (ORR) and disease control rate (DCR) based on investigator review per RECIST v1.1. and overall survival (OS). The association of patient's metabolism with 6-month PFS was first explored in a single-center training cohort to estimate the effect size. The relationship between patient's metabolism and 6-month PFS was then tested in an independent non interventional observational prospective cohort (ELY) of 100 patients recruited in two tertiary university centers. Findings In the entire cohort, the ORR was 14% for the hypermetabolic group (n = 10/74) vs 38% for the normometabolic group (n = 26/68), respectively (estimated difference 25%, 95CI 9–40%, p = 0.001). The DCR was 28% for the hypermetabolic group (n = 21/74) vs 53% for the normometabolic group (n = 36/68), respectively (estimated difference 25%, 95CI 7–42%, p = 0.005). In the validation cohort (100 patients, 2 centers), normometabolic patients (defined as mREE/tREE < 110%) had increased 6-month PFS (57% versus 22%; odds ratio: 4.76; IC95 [1.87 – 12.89]; p<0.001) and improved overall survival (HR 2.20; IC95: 1.41–3.44; p<0.001). The positive and negative predictive values of normometabolism to identify non-progressive patients at 6 months, were 57% and 78% respectively, sensitivity was 72% and specificity was 66%. In multivariate analysis including PD-L1 tumor status, basal metabolism was an independent predictive factor for 6-month PFS. Interpretation Normometabolism is a new independent parameter to identify mNSCLC patients who will benefit from ICI, with both improved tumor response, 6-month PFS, and survival. Funding This work was supported by Baxter (04012016).
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France.
| | - Jennifer Arrondeau
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Claire Gervais
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France
| | - Jean-Philippe Durand
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Thoracic Oncology Department, Hôpital Européen Georges Pompidou (HEGP), AP-HP; Cancer Research for PErsonalized Medicine (CARPEM); Paris University, France
| | - Elizabeth Fabre
- Thoracic Oncology Department, Hôpital Européen Georges Pompidou (HEGP), AP-HP; Cancer Research for PErsonalized Medicine (CARPEM); Paris University, France
| | - Sixtine De Percin
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Clémentine Vaquin Villeminey
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne-Catherine Piketty
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Nathalie Rassy
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France
| | - Guillaume Ulmann
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Clinical Chemistry, Cochin Hospital, AP-HP, Paris University, France; URP 4466 PRETRAM, AP-HP, Paris University, France
| | - Diane Damotte
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pathology Department, Cochin Hospital, AP-HP, Paris University, France; Centre de recherche des Cordeliers, INSERM U1138, Paris University, France
| | - Audrey Mansuet-Lupo
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pathology Department, Cochin Hospital, AP-HP, Paris University, France; Centre de recherche des Cordeliers, INSERM U1138, Paris University, France
| | - Frédérique Giraud
- Molecular Genetics Department, Cochin Hospital, AP-HP, Paris University, France
| | - Marco Alifano
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Thoracic Surgery Department, Cochin Hospital, AP-HP, Paris University, France
| | - Marie Wislez
- Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; Pneumology Department, Cochin Hospital, AP-HP, Paris University, France
| | - Jérôme Alexandre
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France
| | - François Goldwasser
- Medical Oncology Department, Cochin Hospital, AP-HP; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Cochin Hospital, AP-HP, 75014 Paris, France; URP 4466 PRETRAM, AP-HP, Paris University, France
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Tlemsani C, Arrondeau J, De Percin S, Gataa I, Bretagne M, Ajgal Z, Huillard O, Wislez M, Coriat R, Alexandre J, Boudou-Rouquette P, Goldwasser F. Impact of the COVID-19 pandemic on the management of cancer patients: the experience of the cancer outpatients department of a university hospital in Paris. Clin Med (Lond) 2021; 21:e552-e555. [PMID: 38594868 DOI: 10.7861/clinmed.2020-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer patients are a highly vulnerable group in the COVID-19 pandemic and it has been necessary for oncology units to adapt to this unexpected situation. We present our management of outpatients with cancer during the pandemic. We applied two major adaptations: extending the intervals between injections for maintenance therapy and protocol adaptation for patients with comorbidities. Between 17 March and 30 April 2020, 406 patients were treated in our outpatients department. Protocols were adapted for 94 (23.1%) patients. Among them, 49% had an extended interval between treatment administrations, 22.3% had modified protocols to reduce toxicity, 20.2% had therapeutic interruptions and 5.3% did not receive their treatment because of a COVID-19 infection. Overall, protocol adaptations concerned more than 20% of the patients. This pandemic was an opportunity for oncologists to re-examine the risk versus benefit balance of administering immunosuppressive treatment and highlighted that oncology daily routine should not be applied automatically.
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6
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Fayet Y, Tétreau R, Honoré C, Le Nail LR, Dalban C, Gouin F, Causeret S, Piperno-Neumann S, Mathoulin-Pelissier S, Karanian M, Italiano A, Chaigneau L, Gantzer J, Bertucci F, Ropars M, Saada-Bouzid E, Cordoba A, Ruzic JC, Varatharajah S, Ducimetière F, Chabaud S, Dubray-Longeras P, Fiorenza F, De Percin S, Lebbé C, Soibinet P, Michelin P, Rios M, Farsi F, Penel N, Bompas E, Duffaud F, Chevreau C, Le Cesne A, Blay JY, Le Loarer F, Ray-Coquard I. Determinants of the access to remote specialised services provided by national sarcoma reference centres. BMC Cancer 2021; 21:631. [PMID: 34049529 PMCID: PMC8164290 DOI: 10.1186/s12885-021-08393-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. Methods Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. Results Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. Conclusions In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.
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Affiliation(s)
- Yohan Fayet
- Equipe EMS - Département de Sciences Humaines et Sociales, Centre Léon Bérard, F-69008, Lyon, France. .,Univ Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France.
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, Montpellier, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculte de médecine, Université de Tours, Tours, France
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Sylvain Causeret
- Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | | | - Simone Mathoulin-Pelissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000, Bordeaux, France.,Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, F-33000, Bordeaux, France
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, Lyon, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France
| | | | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mickael Ropars
- Orthopaedic and trauma department, Rennes1 University Pontchaillou University Hospital, Rennes, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, University Côte d'Azur, Centre Antoine Lacassagne, Nice, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | | | | | | | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Fabrice Fiorenza
- Department of Orthopedics Traumatology, CHU de Dupuytren, F-87042, Limoges, France
| | - Sixtine De Percin
- Medical Oncology Department, Hôpital Cochin; AP-HP, Cancer Research for PErsonalized Medicine (CARPEM); Paris University, Paris, France
| | - Céleste Lebbé
- AP-HP Dermatology Department, Saint-Louis Hospital, INSERM U976, Université de Paris Diderot, Paris, France
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Paul Michelin
- Department of Radiology and Medical Imaging, CHU-hôpitaux de Rouen, Rouen, France
| | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Fadila Farsi
- CRLCC Léon Berard - Lyon, Oncology Regional Network ONCO-AURA, Lyon, France
| | - Nicolas Penel
- Lille University Medical School and Centre Oscar Lambret, Lille, France
| | - Emmanuelle Bompas
- Medical Oncology Department, ICO, Saint Herblain, Pays de la Loire, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), Marseille, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR IUCT- Oncopole Toulouse, Toulouse, France
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - Jean-Yves Blay
- Departement of Medical Oncology, Centre Léon Bérard, Université de Lyon and Unicancer Paris, Lyon, France
| | | | - Isabelle Ray-Coquard
- Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France.,Department of Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France
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Boudou-Rouquette P, Gataa I, De Percin S, Tlemsani C, Biau D, Dumaine V, Audard V, Larousserie F, Anract P, Jouinot A, Goldwasser F. Abstract 3721: Relationship between insulin resistance and chemosensitivity of high grade bone sarcoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant chemotherapy with intercalated surgery is the standard of care for resectable high-grade bone sarcoma (BS) but identification of biomarkers for chemosensitivity prediction is still needed. Insulin-like Growth Factor (IGF) pathway was first linked with sarcoma biology approximately 30 years ago (El-Brady OM, 1990).
Methods: We recruited 138 pts with newly diagnosed primary localized or metastatic BS. We measured fasting blood glucose and insulin, body mass index (BMI). The HOMA-IR (Homeostasis Model Assessment) score ((Glucose (mmol/l) x Insulin) / 22.5), which has been proven to reliably detect insulin resistance IR was calculated, and patients with HOMA-IR > 2.6 were considered as IR. We collected characteristics usually associated with insulin resistance: age, obesity, diabetes, dyslipidemia and hypertension.
Results: Out of 138 pts, 50 (36%) were insulin resistant: HOMA-IR >2.6. Thirty-two IR patients (64%) had no cardiovascular risk factor. In univariate analysis, IR was associated with obesity (BMI > 30 kg/m2)(22% vs 3%, p=0.0015), but not with age (median 36,8 vs 41 years, p=0.19). IR was more prevalent in Ewing sarcoma (14/29; 48%) and chondrosarcoma (7/16; 44%) followed by osteosarcoma (25/67; 37%) and other rare bone sarcomas (4/26; 15.3%), but not significantly (p=0.097). After neoadjuvant chemotherapy and surgery of Ewing tumor and osteosarcoma, pathologic tumor necrosis was higher in IR pts (88.9 vs 75%, p= 0.028).
Conclusion: Our results suggest that metabolic profile may help to discriminate best candidates for neoadjuvant chemotherapy in high-grade bone sarcomas. Further studies are needed to confirm and explain these results.
Citation Format: Pascaline Boudou-Rouquette, Ithar Gataa, Sixtine De Percin, Camille Tlemsani, David Biau, Valerie Dumaine, Virginie Audard, Frédérique Larousserie, Philippe Anract, Anne Jouinot, François Goldwasser. Relationship between insulin resistance and chemosensitivity of high grade bone sarcoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3721.
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Boudou-Rouquette P, Gataa I, Jouinot A, De Percin S, Bellesoeur A, Alexandre J, Dumaine V, Babinet A, Biau D, Audard V, Larousserie F, Anract P, Tlemsani C, Goldwasser F. Metabolic profile and neoadjuvant chemotherapy sensitivity in high-grade bone sarcoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e22506] [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
e22506 Background: Neoadjuvant chemotherapy with intercalated surgery is the standard of care for resectable high-grade bone sarcoma (BS) but identification of biomarkers for chemosensitivity prediction is still needed. Methods: We recruited 121 pts with new primary localized or metastatic BS, measured fasting blood glucose and insulin, body mass index (BMI). The HOMA-IR (Homeostasis Model Assessment) score ((Glucose (mmol/l) x Insulin) / 22.5), which has been proven to reliably detect insulin resistance was calculated, and patients with HOMA-IR > 2.6 were considered as insulin resistant (IR). We collected characteristics usually associated with insulin resistance (IR): age, obesity, diabetes, dyslipidemia and hypertension. Results: Out of 121 pts, 48 (40%) were IR: HOMA-IR > 2.6. Thirty IR patients (62%) had no cardiovascular risk factor. In univariate analysis, IR was associated with obesity (BMI > 30 kg/m2)(23% vs 3%, p = 0.0013), but not with age (median 38.4 vs 43.3 years, p = 0.15). IR was more prevalent in Ewing sarcoma (12/21; 57%) and chondrosarcoma (7/13; 54%) followed by osteosarcoma (25/61; 41%) and other rare bone sarcomas (4/26; 15.3%)(p = 0.037). After preoperative chemotherapy and surgery of Ewing tumor and osteosarcoma, pathologic tumor necrosis was higher in IR pts (85.8 vs 69.3%, p = 0.012). Using multivariate linear regression models, IR was independently associated with pathologic tumor necrosis (p = 0.042) but not with obesity (p = 0.55). Conclusions: Our results suggest that tumor-induced metabolic profile may help to discriminate best candidates for preoperative chemotherapy in high-grade bone sarcomas. Further studies are needed to confirm and explain these results.
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Paris, France
| | - Ithar Gataa
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, France, Paris, France
| | - Anne Jouinot
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, France, Paris, France
| | - Sixtine De Percin
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, France, Paris, France
| | - Audrey Bellesoeur
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Paris, France
| | - Jerome Alexandre
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, France, Paris, France
| | - Valérie Dumaine
- Department of Orthopedic surgery, Paris Descartes University, Cochin-Port-Royal Hospital, AP-HP, France, Paris, France
| | - Antoine Babinet
- Department of Orthopedic surgery, Paris Descartes University, Cochin-Port-Royal Hospital, AP-HP, France, Paris, France
| | - David Biau
- Chirurgie orthopédique - Hôpital Cochin-Université Paris-Descartes, Paris, France
| | - Virginie Audard
- Department of Pathology, Paris Descartes University, Cochin-Port-Royal Hospital, AP-HP, France, Paris, France
| | | | | | - Camille Tlemsani
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Paris, France
| | - Francois Goldwasser
- Department of Medical Oncology, ARIANE, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Paris, France
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