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Corbaux P, Bayle A, Besle S, Vinceneux A, Vanacker H, Ouali K, Hanvic B, Baldini C, Cassier PA, Terret C, Verlingue L. Patients' selection and trial matching in early-phase oncology clinical trials. Crit Rev Oncol Hematol 2024; 196:104307. [PMID: 38401694 DOI: 10.1016/j.critrevonc.2024.104307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Early-phase clinical trials (EPCT) represent an important part of innovations in medical oncology and a valuable therapeutic option for patients with metastatic cancers, particularly in the era of precision medicine. Nevertheless, adult patients' participation in oncology clinical trials is low, ranging from 2% to 8% worldwide, with unequal access, and up to 40% risk of early discontinuation in EPCT, mostly due to cancer-related complications. DESIGN We review the tools and initiatives to increase patients' orientation and access to early phase cancer clinical trials, and to limit early discontinuation. RESULTS New approaches to optimize the early-phase clinical trial referring process in oncology include automatic trial matching, tools to facilitate the estimation of patients' prognostic and/or to better predict patients' eligibility to clinical trials. Classical and innovative approaches should be associated to double patient recruitment, improve clinical trial enrollment experience and reduce early discontinuation rates. CONCLUSIONS Whereas EPCT are essential for patients to access the latest medical innovations in oncology, offering the appropriate trial when it is relevant for patients should increase by organizational and technological innovations. The oncologic community will need to closely monitor their performance, portability and simplicity for implementation in daily clinical practice.
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Affiliation(s)
- P Corbaux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Medical Oncology, Institut de Cancérologie et d'Hématologie Universitaire de Saint-Étienne (ICHUSE), Centre Hospitalier Universitaire de Saint-Etienne, France
| | - A Bayle
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - S Besle
- Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - A Vinceneux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - H Vanacker
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - K Ouali
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - B Hanvic
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - P A Cassier
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - C Terret
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - L Verlingue
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France.
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Chiapperino L, Besle S, Louvel S, Panese F. Editorial: Personalized health and precision medicine in practice. Front Sociol 2024; 9:1367791. [PMID: 38444604 PMCID: PMC10913194 DOI: 10.3389/fsoc.2024.1367791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Luca Chiapperino
- STS Lab, Institute of Social Sciences, Faculty of Social and Political Sciences, Université de Lausanne, Lausanne, Switzerland
| | - Sylvain Besle
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052-CNRS UMR5286, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon1, Lyon, France
| | - Séverine Louvel
- Université Grenoble Alpes, CNRS, Sciences Po Grenoble, Pacte, Grenoble, France
| | - Francesco Panese
- STS Lab, Institute of Social Sciences, Faculty of Social and Political Sciences, Université de Lausanne, Lausanne, Switzerland
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Pillayre H, Besle S. What rare cancers have in common. The making of lists of (very) rare cancers and the coordination of medical work. Front Sociol 2023; 8:1148639. [PMID: 37727367 PMCID: PMC10505805 DOI: 10.3389/fsoc.2023.1148639] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/12/2023] [Indexed: 09/21/2023]
Abstract
This article aims to understand why medical actors recently published lists of rare and very rare cancers. It studies four lists of rare and very rare cancers based on interviews with the main actors on these lists and an analysis of medical articles in which these lists were published. It argues that these lists constitute boundary objects whose aim is to deal with the organizational challenges raised by precision medicine, which imply increasing the coordination work between various types of actors. Our work therefore allows a better understanding of the functioning of the recursive standardization process of a boundary object and, by analyzing how the category of rarity is built at the intersection of both professional and nosographic principles, shows the intertwining of the biomedical, organizational, and political aspects on which rests the practice of contemporary precision medicine.
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Affiliation(s)
- Héloïse Pillayre
- Centre Léon Bérard, Département SHS, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvain Besle
- Centre Léon Bérard, Département SHS, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Charton E, Baldini C, Fayet Y, Schultz E, Auroy L, Vallier E, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Touzeau C, Le Tourneau C, Ghrieb Z, Kiladjian JJ, Delord JP, Gomez Roca C, Vey N, Barlesi F, Lesimple T, Penel N, Soria JC, Massard C, Besle S. Inequality factors in access to early-phase clinical trials in oncology in France: results of the EGALICAN-2 study. ESMO Open 2023; 8:101610. [PMID: 37536254 PMCID: PMC10415590 DOI: 10.1016/j.esmoop.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Investigation of the disparities in the access to experimental treatment in early-phase clinical trials is lacking. The objective of the EGALICAN-2 study was to identify the factors underpinning such inequalities. METHODS A national prospective survey was conducted in 11 early-phase clinical trial centers (CLIP2) certified by the French National Cancer Institute. Sociodemographic, socioeconomic and medical data were collected. Univariate logistic regression models were carried out to estimate odds ratios and 90% confidence intervals associated with the effect of each study variable. A multivariate logistic regression model was built to explore the independent factors associated with the administration of the experimental treatment (C1D1). A post hoc analysis was carried out excluding female cancer patients. RESULTS Between 2015 and 2016, 1355 patients referred from 11 CLIP2 centers in France were included in the study. Eight hundred and forty-eight patients received C1D1 (73%) and 320 patients (27%) were screening failure. Median age was 58 years (range 17-97 years) and 667 patients (54%) were female. Most patients had a metastatic disease (n = 751, 87%). In the multivariate logistic regression analysis, the significant independent factors associated with C1D1 were male sex, initial care received in a hospital with an early-phase unit and living in wealthy metropolitan areas (P values <0.05). In the post hoc analysis, the sex factor was no longer significant [odds ratio = 1.21 (95% confidence interval 0.86-1.70), P value = 0.271]. CONCLUSIONS This study investigated the factors producing social inequalities in the context of early-phase clinical trials in oncology. Our research highlights factors of sex, care pathway and geographic location. Gynecological cancer was found to impact C1D1 significantly, unlike breast cancer. The results of this study should contribute to improve patient access to early-phase clinical trials.
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Affiliation(s)
- E Charton
- Human and Social Sciences Department, Centre Léon Bérard, Lyon.
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - Y Fayet
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - E Schultz
- CEPED (UMR 196), University of Paris, IRD, Paris; SESSTIM, CANBIOS Team, Aix-Marseille University, INSERM, IRD, Marseille
| | - L Auroy
- University of Grenoble Alpes, CNRS, Sciences Po Grenoble, Grenoble
| | - E Vallier
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | | | - M Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Saint-Herblain
| | - E Coquan
- Medical Oncology Department, Centre François Baclesse, Caen
| | - N Isambert
- Medical Oncology Department, University Hospital of Poitiers, Poitiers
| | - P Moreau
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon
| | - C Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris
| | - Z Ghrieb
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-J Kiladjian
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - C Gomez Roca
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - N Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille
| | - F Barlesi
- CRCM, INSERM, CNRS, APHM, Aix-Marseille University, Marseille; Gustave Roussy, Villejuif
| | - T Lesimple
- Department of Oncology, Eugene Marquis Center, Rennes
| | - N Penel
- Centre Oscar Lambret, Lille University, Lille
| | - J-C Soria
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - C Massard
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - S Besle
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif; Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon, Institut Convergence PLAsCAN, Lyon, France
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Fayet Y, Chanel E, Roussel R, Besle S, Christophe V. [The RCP-SHS: A device at the interface of research and care]. Bull Cancer 2023; 110:136-137. [PMID: 36371285 DOI: 10.1016/j.bulcan.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yohan Fayet
- Centre Léon-Bérard, Département de Sciences Humaines et Sociales, 69008 Lyon, France; Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; UMR 5600 Environnement Ville Société, Lyon, France.
| | - Emilie Chanel
- Centre Léon-Bérard, Département de Sciences Humaines et Sociales, 69008 Lyon, France; Centre Léon-Bérard, Département de Soins Infirmiers, 69008 Lyon, France
| | - Rémi Roussel
- Centre Léon-Bérard, Département de Sciences Humaines et Sociales, 69008 Lyon, France; Centre Léon-Bérard, Département de Soins Infirmiers, 69008 Lyon, France
| | - Sylvain Besle
- Centre Léon-Bérard, Département de Sciences Humaines et Sociales, 69008 Lyon, France; Centre Léon-Bérard, Centre de Recherche en Cancérologie de Lyon, Université Lyon, Université Claude-Bernard Lyon 1, Inserm 1052, CNRS 5286, 69008 Lyon, France; Institut Convergence PLAsCAN, ANR-17-CONV-0002, France
| | - Véronique Christophe
- Centre Léon-Bérard, Département de Sciences Humaines et Sociales, 69008 Lyon, France; Centre Léon-Bérard, Centre de Recherche en Cancérologie de Lyon, Université Lyon, Université Claude-Bernard Lyon 1, Inserm 1052, CNRS 5286, 69008 Lyon, France
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Baldini C, Charton E, Schultz E, Auroy L, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Le Gouill S, Le Tourneau C, Ghrieb Z, Kiladjian J, Delord J, Roca CG, Vey N, Barlesi F, Lesimple T, Penel N, Soria J, Massard C, Besle S. Access to early-phase clinical trials in older patients with cancer in France: the EGALICAN-2 study. ESMO Open 2022; 7:100468. [PMID: 35533427 PMCID: PMC9271476 DOI: 10.1016/j.esmoop.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Patients and methods Results Conclusions Older patients are underrepresented in early-phase clinical trials (17.7%) compared with the number of new cases (50%). The rate of signed informed consent was similar across age groups (92.7% in younger patients versus 90.6% in older patients). The rate of screening failure was consistent across all age groups (28.5% in younger patients versus 24.3% in older patients). In older patients the initial care received in the center having a phase I unit was associated with study drug administration.
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Abstract
This paper focuses on the particular situation of an advanced cancer patient whose condition has taken a chronic turn. We argue that chronicity of this kind sometimes falls at the frontier of Evidence Based Medicine because the uncertainty about the patient's condition can lead physicians to resort to clinical trials or non-licensed drugs to prevent the disease from progressing. This situation leaves plenty of scope for individual adjustments between patients and their doctors. Advanced cancer is regarded here not just as a biological event but as a chronic illness and a 'negotiated reality'. We argue that the chronicity of advanced cancer patients' situation broadens the patients' scope for 'work', and we have called this specific type of patient's work 'decision-making work'. This paper is based on a case study focusing on Patrick, a middle-aged Frenchman with metastatic lung cancer who underwent oncological treatment for seven years and was strongly determined to find new therapeutic options even if this meant having to go abroad. He actively orchestrated his therapeutic itinerary by reorganising his relationships with the medical world and coordinating the physicians' work. His particular social position enabled Patrick to bypass some of the current medical rules and to reorganise the usual pattern of distribution of medical responsibilities. The chronicity of his condition placed him at the very frontier of the health care system.
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Affiliation(s)
- Sylvain Besle
- Universite Claude Bernard Lyon, Villeurbanne, France.,Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Aline Sarradon-Eck
- SESSTIM UMR 1252, CANBIOS, Marseille, France.,Paoli-Calmettes Institute, Marseille, France
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9
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Sarradon-Eck A, Besle S, Troian J, Capodano G, Mancini J. Understanding the Barriers to Introducing Early Palliative Care for Patients with Advanced Cancer: A Qualitative Study. J Palliat Med 2019; 22:508-516. [PMID: 30632886 DOI: 10.1089/jpm.2018.0338] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Palliative care is often underutilized or initiated late in the course of life-threatening illness. Randomized clinical Early Palliative Care (EPC) trials provide an opportunity for changing oncologists' perceptions of palliative care and their attitudes to referring patients to palliative care services. Aim: To describe French oncologists' perceptions of EPC and their effects on referral practices before a clinical EPC trial was launched. Design: A qualitative study involving semistructured face-to-face interviews. The data were analyzed using the Grounded Theory coding method. Setting/Participants: Thirteen oncologists and 19 palliative care specialists (PCSs) working at 10 hospitals all over France were interviewed. Most of them were involved in clinical EPC trials. Results: The findings suggest that referral to PCSs shortly after the diagnosis of advanced cancer increases the terminological barriers, induces avoidance patterns, and makes early disclosure of poor prognosis harder for oncologists. This situation is attributable to the widespread idea that palliative care means terminal care. In addition, the fact that the EPC concept is poorly understood increases the confusion between EPC and supportive care. Conclusion: Defining the EPC concept more clearly and explaining to health professionals and patients what EPC consists of and what role it is intended to play, and the potential benefits of palliative care services could help to overcome the wording barriers rooted in the traditional picture of palliative care. In addition, training French oncologists how to disclose "bad news" could help them cope with the emotional issues involved in referring patients to specialized palliative care.
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Affiliation(s)
- Aline Sarradon-Eck
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,2 Institut Paoli-Calmettes, Cancer, Biomedicine & Society, Marseille, France
| | - Sylvain Besle
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,3 Drug Development Department (DITEP), Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Jaïs Troian
- 4 Aix-Marseille University, Psychologie, Marseille, France
| | - Géraldine Capodano
- 5 Institut Paoli-Calmettes, Département de Soins de Support et Palliatifs, Marseille, France
| | - Julien Mancini
- 6 Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health and Analysis of Medical Information, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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Besle S, Schultz E, Hollebecque A, Varga A, Baldini C, Martin P, Postel-Vinay S, Bahleda R, Gazzah A, Michot JM, Marabelle A, Angevin E, Armand JP, Ribrag V, Soria JC, Massard C. Organisational factors influencing early clinical trials enrollment: Gustave Roussy experience. Eur J Cancer 2018; 98:17-22. [PMID: 29859337 DOI: 10.1016/j.ejca.2018.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Enrolment process influences the likelihood of patients' inclusion in early clinical trials (ECT) through social, medical and organisational factors. PATIENTS AND METHODS All patients referred from 2008 to 2016 to the Drug Development Department (DITEP) of Gustave Roussy (GR) were reviewed. Referring physician, organisational factors, medical and socioeconomic characteristics for patients were analysed. Multivariate analysis was performed with regard to those factors. A telephone survey was conducted on a sample of referring physicians located outside GR (N = 142). RESULTS Between 2008 and 2016, 8694 requests were received with 49% from external physicians. Here, 4517 were male patients with a median age of 58 [49-66] years (range 18-85). Tumour types were gastrointestinal (28%), lung (19%), breast (9%) and gynaecologic (8%). Mean enrolment rate was 37% (ranging from 24 to 45%). From 2008 to 2016, the enrolment rate decreases from 39% to 24%. In the meantime, DITEP trials portfolio evolves with the part of precision medicine trials increase from 12% to 40%. Factors that were significantly associated with a lower likelihood of being enrolled were referral from an external physician (OR 0.15 s.16-0.21]) compared to a physician from DITEP and year of the request (2.74 [1.8-2.9] 2008 versus 2016). The enrolment rate and the number of patients addressed have a high variability regarding referring physicians, which is little explained by characteristics as training, previous experience or attitude regarding ECT. CONCLUSION Beyond patients' individual characteristics, we show that organisational and professional factors have a major impact on likelihood of enrolment in ECT.
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Affiliation(s)
- Sylvain Besle
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, 232 Bd Ste Marguerite BP 156 13273 Marseille Cedex 9 France.
| | - Emilien Schultz
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, 232 Bd Ste Marguerite BP 156 13273 Marseille Cedex 9 France
| | - Antoine Hollebecque
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Andreea Varga
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Patricia Martin
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Sophie Postel-Vinay
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Rastislav Bahleda
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Anas Gazzah
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Eric Angevin
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Pierre Armand
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Vincent Ribrag
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Jean-Charles Soria
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Drug Development Department (DITEP), Villejuif, F-94805, France
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