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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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Touraine C, Cuer B, Conroy T, Juzyna B, Gourgou S, Mollevi C. When a joint model should be preferred over a linear mixed model for analysis of longitudinal health-related quality of life data in cancer clinical trials. BMC Med Res Methodol 2023; 23:36. [PMID: 36765307 PMCID: PMC9912607 DOI: 10.1186/s12874-023-01846-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Patient-reported outcomes such as health-related quality of life (HRQoL) are increasingly used as endpoints in randomized cancer clinical trials. However, the patients often drop out so that observation of the HRQoL longitudinal outcome ends prematurely, leading to monotone missing data. The patients may drop out for various reasons including occurrence of toxicities, disease progression, or may die. In case of informative dropout, the usual linear mixed model analysis will produce biased estimates. Unbiased estimates cannot be obtained unless the dropout is jointly modeled with the longitudinal outcome, for instance by using a joint model composed of a linear mixed (sub)model linked to a survival (sub)model. Our objective was to investigate in a clinical trial context the consequences of using the most frequently used linear mixed model, the random intercept and slope model, rather than its corresponding joint model. METHODS We first illustrate and compare the models on data of patients with metastatic pancreatic cancer. We then perform a more formal comparison through a simulation study. RESULTS From the application, we derived hypotheses on the situations in which biases arise and on their nature. Through the simulation study, we confirmed and complemented these hypotheses and provided general explanations of the bias mechanisms. CONCLUSIONS In particular, this article reveals how the linear mixed model fails in the typical situation where poor HRQoL is associated with an increased risk of dropout and the experimental treatment improves survival. Unlike the joint model, in this situation the linear mixed model will overestimate the HRQoL in both arms, but not equally, misestimating the difference between the HRQoL trajectories of the two arms to the disadvantage of the experimental arm.
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Affiliation(s)
- Célia Touraine
- Biometrics Unit, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France. .,French National Platform Quality of Life and Cancer, Montpellier, France. .,Desbrest Institute of Epidemiology and Public Health, IDESP UMR UA11 INSERM, University of Montpellier, Montpellier, France.
| | - Benjamin Cuer
- grid.121334.60000 0001 2097 0141Biometrics Unit, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France ,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Thierry Conroy
- grid.452436.20000 0000 8775 4825Department of Medical Oncology, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France ,grid.29172.3f0000 0001 2194 6418Team MICS, APEMAC, Université de Lorraine, Nancy, France
| | | | - Sophie Gourgou
- grid.121334.60000 0001 2097 0141Biometrics Unit, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France ,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Caroline Mollevi
- grid.121334.60000 0001 2097 0141Biometrics Unit, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France ,French National Platform Quality of Life and Cancer, Montpellier, France ,grid.121334.60000 0001 2097 0141Desbrest Institute of Epidemiology and Public Health, IDESP UMR UA11 INSERM, University of Montpellier, Montpellier, France
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Winter A, Cuer B, Conroy T, Juzyna B, Gourgou S, Mollevi C, Touraine C. Modélisation flexible de la trajectoire du score de qualité de vie dans différentes dimensions avec prise en compte des sorties d’études informatives dans un essai clinique en oncologie. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cuer B, Mollevi C, Anota A, Charton E, Juzyna B, Conroy T, Touraine C. Handling informative dropout in longitudinal analysis of health-related quality of life: application of three approaches to data from the esophageal cancer clinical trial PRODIGE 5/ACCORD 17. BMC Med Res Methodol 2020; 20:223. [PMID: 32883216 PMCID: PMC7469318 DOI: 10.1186/s12874-020-01104-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/20/2020] [Indexed: 12/04/2022] Open
Abstract
Background Health-related quality of life (HRQoL) has become a major endpoint to assess the clinical benefit of new therapeutic strategies in oncology clinical trials. Typically, HRQoL outcomes are analyzed using linear mixed models (LMMs). However, longitudinal analysis of HRQoL in the presence of missing data remains complex and unstandardized. Our objective was to compare the modeling alternatives that account for informative dropout. Methods We investigated three alternative methods—the selection model (SM), pattern-mixture model (PMM), and shared-parameters model (SPM)—in relation to the LMM. We first compared them on the basis of methodological arguments highlighting their advantages and drawbacks. Then, we applied them to data from a randomized clinical trial that included 267 patients with advanced esophageal cancer for the analysis of four HRQoL dimensions evaluated using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Results We highlighted differences in terms of outputs, interpretation, and underlying modeling assumptions; this methodological comparison could guide the choice of method according to the context. In the application, none of the four models detected a significant difference between the two treatment arms. The estimated effect of time on HRQoL varied according to the method: for all analyzed dimensions, the PMM estimated an effect that contrasted with those estimated by the SM and SPM; the LMM estimated effects were confirmed by the SM (on two of four HRQoL dimensions) and SPM (on three of four HRQoL dimensions). Conclusions The PMM, SM, or SPM should be used to confirm or invalidate the results of LMM analysis when informative dropout is suspected. Of these three alternative methods, the SPM appears to be the most interesting from both theoretical and practical viewpoints. Trial registration This study is registered with ClinicalTrials.gov, number NCT00861094.
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Affiliation(s)
- B Cuer
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, 208, avenue des Apothicaires, 34298, Montpellier, France. .,French National Platform Quality of Life and Cancer, Montpellier, France. .,Institute of Cancer Research of Montpellier (IRCM)- Inserm 1194, ICM, University of Montpellier, Montpellier, France.
| | - C Mollevi
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, 208, avenue des Apothicaires, 34298, Montpellier, France.,French National Platform Quality of Life and Cancer, Montpellier, France.,Institute of Cancer Research of Montpellier (IRCM)- Inserm 1194, ICM, University of Montpellier, Montpellier, France
| | - A Anota
- French National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life Unit in Oncology- Inserm UMR 1098, University Hospital of Besançon, Besançon, France.,University Bourgogne Franche-Comté, Inserm, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - E Charton
- French National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life Unit in Oncology- Inserm UMR 1098, University Hospital of Besançon, Besançon, France.,University Bourgogne Franche-Comté, Inserm, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - B Juzyna
- UNICANCER R&D, French Federation of Comprehensive Cancer Centres, Paris, France
| | - T Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France.,APEMAC, équipe MICS, Université de Lorraine, Nancy, France
| | - C Touraine
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, 208, avenue des Apothicaires, 34298, Montpellier, France.,French National Platform Quality of Life and Cancer, Montpellier, France
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Bascoul-Mollevi C, Barbieri A, Bourgier C, Conroy T, Chauffert B, Hebbar M, Jacot W, Juzyna B, De Forges H, Gourgou S, Bonnetain F, Touraine C, Anota A. Longitudinal analysis of health-related quality of life in cancer clinical trials: methods and interpretation of results. Qual Life Res 2020; 30:91-103. [PMID: 32809099 DOI: 10.1007/s11136-020-02605-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is assessed by self-administered questionnaires throughout the care process. Classically, two longitudinal statistical approaches were mainly used to study HRQoL: linear mixed models (LMM) or time-to-event models for time to deterioration/time until definitive deterioration (TTD/TUDD). Recently, an alternative strategy based on generalized linear mixed models for categorical data has also been proposed: the longitudinal partial credit model (LPCM). The objective of this article is to evaluate these methods and to propose recommendations to standardize longitudinal analysis of HRQoL data in cancer clinical trials. METHODS The three methods are first described and compared through statistical, methodological, and practical arguments, then applied on real HRQoL data from clinical cancer trials or published prospective databases. In total, seven French studies from a collaborating group were selected with longitudinal collection of QLQ-C30. Longitudinal analyses were performed with the three approaches using SAS, Stata and R software. RESULTS We observed concordant results between LMM and LPCM. However, discordant results were observed when we considered the TTD/TUDD approach compared to the two previous methods. According to methodological and practical arguments discussed, the approaches seem to provide additional information and complementary interpretations. LMM and LPCM are the most powerful methods on simulated data, while the TTD/TUDD approach gives more clinically understandable results. Finally, for single-item scales, LPCM is more appropriate. CONCLUSION These results pledge for the recommendation to use of both the LMM and TTD/TUDD longitudinal methods, except for single-item scales, establishing them as the consensual methods for publications reporting HRQoL.
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Affiliation(s)
- Caroline Bascoul-Mollevi
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France. .,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France. .,National Platform Quality of Life and Cancer, Montpellier, France.
| | | | - Céline Bourgier
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Radiation Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Thierry Conroy
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.,Lorraine University, APEMAC, Team MICS, Nancy, France
| | - Bruno Chauffert
- Medical Oncology Department, Amiens University Hospital, Amiens, France
| | - Mohamed Hebbar
- Department of Medical Oncology, University Hospital, Lille, France
| | - William Jacot
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Medical Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | | | - Hélène De Forges
- Clinical Research and Innovation Department, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Franck Bonnetain
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
| | - Célia Touraine
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Amélie Anota
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
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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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Boige V, Mollevi C, Gourgou S, Azria D, Seitz JF, Vincent M, Bigot L, Juzyna B, Miran I, Gerard JP, Laurent-Puig P. Impact of single-nucleotide polymorphisms in DNA repair pathway genes on response to chemoradiotherapy in rectal cancer patients: Results from ACCORD-12/PRODIGE-2 phase III trial. Int J Cancer 2019; 145:3163-3172. [PMID: 31107542 DOI: 10.1002/ijc.32417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/14/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 01/07/2023]
Abstract
We examined whether 66 germline single-nucleotide polymorphisms (SNPs) in 10 candidate genes would predict clinical outcome in 316 patients with resectable locally advanced rectal cancer (LARC) enrolled in the ACCORD-12 phase III trial who were randomly treated with preoperative radiotherapy plus capecitabine (CAP45; n = 155) or dose-intensified radiotherapy plus capecitabine and oxaliplatin (CAPOX50; n = 161). The primary endpoint was tumor response according to the Dworak score. Multivariate logistic regression models adjusted on treatment arm and T stage determined the SNPs prognostic and predictive values for tumor response. In univariate analysis, five SNPs in ERCC2, XPA, MTHFR and ERCC1 were associated with the Dworak score in the CAPOX50 arm. In the overall population, interaction with treatment arm was significant for ERCC2 rs1799787 (pinteraction = 0.05) and XPA rs3176683 (pinteraction = 0.008), suggesting a predictive effect for response to oxaliplatin-based chemoradiotherapy (CRT). All but XPA rs3176683 had a prognostic effect on tumor response. In a multivariate model, interaction remained significant for XPA rs3176683 ([OR 7.33, 95% CI 1.40-38.23], pinteraction = 0.018) and the prognostic effect significant for ERCC2 rs1799787 ([OR 0.55, 95%CI 0.32-0.93], p = 0.027) and ERCC1 rs10412761 ([OR 0.57, 95%CI 0.34-0.98], p = 0.042). Patients with the T/G haplotype of rs1799787 and rs10412761 had a 60% decrease in odds of response (p < 0.001). None of the five SNPs were associated with toxicity, overall and disease-free survival. These data suggest that genetic variation in DNA repair genes influences response to preoperative CRT in LARC and identify patients who benefit from the addition of oxaliplatin to CRT.
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Affiliation(s)
- Valérie Boige
- Department of Oncologic Medicine, Gustave-Roussy, Villejuif, France.,Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
| | - Caroline Mollevi
- Biometry Unit, Institut du Cancer Montpellier, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, Université de Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometry Unit, Institut du Cancer Montpellier, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, Université de Montpellier, Montpellier, France
| | - David Azria
- Department of Radiation Oncology, Institut du Cancer Montpellier, Univ Montpellier, Inserm U1194 IRCM, Montpellier, France
| | - Jean-François Seitz
- Department of Digestive Oncology, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marc Vincent
- Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
| | - Ludovic Bigot
- Inserm U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Isabelle Miran
- Inserm U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Pierre Gerard
- Department of Radiation Oncology, Centre Antoine Lacassagne, Université Côte d'azur, Nice, France
| | - Pierre Laurent-Puig
- Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
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Touraine C, Cuer B, Conroy T, Juzyna B, Gourgou S, Mollevi C. Analyse conjointe de la survie et de la qualité de vie relative à la santé chez des patients atteints de cancer du pancréas métastatique. Application aux données de l’essai clinique PRODIGE 4/ACCORD 11. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cuer B, Mollevi C, Conroy T, Juzyna B, Gourgou S, Touraine C. Modélisation conjointe de la trajectoire de qualité de vie relative à la santé et du temps de « dropout » pour la prise en compte des données manquantes monotones potentiellement informatives : application aux données de l’essai clinique ACCORD 17. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Azria D, Doyen J, Jarlier M, Martel-Lafay I, Hennequin C, Etienne P, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah J, Mahé M, Bécouarn Y, Dupuis O, Lledo G, Seitz J, Bedenne L, Gourgou-Bourgade S, Juzyna B, Conroy T, Gérard J. Late toxicities and clinical outcome at 5 years of the ACCORD 12/0405-PRODIGE 02 trial comparing two neoadjuvant chemoradiotherapy regimens for intermediate-risk rectal cancer. Ann Oncol 2018; 28:2436-2442. [PMID: 28961836 DOI: 10.1093/annonc/mdx351] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 01/04/2023] Open
Abstract
Background Outcome of intermediate risk rectal cancer may be improved by the addition of oxaliplatin during 5-fluoruracil concomitant neoadjuvant chemoradiotherapy. The purpose of this study is to analyze the main clinical results of the ACCORD12 trial (NCT00227747) in rectal cancer after 5 years of follow-up. Patients and methods Inclusion criteria were as follows: rectal adenocarcinoma accessible to digital examination staged T3-T4 Nx M0 (or T2 Nx distal anterior rectum). Two neoadjuvant chemoradiotherapy regimens were randomized: CAP45 (RT 45 Gy + capecitabine) and CAPOX50 (RT 50 Gy + capecitabine and oxaliplatin). Main end point was sterilization of the operative specimen. Acute and late toxicities were prospectively analyzed with dedicated questionnaires. Results Between November 2005 and July 2008, 598 patients were included in the trial. After a median follow-up of 60.2 months, there was no difference between treatment arms in multivariate analysis either for disease-free survival or overall survival (OS) [P = 0.9, hazard ratio (HR)=1.02; 95% confidence interval (CI), 0.76-1.36 and P = 0.3, HR = 0.87; 95% CI, 0.66-1.15, respectively]. There was also no difference of local control in univariate analysis (P = 0.7, HR = 0.92; 95% CI, 0.51-1.66). Late toxicities were acceptable with 1.6% G3 anal incontinence, and <1% G3 diarrhea, G3 rectal bleeding, G3 stenosis, G3-4 pain, G3 urinary incontinence, G3 urinary retention and G3 skeletal toxicity. There was a slight increase of erectile dysfunction over time with a 63% rate of erectile dysfunction at 5 years. There was no significant statistical difference for these toxicities between treatment arms. Conclusions The CAPOX50 regimen did not improve local control, disease-free survival and overall survival in the ACCORD12 trial. Late toxicities did not differ between treatment arms.
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Affiliation(s)
- D Azria
- Department of Radiation oncology, Montpellier Cancer Institute, Montpellier
| | - J Doyen
- Department of Radiation oncology, Antoine-Lacassagne Center, Nice;; University of Côte d'Azur, Nice;.
| | - M Jarlier
- Biometrics Unit, Montpellier Cancer Institute, Montpellier
| | - I Martel-Lafay
- Department of Radiation Oncology, Léon-Bérard Center, Lyon
| | - C Hennequin
- Department of Radiation Oncology, Saint-Louis Hospital, Paris
| | - P Etienne
- Department of Radiation Oncology, Armorican Center of Radiotherapy and Radiology, Plérin
| | - V Vendrely
- Department of Radiation Oncology, Teaching Hospital CHU of Bordeaux, Bordeaux
| | - E François
- University of Côte d'Azur, Nice;; Department of Medical Oncology, Antoine-Lacassagne Center, Nice
| | - G de La Roche
- Department of Medical Oncology, Oncology Institute of Loire, Saint Priest en Jarez
| | - O Bouché
- Department of Medical Oncology, Teaching Hospital CHU of Reims, Reims
| | - X Mirabel
- Department of Radiation Oncology, Oscar-Lambret Center, Lille
| | - B Denis
- Department of Medical Oncology, Teaching Hospital CHU Louis Pasteur, Colmar
| | - L Mineur
- Department of Radiation Oncology, Sainte-Catherine Institute, Avignon
| | - J Berdah
- Sainte-Marguerite Private Hospital, Toulon-Hyères
| | - M Mahé
- Department of Radiation Oncology, West Oncology Institute, Saint-Herblain
| | - Y Bécouarn
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - O Dupuis
- Department of Medical Oncology, Jean Bernard Center, Le Mans
| | - G Lledo
- Department of Medical Oncology, Jean Mermoz Private Hospital, Lyon
| | - J Seitz
- Department of Medical Oncology, Teaching Hospital CHU La Timone, Marseille
| | - L Bedenne
- Department of Medical Oncology, Teaching Hospital CHU of Dijon, Dijon
| | | | | | - T Conroy
- Department of Medical Oncology, Oncology Institute of Lorraine, Vandoeuvre-les-Nancy, France
| | - J Gérard
- Department of Radiation oncology, Antoine-Lacassagne Center, Nice;; University of Côte d'Azur, Nice
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Cuer B, Anota A, Conroy T, Juzyna B, Gourgou S, Mollevi C, Touraine C. Prise en compte des données manquantes potentiellement informatives dans l’analyse longitudinale de la qualité de vie relative à la santé sur les données de l’essai clinique PRODIGE5/ACCORD 17. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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12
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Robert M, Jarlier M, Gourgou S, Desseigne F, Ychou M, Bouché O, Juzyna B, Conroy T, Bennouna J. Retrospective Analysis of CA19-9 Decrease in Patients with Metastatic Pancreatic Carcinoma Treated with FOLFIRINOX or Gemcitabine in a Randomized Phase III Study (ACCORD11/PRODIGE4). Oncology 2017; 93:367-376. [PMID: 28982109 DOI: 10.1159/000477850] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 01/10/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2023]
Abstract
OBJECTIVES Carbohydrate antigen 19-9 (CA19-9) is a sensitive and specific serum marker in pancreatic cancer. Our retrospective analysis aims to evaluate CA19-9 decrease in patients with metastatic pancreatic cancer treated in ACCORD11/PRODIGE4 (FOLFIRINOX vs. gemcitabine). METHODS A total of 342 patients were treated. CA19-9 was measured at 8 weeks (±2) in 160 patients from a total of 282 with abnormal CA19-9 values at baseline (gemcitabine arm, n = 75; FOLFIRINOX arm, n = 85). In the present study, 8-week CA19-9 decrease or greater CA19-9 decrease according to the 20 and 90% thresholds were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated in each subgroup. RESULTS In the FOLFIRINOX arm, patients with an 8-week CA19-9 decrease or greater CA19-9 decrease ≥20% showed improved median OS, PFS, and objective response rate. In the overall study population, median OS and PFS were significantly improved in patients with an 8-week CA19-9 decrease ≥20% (vs. <20%). The 8-week CA19-9 decrease was predictive of PFS (interaction test significant according to treatment arm; p = 0.006). CONCLUSION An 8-week CA19-9 decrease ≥20% is a prognostic factor for OS and PFS. The 8-week CA19-9 decrease (20% threshold) is predictive of PFS. It could help to evaluate the efficacy of FOLFIRINOX and gemcitabine regimens.
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Affiliation(s)
- Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St. Herblain, France
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Edeline J, Bonnetain F, Phelip JM, Watelet J, Hammel P, Joly JP, Benabdelghani M, Fartoux L, Bouhier-Leporrier K, Jouve JL, Faroux R, Guerin-Meyer V, Assenat E, Seitz JF, Malka D, Louvet C, Bertaut A, Juzyna B, Stanbury T, Boucher E. Adjuvant GEMOX for biliary tract cancer: Updated relapse-free survival and first overall survival results of the randomized PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Valerie B, Mollevi C, Chaput N, Gourgou S, Azria D, Seitz J, Bigot L, Juzyna B, Miran I, Gérard JP, Laurent-Puig P. Impact of Immune response-associated gene polymorphisms on tumor response in rectal cancer patients treated with capecitabine +/- oxaliplatine and radiation in the ACCORD-12/PRODIGE-2 phase III trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.086] [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: 11/14/2022] Open
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15
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Boige V, Mollevi C, Chaput N, Gourgou S, Azria D, Seitz JF, Bigot L, Juzyna B, Miran I, Gerard JP, Laurent-Puig P. Impact of Immune response-associated gene polymorphisms on tumor response in rectal cancer patients treated with capecitabine +/- oxaliplatine and radiation in the ACCORD-12/PRODIGE-2 phase III trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15151] [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
e15151 Background: We examined whether 133 germline polymorphisms (SNPs) in 15 candidate genes (CSF1R, IL8RA, TLR4, IL10, IL10RA, CTLA4, IL2, IL2RA, TGF b1, ICOS, IL13, IL13RA2, IFNgR, IL15 and IL15RA) would predict clinical outcome in the ACCORD-12 phase III trial which randomly compared neoadjuvant radiotherapy (RT) plus capecitabine (CAP45) with dose-intensified RT plus capecitabine and oxaliplatin (CAPOX50) in T3-4 Nx M0 resectable rectal cancer. Methods: A candidate-gene association study was conducted in 316 patients (n = 161 in the CAPOX50 and n = 155 in the CAP45 arm). The primary end-point was tumor response according to the Dworak score in each arm. Logistic regressions were used to assess univariate/multivariate associations. The Storey and Tibshirani method based on the control of false discovery rate was used ( q-value < 0.10 (adjusted p-value) considered as true discovery). Multivariate models adjusted on treatment arm and T stage were performed to determine prognostic and predictive values of SNPs for tumor response. Results: In univariate analysis, two SNPs in IL2RA (rs11256456: OR = 5.1 [2.38; 11] and rs706781: OR = 4.2 [1.98 ; 8.74]) were significantly associated with the Dworak score in the CAP45 arm, and one in IL2RA the CAPOX50 arm (rs2104286: OR = 0.11 [0.01 ; 0.90]. All were confirmed in the multivariate analysis. A significant haplotypic effect was observed in the CAP-45 arm (p = 0.0001). Interaction was significant for IL2RA rs11256456 ( p= 0.03) and rs706781 ( p= 0.002) and no significant for IL2RA rs2104286 ( p= 0.722), suggesting a predictive deleterious effect the first two ones for response to oxaliplatin-based chemoRT, and a prognostic effect of the third one for response to chemoRT (+/- oxaliplatin). None of the three IL2RA SNPs were correlated with survival in the multivariate analysis. Conclusions: This pharmacogenetic analysis shows that SNPs in IL2RA have a significant association with response to chemoRT with capecitabine in patients with locally advanced rectal cancer. Their predictive effect may identify patients in whom oxaliplatin addition to chemoRT is deleterious.
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Affiliation(s)
- Valerie Boige
- Service d'Oncologie Digestive, Gustave Roussy, Villejuif, France
| | | | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS / US 23 INSERM, Gustave Roussy, Villejuif, France
| | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - David Azria
- Institut Régional du Cancer, Montpellier, France
| | | | - Ludovic Bigot
- Gustave Roussy, Drug Development Department (DITEP); Inserm U981, Villejuif, France
| | | | - Isabelle Miran
- Laboratoire de Recherche Translationnelle, Gustave Roussy, Villejuif, France
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Edeline J, Bonnetain F, Phelip JM, Watelet J, Hammel P, Joly JP, Ben Abdelghani M, Rosmorduc O, Bouhier-Leporrier K, Jouve JL, Faroux R, Guerin Meyer V, Assenat E, Seitz JF, Malka D, Louvet C, Bertaut A, Juzyna B, Stanbury T, Boucher E. Gemox versus surveillance following surgery of localized biliary tract cancer: Results of the PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.225] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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
225 Background: No standard post-surgery adjuvant treatment is currently recommended in localized biliary tract cancer (BTC). Gemcitabine combined with platinum is the standard chemotherapy for advanced BTC. The aim of this phase III randomized trial was to assess whether GEMOX would increase relapse-free survival (RFS) while maintaining health-related quality of life (HrQoL). Methods: We performed a multicenter randomized phase III trial. Patients were randomized, within 3 months of R0 or R1 resection of a localized BTC (intra-hepatic, perihilar, extra-hepatic cholangiocarcinoma or gallbladder cancer), to receive either GEMOX 85 for 12 cycles (Experimental Arm A) or surveillance (Standard Arm B). Co-primary objectives were RFS and HrQoL. 190 patients and 126 RFS events were required to show an increase of median RFS from 18 to 30 months. Results: Between July 2009 and February 2014, 196 patients were included in 33 French centers. Baseline characteristics were balanced, with similar primary sites, R0 resection rates were 86.2% (Arm A) vs 87.9% (Arm B), lymph node invasion present in 37.2% vs 36.4%. In Arm A, a median of 12 cycles was delivered (mean: 9.3, range: 0-12). Maximal grade of adverse events were grade 3 in 57.5% vs 22.2%, and grade 4 in 17.0% vs 9.1%. During treatment one patient died in each arm. The main grade ≥ 3 adverse events in the year following inclusion were peripheral neuropathy (50.0% vs 1.1%), and neutropenia (22.3% vs 0%). Median follow-up was 44.3 months, with 54 and 64 RFS events in arms A vs B. There was no significant difference in RFS between the arms (log-rank p = 0.31), with a hazard ratio of 0.83 [95% CI: 0.58-1.19], p = 0.31 (futility boundaries were crossed). Median RFS was 30.4 [95% CI: 15.4-45.8] vs 22.0 months [95%CI: 13.6-38.3] in arms A & B respectively, and 4-years RFS was 39.3% [95%CI: 28.4%-50.0%] vs 33.2% [95%CI: 23.1-43.7%]. Global Health HrQoL scores were not different at 12 months (70.8 vs 83.3, p = 0.18) and at 24 months (75.0 vs 83.3, p = 0.50). Conclusions: Adjuvant chemotherapy in BTC with GEMOX was feasible and associated with expected toxicities and no deterioration of HrQoL. There was no significant difference in RFS between GEMOX and surveillance. Clinical trial information: NCT01313377.
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Affiliation(s)
- Julien Edeline
- Oncology Medical Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | - Franck Bonnetain
- Methodology and Quality of Life Unit, Department of Oncology, INSERM UMR 1098, University Hospital of Besancon; French National Platform Quality of Life and Cancer, Besancon, France
| | | | | | | | - Jean-Paul Joly
- Department of Hepatogastroenterology, Amiens University Medical Center, Amiens, France
| | | | - Olivier Rosmorduc
- Hopital de la Pitie-Salpétrière, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | | | | | - Roger Faroux
- Centre Hospitalier Departemental Les Oudairies, La Roche Sur Yon, France
| | | | - Eric Assenat
- Institut du regional du Cancer de Montpellier (ICM), Montpellier, France
| | - Jean Francois Seitz
- Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - David Malka
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | - Eveline Boucher
- Service d'Oncologie Medicale, Central Eugene Marquis, Rennes, France
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Boige V, Mollevi C, Azria D, Gourgou S, Seitz JF, Vincent M, Bigot L, Juzyna B, Miran I, Gerard JP, Laurent-Puig P. Association of polymorphisms with tumor response in rectal cancer patients treated with capecitabine +/- oxaliplatine and radiation: Pharmacogenetic analysis of ACCORD-12/PRODIGE-2 trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3583] [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)
| | - Caroline Mollevi
- Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - David Azria
- Institut Régional du Cancer, Montpellier, France
| | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | | | | | | | | | - Isabelle Miran
- Laboratoire de recherche translationnelle, Gustave Roussy, Villejuif, France
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Barbieri A, Anota A, Conroy T, Gourgou-Bourgade S, Juzyna B, Bonnetain F, Lavergne C, Bascoul-Mollevi C. Applying the Longitudinal Model from Item Response Theory to Assess Health-Related Quality of Life in the PRODIGE 4/ACCORD 11 Randomized Trial. Med Decis Making 2015; 36:615-28. [PMID: 26683246 DOI: 10.1177/0272989x15621883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A new longitudinal statistical approach was compared to the classical methods currently used to analyze health-related quality-of-life (HRQoL) data. The comparison was made using data in patients with metastatic pancreatic cancer. METHODS Three hundred forty-two patients from the PRODIGE4/ACCORD 11 study were randomly assigned to FOLFIRINOX versus gemcitabine regimens. HRQoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. The classical analysis uses a linear mixed model (LMM), considering an HRQoL score as a good representation of the true value of the HRQoL, following EORTC recommendations. In contrast, built on the item response theory (IRT), our approach considered HRQoL as a latent variable directly estimated from the raw data. For polytomous items, we extended the partial credit model to a longitudinal analysis (longitudinal partial credit model [LPCM]), thereby modeling the latent trait as a function of time and other covariates. RESULTS Both models gave the same conclusions on 11 of 15 HRQoL dimensions. HRQoL evolution was similar between the 2 treatment arms, except for the symptoms of pain. Indeed, regarding the LPCM, pain perception was significantly less important in the FOLFIRINOX arm than in the gemcitabine arm. For most of the scales, HRQoL changes over time, and no difference was found between treatments in terms of HRQoL. DISCUSSION The use of LMM to study the HRQoL score does not seem appropriate. It is an easy-to-use model, but the basic statistical assumptions do not check. Our IRT model may be more complex but shows the same qualities and gives similar results. It has the additional advantage of being more precise and suitable because of its direct use of raw data.
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Affiliation(s)
- Antoine Barbieri
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M),Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Montpellier, France (AB, CL)
| | - Amélie Anota
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Methodological and Quality of Life Unit in Oncology (EA 3181), Besançon, France (AA, FB)
| | - Thierry Conroy
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Institut de Cancérologie de Lorraine, Nancy, France (TC)
| | - Sophie Gourgou-Bourgade
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M)
| | | | - Franck Bonnetain
- National Quality of Life in Oncology Platform, France (AA, TC, FB),Methodological and Quality of Life Unit in Oncology (EA 3181), Besançon, France (AA, FB)
| | - Christian Lavergne
- Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Montpellier, France (AB, CL),Université Paul-Valéry Montpellier 3, Montpellier, France (CL)
| | - Caroline Bascoul-Mollevi
- Biometrics Unit-CTD INCa, Institut régional du Cancer Montpellier (ICM) - Val d'Aurelle, Montpellier, France (AB, SG-B, CB-M)
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Gourgou S, Jarlier M, Barbieri A, Desseigne F, Ychou M, Bouche O, Juzyna B, Conroy T. Evolution of pain in patients with metastatic pancreatic carcinoma treated with FOLFIRINOX or gemcitabine in a randomized phase III study (ACCORD11/PRODIGE4). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15251] [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)
- Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Marta Jarlier
- Biostatistic Unit - CTD INCa, ICM - Montpellier Cancer Institute, Montpellier, France
| | - Antoine Barbieri
- Biostatistic Unit - CTD INCa, ICM - Montpellier Cancer Institute, Montpellier, France
| | | | - Marc Ychou
- Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les -Nancy, France
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Ducreux M, Giovannini M, Baey C, Llacer C, Bennouna J, Adenis A, Peiffert D, Mornex F, Abbas M, Boige V, Pignon JP, Conroy T, Cellier P, Juzyna B, Viret F. Radiation plus docetaxel and cisplatin in locally advanced pancreatic carcinoma: a non-comparative randomized phase II trial. Dig Liver Dis 2014; 46:950-5. [PMID: 25027552 DOI: 10.1016/j.dld.2014.06.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/31/2014] [Accepted: 06/13/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND We performed a randomized, non-comparative phase II study evaluating docetaxel in combination with either daily continuous (protracted IV) 5-fluorouracil or cisplatin administered weekly, concurrent to radiotherapy in the treatment of locally advanced pancreatic carcinoma. Results of the docetaxel plus cisplatin regimen are reported. METHODS Forty chemotherapy-naive patients with locally advanced pancreatic carcinoma were randomly assigned to receive 5-fluorouracil and docetaxel or docetaxel 20mg/m(2) and cisplatin 20mg/m(2)/week, plus concurrent radiotherapy for 6 weeks. The radiation dose to the primary tumour was 54Gy in 30 fractions. The trial's primary endpoint was the 6-month crude non-progression rate. RESULTS 51 patients from 7 centres were included in the docetaxel-cisplatin treatment group. Six-month non-progression rate was 39% (95% confidence interval: 26-53). Median overall survival was 9.6 months (95% confidence interval: 2.4-60.7); 6 complete and 8 partial responses were obtained. Six patients survived more than 2 years after their inclusion in the trial. Grade ≥3 toxicity was reported in 63% of patients; no treatment-related death occurred. Severe toxicities were mainly anorexia (22%), vomiting (20%) and fatigue (24%). CONCLUSIONS Despite inadequate efficacy according to the main end point, this regimen gave a satisfactory rate of objective response (27%) with tolerable toxicity.
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Affiliation(s)
- Michel Ducreux
- Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France.
| | | | | | - Carmen Llacer
- Institut du Cancer Montpellier - Val d'Aurelle, Montpellier, France
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest - René Gauducheau, Nantes, France
| | | | - Didier Peiffert
- Institut de Cancérologie de Lorraine - Alexis Vautrin, Nancy, France
| | | | | | | | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine - Alexis Vautrin, Nancy, France
| | - Patrice Cellier
- Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
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21
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Robert M, Jarlier M, Conroy T, Gourgou S, Desseigne F, Ychou M, Bouche O, Juzyna B, Bennouna J. Retrospective analysis of CA19-9 decrease in patients with metastatic pancreatic carcinoma (MPC) treated with FOLFIRINOX or gemcitabine (gem) in a randomized phase III study (ACCORD11/PRODIGE4). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4115] [Citation(s) in RCA: 4] [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)
- Marie Robert
- Institut de cancérologie de l'Ouest, Nantes, France
| | | | | | - Sophie Gourgou
- Biostatistics Unit – CTD INCa, Montpellier Cancer Institute, Montpellier, France
| | | | - Marc Ychou
- Montpellier Cancer Institute, Montpellier, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | - Jaafar Bennouna
- Institut de Cancerologie de l’Ouest-site René Gauducheau, Nantes, 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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Deutsch E, Lemanski C, Pignon JP, Levy A, Delarochefordiere A, Martel-Lafay I, Rio E, Malka D, Conroy T, Miglianico L, Becouarn Y, Malekzadeh K, Paris E, Juzyna B, Ezra P, Azria D. Unexpected toxicity of cetuximab combined with conventional chemoradiotherapy in patients with locally advanced anal cancer: results of the UNICANCER ACCORD 16 phase II trial. Ann Oncol 2013; 24:2834-8. [PMID: 24026540 DOI: 10.1093/annonc/mdt368] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The ACCORD 16 phase II trial aimed to evaluate the objective response rate after combination of conventional chemoradiotherapy (CRT) and cetuximab in locally advanced anal canal carcinoma (LAACC). PATIENTS AND METHODS Immunocompetent patients with histologically confirmed LAACC received CRT [45 gray (Gy)] in 25 fractions over 5 weeks, fluorouracil and cisplatin during weeks 1 and 5), in combination with weekly dose of cetuximab (250 mg/m(2) with a loading dose of 400 mg/m(2) 1 week before irradiation), and a standard dose boost (20 Gy). The trial was originally designed to include 81 patients to detect a 15% of objective response increase with the new combination in comparison with CRT. RESULTS The trial was prematurely stopped after the declaration of 15 serious adverse events (SAEs) in 14 out of 16 patients. Five patients received the entire planned treatment, and the compliance was higher after amendments of the protocol. Among the 15 SAEs, 6 were unexpected. Grade (G) 3/4 acute toxic effects, observed in 88% patients, were general (n = 13, 81%), digestive (n = 9, 56%), dermatological (n = 5, 31%), infectious (n = 4, 25%), haematological (n = 3, 19%), and others (n = 9); and three patients suffered from six G3/4 late toxic effects. No treatment-related death was reported. All 11 assessable patients had an objective response consisting of six complete (55%) and five partial (45%) response 2 months after the end of the treatment. Thirteen patients were followed up with a median of 22 months [95% confidence interval (CI ): 18-27] and had a 1-year colostomy-free survival, progression-free and overall survival rate of 67% (95% CI: 40%-86%), 62% (95% CI: 36%-82%), and 92% (95% CI: 67%-99%), respectively. CONCLUSION CRT plus cetuximab was unacceptably toxic in this population of patients. Results of others phase II trials evaluating this combination are awaited to confirm these findings. EUDRA CT NO 2007-007029-38.
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Affiliation(s)
- E Deutsch
- Department of Radiotherapy, Institut Gustave-Roussy, Villejuif
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24
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Peiffert D, Tournier-Rangeard L, Gérard JP, Lemanski C, François E, Giovannini M, Mirabel X, Bouché O, Conroy T, Juzyna B, Mornex F, Hannoun-Lévy JM, Seitz JF, Adenis A, Hennequin C, Ducreux M. Reply to R. Glynne-Jones et al. J Clin Oncol 2013; 31:165-6. [DOI: 10.1200/jco.2012.45.5717] [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)
- Didier Peiffert
- Equipe d'Accueil 4360 Centre Alexis Vautrin, Nancy University, Vandoeuvre-les-Nancy, France
| | | | | | | | | | | | | | | | - Thierry Conroy
- Equipe d'Accueil 4360 Centre Alexis Vautrin, Nancy University, Vandoeuvre-les-Nancy, France
| | - Beata Juzyna
- Research and Development UNICANCER, Paris, France
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25
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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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