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Alouani E, Mercier M, Flecchia C, Auclin E, Hollebecque A, Mazard T, Turpin A, Pernot S, Cohen R, Dutherage M, Kim S, Sclafani F, Ben-Abdelghani M, Herve C, Aparicio T, De La Fouchardière C, Perkins G, Hautefeuille V, Jaffrelot M, Gallois C, Bongard V, Tougeron D, Taïeb J, Guimbaud R. Efficacy of immunotherapy in mismatch repair-deficient advanced colorectal cancer in routine clinical practice. An AGEO study. ESMO Open 2023; 8:101574. [PMID: 37244250 DOI: 10.1016/j.esmoop.2023.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Immunotherapy demonstrated remarkable efficacy in metastatic colorectal cancers (mCRCs) with mismatch repair deficiency (MMRd)/microsatellite instability (MSI). However, data regarding efficacy and safety of immunotherapy in the routine clinical practice are scarce. PATIENTS AND METHODS This is a retrospective, multicenter study aiming to evaluate efficacy and safety of immunotherapy in routine clinical practice and to identify predictive markers for long-term benefit. Long-term benefit was defined as progression-free survival (PFS) exceeding 24 months. All patients who received immunotherapy for an MMRd/MSI mCRC were included. Patients who received immunotherapy in combination with another known effective therapeutic class agent (chemotherapy or tailored therapy) were excluded. RESULTS Overall, 284 patients across 19 tertiary cancer centers were included. After a median follow-up of 26.8 months, the median overall survival (mOS) was 65.4 months [95% confidence interval (CI) 53.8 months-not reached (NR)] and the median PFS (mPFS) was 37.9 months (95% CI 30.9 months-NR). There was no difference in terms of efficacy or toxicity between patients treated in the real-world or as part of a clinical trial. Overall, 46.6% of patients had long-term benefit. Independent markers associated with long-term benefit were Eastern Cooperative Oncology Group-performance status (ECOG-PS) 0 (P = 0.025) and absence of peritoneal metastases (P = 0.009). CONCLUSIONS Our study confirms the efficacy and safety of immunotherapy in patients with advanced MMRd/MSI CRC in the routine clinical practice. ECOG-PS score and absence of peritoneal metastases provide simple markers that could help identify patients who benefit the most from this treatment.
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Affiliation(s)
- E Alouani
- Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse.
| | - M Mercier
- University of Poitiers and Gastroenterology and Hepatology Department, Poitiers University Hospital, Poitiers
| | - C Flecchia
- Institut du Cancer Paris CARPEM, Université Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris
| | - E Auclin
- Department of Oncology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université Paris Cité, Paris
| | - A Hollebecque
- Drug Development Department (DITEP), Gustave Roussy, Saclay University of Paris, Villejuif
| | - T Mazard
- Institute de Recherche en Cancérologie de Montpellier, INSERM, University of Montpellier, ICM, Montpellier
| | - A Turpin
- Department of Medical Oncology, CNRS UMR9020, Inserm UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CHU Lille, Lille
| | - S Pernot
- Department of Digestive Oncology, Institut Bergonié, Bordeaux
| | - R Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris
| | - M Dutherage
- Department of Medical Oncology, Henri Becquerel Centre, Rouen
| | - S Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - F Sclafani
- Department of Digestive Oncology, The Brussels University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - C Herve
- Clinique Mutualiste de Grenoble, Institut de cancérologie Daniel Hollard, Grenoble
| | - T Aparicio
- Gastroenterology Department, Saint Louis Hospital, Paris
| | | | - G Perkins
- Department of Gastroenterology, University Hospital Pontchaillou, Rennes
| | - V Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Amiens Picardie, Amiens
| | - M Jaffrelot
- Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse
| | - C Gallois
- Institut du Cancer Paris CARPEM, Université Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris
| | - V Bongard
- Epidemiology Department CHU de Toulouse, UMR 1295, Centre d'Epidémiologie et de Recherche en santé des Populations, Université Paul Sabatier Toulouse III-Inserm, Toulouse, France
| | - D Tougeron
- University of Poitiers and Gastroenterology and Hepatology Department, Poitiers University Hospital, Poitiers
| | - J Taïeb
- Institut du Cancer Paris CARPEM, Université Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris
| | - R Guimbaud
- Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse
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Alouani E, Gazzah A, Mercier S, Bahleda R, Hollebecque A, Michot JM, Baldini C, Champiat S, Marabelle A, Postel-Vinay S, Ribrag V, Loriot Y, Ponce S, Mahjoubi L. 461P Overview of patients inclusions and outcomes into modern phase I trials at Gustave Roussy over the last 5 years, OVATION study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.590] [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: 11/01/2022] Open
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Pons-Tostivint E, Alouani E, Kirova Y, Dalenc F, Vaysse C. Is there a role for locoregional treatment of the primary tumor in de novo metastatic breast cancer in the era of tailored therapies?: Evidences, unresolved questions and a practical algorithm. Crit Rev Oncol Hematol 2020; 157:103146. [PMID: 33227574 DOI: 10.1016/j.critrevonc.2020.103146] [Citation(s) in RCA: 8] [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: 04/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Improvements in systemic therapies have changed the face of de novo metastatic breast cancer (dnMBC), with a 5-year survival rate exceeding 25 %. Increasing evidence suggests that a subset of patients could benefit from a locoregional treatment (LRT) with prolonged survival, although the diversity of publications on the subject make it difficult to draw any conclusions. In this review, we summarize the available data on retrospective, prospective and current ongoing clinical trials. Since factors such as tumor biology, pattern of metastatic dissemination and the timing of the treatment are closely linked to the therapeutic strategy, we focus on papers which include these aspects. We discuss recent studies indicating that exclusive radiotherapy provides results comparable with those obtained by surgery. We will then discuss the biological rationale for LRT. Finally, we propose a decision-tree to select the optimal candidates for LRT in dnMBC patients.
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Affiliation(s)
- E Pons-Tostivint
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.
| | - E Alouani
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - Y Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - F Dalenc
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - C Vaysse
- Surgical Department, Toulouse University Hospital Center (CHU Toulouse), IUCT-Oncopole, 31000, Toulouse, France
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Alouani E, Parent L, Massabeau C, Selmes G, Jouve E, Izar F. [Rib fracture following intra-operative radiotherapy for breast cancer. Case Report and local experience]. Cancer Radiother 2020; 24:64-66. [PMID: 32044159 DOI: 10.1016/j.canrad.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Abstract
Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.
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Affiliation(s)
- E Alouani
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - L Parent
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - C Massabeau
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - G Selmes
- Département de chirurgie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - E Jouve
- Département de chirurgie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - F Izar
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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