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Lachkar S, Guisier F, Dantoing E, Thiberville L, Salaün M. [The role of endoscopy in the management of peripheral pulmonary nodules, part 2: Treatment]. Rev Mal Respir 2024; 41:390-398. [PMID: 38580585 DOI: 10.1016/j.rmr.2024.03.006] [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: 12/29/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024]
Abstract
The management of peripheral lung nodules is challenging, requiring specialized skills and sophisticated technologies. The diagnosis now appears accessible to advanced endoscopy (see Part 1), which can also guide treatment of these nodules; this second part provides an overview of endoscopy techniques that can enhance surgical treatment through preoperative marking, and stereotactic radiotherapy treatment through fiduciary marker placement. Finally, we will discuss how, in the near future, these advanced endoscopic techniques will help to implement ablation strategy.
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Affiliation(s)
- S Lachkar
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France.
| | - F Guisier
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
| | - E Dantoing
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France
| | - L Thiberville
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
| | - M Salaün
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
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2
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Auliac JB, Thomas PA, Bylicki O, Guisier F, Curcio H, AlainVegnenègre, Swalduz A, Wislez M, Le Treut J, Decroisette C, Basse V, Falchero L, De Chabot G, Moreau D, Huchot E, Lupo Mansuet A, Blons H, Chouaïd C, Greillier L. Resected EGFR-mutated non-small-cell lung cancers: incidence and outcomes in a European population (GFPC Exerpos Study). Ther Adv Med Oncol 2024; 16:17588359241236451. [PMID: 38455711 PMCID: PMC10919127 DOI: 10.1177/17588359241236451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
Background Few epidemiological data are available on surgically treated Caucasian patients with non-small-cell lung cancers (NSCLCs) harboring epidermal growth factor receptor (EGFR) mutations. The main objective of this study was to describe, in the real-world setting, these patients' incidence, clinical, and tumoral characteristics. Methods The participating centers included all consecutive localized non-squamous NSCLC patients undergoing surgery between January 2018 and December 2019 in France. EGFR status was determined retrospectively when not available before surgery. Results The study includes 1391 no squamous NSCLC patients from 16 centers; EGFR status was determined before surgery in 692 (49.7%) of the cases and conducted as part of the study for 699 (50.3%); 171 (12.3%) were EGFR mutated; median age: 70 (range: 36-88) years; female: 59.6%; never smokers: 75.7%; non-squamous histology 97.7%, programmed death ligand-1 expression 0%/1-49%/⩾50 in 60.5%/25.7%/13.8%, respectively. Surgery was predominantly lobectomy (81%) or segmentectomy (14.9%), with systematic lymph node dissection in 95.9%. Resection completeness was R0 for 97%. Post-surgery staging was as follows: IA: 52%, IB: 16%, IIA: 4%, IIB: 10%, IIIA: 16%, and IIIB: 0.05%; EGFR mutation exon was Del19/exon 21 (L858R)/20/18 in 37.4%/36.8%/14%, and 6.4% of cases, respectively; 31 (18%) patients received adjuvant treatment (chemotherapy: 93%, EGFR tyrosine kinase inhibitor: 0%, radiotherapy: 20%). After a median follow-up of 31 (95% confidence interval: 29.6-33.1) months, 45 (26%) patients relapsed: 11/45 (24%) locally and 34 (76%) with metastatic progression. Median disease-free survival (DFS) and overall survival were not reached and 3-year DFS was 60%. Conclusion This real-world analysis provides the incidence and outcomes of resected EGFR-mutated NSCLCs in a European patient cohort.
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Affiliation(s)
- Jean-Bernard Auliac
- Service de Pneumologie, Pneumology Department, CHI Créteil, 40 Avenue de Verdun, Creteil 94010, France
| | | | - Olivier Bylicki
- Pneumology Department, Hôpital d’instruction des Armées Sainte-Anne, Toulon, France
| | - Florian Guisier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France
| | - Hubert Curcio
- Oncology Department, Centre Francois Baclesse, Caen, France
| | - AlainVegnenègre
- Pneumology Department, CHU Limoges – Hopital Dupuytren, Limoges, France
| | - Aurelie Swalduz
- Department of Pneumology, Comprehensive Cancer Centre Léon Bérard, Lyon, France
| | - Marie Wislez
- Pneumology Department, Hôpital Cochin, AP-HP, Paris, France
| | - Jacques Le Treut
- Pneumology Department, Hôpital Européen Marseille, Marseille, France
| | - Chantal Decroisette
- Pneumology Department, Le Centre Hospitalier Annecy Genevois, Metz-Tessy, France
| | - Victor Basse
- Oncology Department, Clinique Saint-Yves, Vannes, France
| | - Lionel Falchero
- Pneumology Department, Hospital Center De Villefranche-Sur-Saône, Gleizé, France
| | - Gonzague De Chabot
- Oncology Department, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Diane Moreau
- Pneumology Department, Centre Hospitalier Universitaire de Saint Pierre de la Réunion, Saint-Pierre, Reunion Islands
| | - Eric Huchot
- Pneumology Department, Centre Hospitalier Universitaire Felix-Guyon, Saint Denis, France
| | - Audrey Lupo Mansuet
- Service d’Anatomie-Pathologique, Hôpital Cochin, Université de Paris, AP-HP, Paris, France
| | - Helene Blons
- HEGP Biochimie, UF de Pharmacogénétique et Oncologie Moléculaire, Paris, France
| | | | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hopital St. Marguerite Assistance Publique Hopitaux de Marseille, Marseille, France
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3
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Arhant G, Lachkar S, Thiebaut PA, Marguet F, Lamy A, Thiberville L, Salaün M, Guisier F, Sabourin JC, Piton N. Detection of Tumor DNA in Bronchoscopic Fluids in Peripheral NSCLC: A Proof-of-Concept Study. JTO Clin Res Rep 2024; 5:100596. [PMID: 38328474 PMCID: PMC10847031 DOI: 10.1016/j.jtocrr.2023.100596] [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: 05/25/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction DNA genotyping from plasma is a useful tool for molecular characterization of NSCLC. Nevertheless, the false-negative rate justifies the development of methods with higher sensitivity, especially in difficult-to-reach peripheral lung tumors. Methods We aimed at comparing molecular analysis from the supernatant of guide sheath flush fluid collected during radial-EndoBronchial UltraSound (r-EBUS) bronchoscopy with plasma sampling and tumor biopsies in patients with peripheral NSCLC. The DNA was genotyped using high-throughput sequencing or the COBAS mutation test. There were 65 patients with peripheral lung tumors subjected to concomitant sampling of guide sheath flush supernatant, plasma tumor DNA, and tumor biopsy and cytology using r-EBUS. There were 33 patients (including 24 newly diagnosed with having NSCLC) with an identifiable tumor mutation in the primary lesion selected for the comparative analysis. Results Guide sheath flush-based genotyping yielded a mutation detection rate of 61.8% (17 of 24 mutated EGFR, one of two ERBB2, one of one KRAS, one of one MAP2K, one of four MET, and zero of one STK11), compared with 33% in plasma-based genotyping (p = 0.0151). Furthermore, in eight of 34 r-EBUS without tumor cells on microscopic examination, we were able to detect the mutation in four paired guide sheath flush supernatant, compared with only two in paired plasma. Conclusion The detection of tumor DNA in the supernatant of guide sheath flush fluid collected during r-EBUS bronchoscopy represents a sensitive and complementary method for genotyping NSCLC.
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Affiliation(s)
- Gwenaëlle Arhant
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
| | - Samy Lachkar
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Pierre-Alain Thiebaut
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
| | - Florent Marguet
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
| | - Aude Lamy
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
| | - Luc Thiberville
- Department of Pneumology, CHU Rouen, Rouen, France
- Department of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, and Institut national de la santé et de la recherche médicale (INSERM) CIC-CRB 1404, Rouen, France
| | - Mathieu Salaün
- Department of Pneumology, CHU Rouen, Rouen, France
- Department of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, and Institut national de la santé et de la recherche médicale (INSERM) CIC-CRB 1404, Rouen, France
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, Rouen, France
- Department of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, and Institut national de la santé et de la recherche médicale (INSERM) CIC-CRB 1404, Rouen, France
| | - Jean-Christophe Sabourin
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
| | - Nicolas Piton
- Department of Pathology, Normandie Univ, UNIROUEN, Institut national de la santé et de la recherche médicale (INSERM) U1245, CHU Rouen, Rouen, France
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Haddad E, Bottet B, Thiebaut PA, Morin S, Dreyfus H, Vannier É, Vincent C, Marguet F, Lamy A, Sobol H, Baste JM, Guisier F, Sabourin JC, Piton N. Squamous Cell Carcinoma of the Lung With Microsatellite Instability in a Patient With Lynch Syndrome: A Case Report. JTO Clin Res Rep 2024; 5:100595. [PMID: 38229768 PMCID: PMC10788277 DOI: 10.1016/j.jtocrr.2023.100595] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024] Open
Abstract
Lynch syndrome is the most common autosomal dominant inherited cancer predisposing syndrome, due to mutations in DNA mismatch repair genes. The key feature of cancers in Lynch syndrome is microsatellite instability and a high risk of developing mainly colorectal and uterine cancers. However, cancers with microsatellite instability outside this spectrum, for example, lung cancer, are extremely rare. Here, we report a case of squamous cell carcinoma of the lung with microsatellite instability in a patient with Lynch syndrome.
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Affiliation(s)
- Emna Haddad
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | - Pierre-Alain Thiebaut
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | | | | | | | - Colette Vincent
- Centre Hospitalier Intercommunal (CHI) Elbeuf Louviers Val de Reuil, Saint-Aubin-lès-Elbeuf, France
| | - Florent Marguet
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Aude Lamy
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Hagay Sobol
- Département de Biologie du Cancer, Institut Paloi-Calmettes, Marseille, France
- Faculté des Sciences Médicales et Paramédicales, Aix-Marseille University (AMU), Marseille, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | | | - Jean-Christophe Sabourin
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Nicolas Piton
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
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5
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Dehem A, Mazieres J, Chour A, Guisier F, Ferreira M, Boussageon M, Girard N, Moro-Sibilot D, Cadranel J, Zalcman G, Ricordel C, Wislez M, Munck C, Poulet C, Gauvain C, Descarpentries C, Wasielewski E, Cortot AB, Baldacci S. Characterization of 164 patients with NRAS mutated non-small cell lung cancer (NSCLC). Lung Cancer 2023; 186:107393. [PMID: 37839252 DOI: 10.1016/j.lungcan.2023.107393] [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: 07/16/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND NRAS mutations are observed in less than 1% of non-small cell lung cancer (NSCLC). Clinical data regarding this rare subset of lung cancer are scarce and response to systemic treatment such as chemotherapy or immune checkpoint inhibitors (ICI) has never been reported. METHODS All consecutive patients with an NRAS mutated NSCLC, diagnosed between August 2014 and November 2020 in 14 French centers, were included. Clinical and molecular data were collected and reviewed from medical records. RESULTS Out of the 164 included patients, 106 (64.6%) were men, 150 (91.5%) were current or former smokers, and 104 (63.4%) had stage IV NSCLC at diagnosis. The median age was 62 years, and the most frequent histology was adenocarcinoma (81.7%). NRAS activating mutations were mostly found in codon 61 (70%), while codon 12 and 13 alterations were observed in 16.5% and 4.9% of patients, respectively. Programmed death ligand-1 expression level <1%/1-49%/≥50% were respectively found in 30.8%/27.1%/42.1% of tumors. With a median follow-up of 12.5 months, median overall survival (OS) of stage IV patients was 15.3 months (95% CI 9.9-27.6). No significant difference in OS was found according to the type of mutation (codon 61 vs. other), HR = 1.12 (95% CI 0.65-1.95). Among stage IV patients treated with platinum-based doublet (n = 66), ICI (n = 48), or combination of both (n = 10), objective response rate, and median progression free survival were respectively 45% and 5.8 months, 35% and 6.9 months, 70% and 8.6 months. CONCLUSION NRAS mutated NSCLC are characterized by a high frequency of smoking history and codon 61 mutations. Further studies are needed to confirm the encouraging outcome of immunotherapy in combination with chemotherapy.
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Affiliation(s)
- Agathe Dehem
- Univ. Lille, CHU Lille, Thoracic Oncology Department, F-59000 Lille, France
| | - Julien Mazieres
- Thoracic Oncology, Respiratory Department, Centre Hospitalier Universitaire de Toulouse - Hôpital Larrey, Toulouse, France
| | - Ali Chour
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France; Oncopharmacology Laboratory, Cancer Research Center of Lyon, UMR INSERM 1052 CNRS 5286, Lyon, France; Université Claude Bernard, Université de Lyon, Lyon, France
| | - Florian Guisier
- Department of Pneumology, Hôpital Charles-Nicolle - CHU de Rouen, Rouen, France
| | - Marion Ferreira
- Department of Pneumology and Respiratory Functional Exploration, University Hospital of Tours, Tours, France
| | | | - Nicolas Girard
- Thorax Institute, Institut Curie, Paris, France and Paris Saclay, UVSQ, UFR Simone Veil, Versailles, France
| | | | - Jacques Cadranel
- Pneumology and Thoracic Oncology department, APHP Paris - Hôpital Tenon and Sorbonne University, Paris, France
| | - Gérard Zalcman
- Université Paris Cité, Institut du Cancer AP-HP.Nord, Thoracic Oncology Department, CIC INSERM 1425, Hôpital Bichat Claude Bernard, Paris, France
| | | | - Marie Wislez
- Oncology Thoracic Unit Pulmonology Department, Hôpital Cochin, APHP, Paris, France
| | - Camille Munck
- Pneumologie, Hôpital Saint Vincent de Paul, Lille, France
| | - Claire Poulet
- Pneumology department, CHU Amiens-Picardie - Site Sud, Amiens, France
| | - Clément Gauvain
- Univ. Lille, CHU Lille, Thoracic Oncology Department, F-59000 Lille, France
| | - Clotilde Descarpentries
- Department of Biochemistry and Molecular Biology « Hormonology Metabolism Nutrition Oncology », CHU lille, F-59000 Lille, France
| | - Eric Wasielewski
- Univ. Lille, CHU Lille, Thoracic Oncology Department, F-59000 Lille, France
| | - Alexis B Cortot
- Univ. Lille, CHU Lille, Thoracic Oncology Department, CNRS, Inserm, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther, F-59000 Lille, France
| | - Simon Baldacci
- Univ. Lille, CHU Lille, Thoracic Oncology Department, CNRS, Inserm, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther, F-59000 Lille, France.
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6
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Dhamelincourt E, Descourt R, Rousseau-Bussac G, Doubre H, Decroisette C, Demontrond P, Le Garff G, Falchero L, Huchot E, Vieillot S, Corre R, Kazulinski L, Bizieux A, Bigay-Gamé L, Morel H, Molinier O, Chouaïd C, Guisier F. Clinical Characteristics of Patients with Advanced ALK-Translocated Non-small Cell Lung Cancers and Long-Term Responses to Crizotinib (CRIZOLONG GFPC 05-19 Study). Target Oncol 2023; 18:905-914. [PMID: 37966566 DOI: 10.1007/s11523-023-01014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Although ALK-translocated (ALK+) advanced non-small cell lung cancers (aNSCLCs) are currently treated with second- or third-generation ALK inhibitors (ALK-TKIs), some patients respond durably to the first-generation ALK-TKI crizotinib. OBJECTIVE This study aimed to describe the clinical characteristics of these long-term responders. PATIENTS AND METHODS This national, multicenter, retrospective, non-interventional study included patients with ALK+ aNSCLCs and long-term responses to first (L1)- or subsequent (≥ L2)-line crizotinib, defined, respectively, as treatments lasting > 18 and > 10 months. Median treatment duration (mDOT) was the primary endpoint. RESULTS A total of 85 patients (32 L1 and 53 ≥ L2 responders) from 23 centers were included (receiving crizotinib between 10/24/2011-10/02/2018): median age of 59 years, 83.6% non-smokers or ex-smokers, 85.9% performance status (PS) 0/1, 94.1% with adenocarcinomas, median of one metastatic site, and 22.4% with brain metastases (BMs). After median follow-up of 73.4 [95% confidence interval, 67.5-79.9] months, respective L1 and ≥ L2 mDOTs were 43.3 [26.7-56.8] and 29.6 [22.6-35.8] months, with overall survival (OS) not reached (NR) and 116.2 [83.4-NR] months. BM presence or absence did not affect mDOT (31.4 versus 32.9 months) but significantly impacted median OS (70.6 versus 158.6 months; p = 0.0008). Progression on crizotinib was paucisymptomatic (74.1%) and oligometastatic (34.8%), especially BMs (42.4%). After crizotinib discontinuation, 65 (76.5%) patients received subsequent systemic therapy: 57 (67.1%) with second-generation ALK-TKIs. Respective mDOTs of first- and second-line post-crizotinib ALK-TKIs lasted 19.4 [14.9-25.6] and 11.1 [4.8-17.9] months, respectively. CONCLUSIONS Most ALK+ aNSCLC patients with prolonged crizotinib efficacy had paucisymptomatic and oligometastatic disease without BMs. They subsequently benefited from a sequential strategy with other ALK-TKIs.
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Affiliation(s)
| | - Renaud Descourt
- Institut de Cancérologie, Hôpital Morvan, CHU de Brest, Brest, France
| | | | - Hélène Doubre
- Service d'Oncologie Thoracique, Hôpital Foch, Suresnes, France
| | | | | | | | - Lionel Falchero
- Service de Pneumologie, Hôpital Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
| | - Eric Huchot
- Service de Pneumologie, CHU Saint-Pierre, La Réunion, France
| | - Sabine Vieillot
- Service d'Oncologie, Clinique Saint Pierre, Perpignan, France
| | - Romain Corre
- Service de Pneumologie, CH Quimper, Quimper, France
| | - Laure Kazulinski
- Service de Pneumologie, CH du Cotentin Cherbourg, Cherbourg, France
| | - Acya Bizieux
- Service de Pneumologie, CH La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Hugues Morel
- Service de Pneumologie, CH Orléans, Orléans, France
| | | | - Christos Chouaïd
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
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7
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Falchero L, Guisier F, Darrason M, Boyer A, Dayen C, Cousin S, Merle P, Lamy R, Madroszyk A, Otto J, Tomasini P, Assoun S, Canellas A, Gervais R, Hureaux J, Le Treut J, Leleu O, Naltet C, Tiercin M, Van Hulst S, Missy P, Morin F, Westeel V, Girard N. Long-term effectiveness and treatment sequences in patients with extensive stage small cell lung cancer receiving atezolizumab plus chemotherapy: Results of the IFCT-1905 CLINATEZO real-world study. Lung Cancer 2023; 185:107379. [PMID: 37757576 DOI: 10.1016/j.lungcan.2023.107379] [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: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Small cell lung cancer (SCLC) has a tendency towards recurrence and limited survival. Standard-of-care in 1st-line is platinum-etoposide chemotherapy plus atezolizumab or durvalumab,based on landmarkclinical trials. METHODS IFCT-1905 CLINATEZO is a nationwide, non-interventional, retrospectivestudy of patients with extensive-SCLC receivingatezolizumab plus chemotherapy as part of French Early Access Program. Objectives were to analyse effectiveness,safetyand subsequent treatments. RESULTS The population analyzed included 518 patients who received atezolizumabin 65 participating centers. There were 66.2% male,mean age was 65.7 years; 89.1% had a performance status (PS) 0/1 and 26.6% brain metastases. Almost all(95.9%) were smokers. Fifty-five (10.6%) received at least 1 previous treatment. Median number of atezolizumab injections was 7.0 (range [1.0-48.0]) for a median duration of 4.9 months (95% CI 4.5-5.1). Atezolizumab was continued beyond progression in 122 patients (23.6%) for a median duration of 1.9 months (95% CI: [1.4-2.3]). Best objective response was complete and partialin 19 (3.9%) and 378 (77.1%)patients. Stable diseasewas observed in 50 patients (10.2%). Median follow-up was30.8 months (95% CI: [29.9-31.5]). Median overall survival (OS), 12-, 24-month OS rates were 11.3 months (95% CI: [10.1-12.4]), 46.7% (95% CI [42.3-50.9]) and 21.2% (95% CI [17.7-24.8]). Median real-world progression-free survival, 6-, 12-month rates were 5.2 months (95% CI [5.0-5.4]), 37.5% (95% CI [33.3-41.7]) and 15.2% (95% CI [12.2-18.6]). For patients with PS 0/1, median OS was 12.2 months (95% CI [11.0-13.5]). For patients with previous treatment, median OS was 14.9 months (95% CI [10.1-21.5]). Three-hundred-and-twenty-six patients(66.4%) received subsequent treatment and27 (5.2%) were still underatezolizumabat date of last news. CONCLUSIONS IFCT-1905 CLINATEZO shows reproductibility, in real-life,ofIMpower-133survival outcomes, possibly attributed to selection of patients fit for this regimen, adoption of pragmatic approaches,including concurrent radiotherapy and treatment beyond progression.
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Affiliation(s)
- Lionel Falchero
- Service de Pneumologie et Cancérologie Thoracique, Hôpitaux Nord-Ouest, Villefranche Sur Saône, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, Rouen, France, CHU Rouen, Inserm CIC-CRB 1404, Department of Pneumology, Thoracic oncology and respiratory intensive care, Rouen, France
| | - Marie Darrason
- HCL, Centre Hospitalier Lyon Sud, URCC Secteur essais cliniques, Pierre-Bérard, France
| | - Arnaud Boyer
- Hôpital Saint Joseph, Service de Pneumologie, Marseille, Franc'
| | - Charles Dayen
- Clinique de l'Europe, Service de Pneumologie, Amiens, France
| | - Sophie Cousin
- Institut'Bergonié, Département d'Oncologie Médicale, Bordeaux, France
| | - Patrick Merle
- CHU, Hôpital Gabriel Montpied, Hôpital de jour, Service d'oncologie Thoracique, Clermont Ferrand, France
| | - Régine Lamy
- CHBS, Hôpital Du Scorff, Oncologie médicale, Lorient, France
| | - Anne Madroszyk
- Institut Paoli Calmettes, Département d'Oncologie Médicale, Marseille, France Centre Antoine Lacassagne, Oncologie, Nice, France
| | | | - Pascale Tomasini
- APHM, Service d'Oncologie Multidisciplinaire &Franceations Thérapeutiques, Hôpital Nord, Marseille, France
| | - Sandra Assoun
- APHP, Service de Pneumologie, Hôpital Bichat, Paris, France
| | | | - Radj Gervais
- Service de Pneumol'gie, Centre François Baclesse, Caen, France
| | - José Hureaux
- Service de Pneumologie, CHU Angers, Angers, France
| | | | - Olivier Leleu
- Service de Pneumologie, Centre Hospitalier, Abbeville, France
| | - Charles Naltet
- Service de Pneumologie Oncologie, Groupe Hospitalier ParisFrance Joseph, Paris, France
| | - Marie Tiercin
- Fédération de Pneumologie, Centre Hospitalier, Saint Malo, France
| | - Sylvie Van Hulst
- Service de Cancérologie, Centre Hospitalier Universitaire, Nîmes, France
| | | | - Franck Morin
- IFCT, Unité de Recherche Clinique, Paris, France
| | - Virginie Westeel
- CHU Besançon, Hôpita Minjoz, Service de Pneumologie, Besançon, France
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France, Paris Saclay University, University Versailles Saint Quentin, Versailles, France.
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8
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Lachkar S, Guisier F, Thiberville L, Dantoing E, Salaün M. [Advanced bronchoscopic techniques for the diagnosis of peripheral lung nodule]. Rev Mal Respir 2023; 40:810-819. [PMID: 37798173 DOI: 10.1016/j.rmr.2023.09.001] [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: 03/04/2023] [Accepted: 07/25/2023] [Indexed: 10/07/2023]
Abstract
The endoscopic diagnosis of peripheral lung nodules is a challenging aspect of oncological practice. More often than not inaccessible by traditional endoscopy, these nodules necessitate multiple imagery tests, as well as diagnostic surgery for benign lesions. Even though transthoracic ultrasonography has a high diagnostic yield, a sizeable complication rate renders it suboptimal. Over recent years, a number of safe and accurate navigational bronchoscopic procedures have been developed. In this first part, we provide an overview of the bronchoscopic techniques currently applied for the excision and diagnostic analysis of peripheral lung nodules; emphasis is laid on electromagnetic navigation bronchoscopy and the association of virtual bronchoscopy planner with radial endobronchial ultrasound. We conclude by considering recent innovations, notably robotic bronchoscopy.
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Affiliation(s)
- S Lachkar
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France.
| | - F Guisier
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
| | - L Thiberville
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
| | - E Dantoing
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France
| | - M Salaün
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
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9
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Doubre H, Greillier L, Justeau G, Ricordel C, Swalduz A, Curcio H, Bylicki O, Auliac JB, Guisier F, Bigay-Game L, Bernardi M, Pinsolle J, Amrane K, Decroisette C, Descourt R, Chouaid C, Geier M. Venous thrombotic events and impact on outcomes in patients treated with first-line single-agent pembrolizumab in PD-L1 ≥ 50% advanced non small cell lung cancer. J Cancer Res Clin Oncol 2023; 149:15095-15102. [PMID: 37626173 DOI: 10.1007/s00432-023-05321-w] [Citation(s) in RCA: 1] [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: 05/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Few data are available on the impact of venous thrombotic events (VTE) in patients with metastatic non-small cell lung cancer (mNSCLC) treated with immunotherapy. METHODS This is a secondary analysis of the ESKEYP study, a national, retrospective, multicenter study that consecutively included all PD-L1 ≥ 50% mNSCLC patients who initiated first-line treatment with pembrolizumab monotherapy. From May 2017 to November 2019, 845 patients were included (from availability of pembrolizumab in this indication in France to the authorization of the combination with chemotherapy). Impact of VTE and patient characteristics were analyzed. RESULTS Of the 748 patients (88.5%) with available data, the incidence of VTE was 14.8% (111/748). At pembrolizumab initiation, Khorana score was ≥ 2 for 55.0% (61/111) of them. Recurrence of VTE was reported for 4 of the 111 patients and 5 had bleeding complications. Patients with VTE were significantly younger, had more frequently long-term corticosteroids treatment and more often liver metastases. Progression-free survival (PFS) was significantly shorter in patients with VTE compared to patients without VTE: 6.1 (95% CI 4.1-9.0) months vs. 8.3 (6.9-10.3) months (p = 0.03). VTE did not significantly impact overall survival (OS): 15.2 (10.0-24.7) months with VTE and 22.6 (18.4-29.8) months without VTE (p = 0.07). In multivariate analysis for PFS and OS, HRs for VTE were 1.3 (0.99-1.71), p = 0.06 and 1.32 (0.99-1.76), p = 0.05. CONCLUSION The incidence of VTE appears to be as high with in first-line immunotherapy as with chemotherapy in patients with mNSCLC, with in patient with VTE, a no significant trend for lower PFS and OS in multivariate analysis. more marked impact on PFS than on OS.
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Affiliation(s)
- Hélène Doubre
- Suresnes, Pneumology Department, Hôpital Foch, Suresnes, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | | | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Hubert Curcio
- OncologyDepartment, Caen François-Baclesse Cancer Center, Caen, France
| | | | - Jean-Bernard Auliac
- Service de Pneumologie, CHI Créteil, 40 Avenue de Verdun, 94010, Créteil, France
| | - Florian Guisier
- PneumologyDepartment, Rouen University Hospital, Rouen, France
| | | | - Marie Bernardi
- PneumologyDepartment, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Julian Pinsolle
- Pneumology Department, ChambéryMétropoleSavoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | | | | | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, 40 Avenue de Verdun, 94010, Créteil, France.
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10
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Decroisette C, Greillier L, Curcio H, Pérol M, Ricordel C, Auliac JB, Falchero L, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Descourt R. Three-Year Overall Survival of Patients With Advanced Non-Small-Cell Lung Cancers With ≥50% PD-L1 Expression Treated With First-Line Pembrolizumab Monotherapy in a Real-World Setting (ESCKEYP GFPC Study). J Immunother 2023:00002371-990000000-00069. [PMID: 37807621 DOI: 10.1097/cji.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
Outside clinical trials, few data are available on the effect of long-term first-line pembrolizumab in patients with advanced non-small-cell lung cancers with ≥50% of tumor cells expressing programmed cell death ligand 1 (PD-L1). This French, multicenter study included consecutive advanced patients with non-small-cell lung cancer given first-line pembrolizumab alone between May 2017 (authorization date for this indication) and November 2019 (authorization date for pembrolizumab-chemotherapy combination). Information was collected from patients' medical files, with a local evaluation of the response and progression-free survival (PFS). Overall survival (OS) was calculated from pembrolizumab onset using the Kaplan-Meier method. The analysis concerned 845 patients, managed in 33 centers: median age: 65 (range: 59-72) years, 67.8% men, 78.1% Eastern Cooperative Oncology Group performance status 0/1, 38.9%/51.5%/6.6% active, ex or never-smokers, respectively, 10.9%/16.8% taking or recently took corticosteroids/antibiotics, 69.6% nonsquamous histology, 48.9% ≥75% PD-L1-positive, and 20.8% had brain metastases at diagnosis. After a median (95% CI) follow-up of 45 (44.1-45.9) months, respective median (95% CI) PFS and OS lasted 8.2 (6.9-9.2) and 22 (8.5-25.9) months; 3-year PFS and OS rates were 25.4% and 39.4%, respectively. Multivariate analysis retained never-smoker status, adenocarcinoma histology, Eastern Cooperative Oncology Group performance status ≥2, and neutrophil/lymphocyte ratio >4 as being significantly associated with shorter survival, but not brain metastases at diagnosis or <75% PD-L1 tumor-cell expression. These long-term results of pembrolizumab efficacy based on a nationwide "real-world" cohort reproduced those obtained in clinical trials.
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Affiliation(s)
- Chantal Decroisette
- Department of Pneumology, Annecy Genevois Hospital, Annecy, France
- Department of Medical Oncology, Léon-Bérard Cancer Center, Lyon, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix-Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | - Hubert Curcio
- Departement of Oncology, Centre Anti-Cancer Francois-Baclesse, Caen, France
| | - Maurice Pérol
- Department of Medical Oncology, Léon-Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Department of Pneumology, Rennes University Hospital, Rennes, France
| | | | - Lionel Falchero
- Department of Pneumology, Villefranche-sur-Saône Hospital, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Remi Veillon
- Department of Pneumology, Bordeaux University Hospital, Bordeaux, France
| | - Sabine Vieillot
- Department of Oncology, Perpignan Hospital, Perpignan, France
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Department of Pneumology, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - Grégoire Justeau
- Department of Oncology, Angers University Hospital, Angers, France
| | | | - Marie Bernardi
- Department of Pneumology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Hélène Doubre
- Department of Pneumology, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Department of Pneumology, Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Department of Oncology, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Department of Pneumology, Créteil University Hospital, Créteil, France
| | - Renaud Descourt
- Department of Oncology, Brest University Hospital, Brest, France
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11
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Decazes P, Ammari S, Belkouchi Y, Mottay L, Lawrance L, de Prévia A, Talbot H, Farhane S, Cournède PH, Marabelle A, Guisier F, Planchard D, Ibrahim T, Robert C, Barlesi F, Vera P, Lassau N. Synergic prognostic value of 3D CT scan subcutaneous fat and muscle masses for immunotherapy-treated cancer. J Immunother Cancer 2023; 11:e007315. [PMID: 37678919 PMCID: PMC10496660 DOI: 10.1136/jitc-2023-007315] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Our aim was to explore the prognostic value of anthropometric parameters in a large population of patients treated with immunotherapy. METHODS We retrospectively included 623 patients with advanced non-small cell lung cancer (NSCLC) (n=318) or melanoma (n=305) treated by an immune-checkpoint-inhibitor having a pretreatment (thorax-)abdomen-pelvis CT scan. An external validation cohort of 55 patients with NSCLC was used. Anthropometric parameters were measured three-dimensionally (3D) by a deep learning software (Anthropometer3DNet) allowing an automatic multislice measurement of lean body mass, fat body mass (FBM), muscle body mass (MBM), visceral fat mass (VFM) and sub-cutaneous fat mass (SFM). Body mass index (BMI) and weight loss (WL) were also retrieved. Receiver operator characteristic (ROC) curve analysis was performed and overall survival was calculated using Kaplan-Meier (KM) curve and Cox regression analysis. RESULTS In the overall cohort, 1-year mortality rate was 0.496 (95% CI: 0.457 to 0.537) for 309 events and 5-year mortality rate was 0.196 (95% CI: 0.165 to 0.233) for 477 events. In the univariate Kaplan-Meier analysis, prognosis was worse (p<0.001) for patients with low SFM (<3.95 kg/m2), low FBM (<3.26 kg/m2), low VFM (<0.91 kg/m2), low MBM (<5.85 kg/m2) and low BMI (<24.97 kg/m2). The same parameters were significant in the Cox univariate analysis (p<0.001) and, in the multivariate stepwise Cox analysis, the significant parameters were MBM (p<0.0001), SFM (0.013) and WL (0.0003). In subanalyses according to the type of cancer, all body composition parameters were statistically significant for NSCLC in ROC, KM and Cox univariate analysis while, for melanoma, none of them, except MBM, was statistically significant. In multivariate Cox analysis, the significant parameters for NSCLC were MBM (HR=0.81, p=0.0002), SFM (HR=0.94, p=0.02) and WL (HR=1.06, p=0.004). For NSCLC, a KM analysis combining SFM and MBM was able to separate the population in three categories with the worse prognostic for the patients with both low SFM (<5.22 kg/m2) and MBM (<6.86 kg/m2) (p<0001). On the external validation cohort, combination of low SFM and low MBM was pejorative with 63% of mortality at 1 year versus 25% (p=0.0029). CONCLUSIONS 3D measured low SFM and MBM are significant prognosis factors of NSCLC treated by immune checkpoint inhibitors and can be combined to improve the prognostic value.
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Affiliation(s)
- Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Samy Ammari
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Younes Belkouchi
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Centre de Vision Numérique, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Léo Mottay
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Littisha Lawrance
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
| | - Antoine de Prévia
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
| | - Hugues Talbot
- Centre de Vision Numérique, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Siham Farhane
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
| | - Paul-Henry Cournède
- MICS Lab, CentraleSupelec, Universite Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Aurelien Marabelle
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Florian Guisier
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
- Department of Pneumology and Inserm CIC-CRB 1404, CHU Rouen, 76000 Rouen, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Tony Ibrahim
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Caroline Robert
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Nathalie Lassau
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
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12
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Bottet B, Piton N, Selim J, Sarsam M, Guisier F, Baste JM. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art. Cancers (Basel) 2023; 15:4039. [PMID: 37627067 PMCID: PMC10452134 DOI: 10.3390/cancers15164039] [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: 07/07/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Nicolas Piton
- Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France;
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
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13
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Lachkar S, Faur Q, Marguet F, Veresezan L, Bubenheim M, Salaün M, Thiberville L, Sabourin JC, Guisier F, Piton N. Assessment of endobronchial ultrasound-guided bronchoscopy (EBUS) intranodal forceps biopsy added to EBUS 19-gauge transbronchial needle aspiration: A blinded pathology panel analysis. Thorac Cancer 2023. [PMID: 37340870 PMCID: PMC10396793 DOI: 10.1111/1759-7714.15000] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS-TBNA combined with EBUS-IFB, compared to EBUS-TBNA alone. METHODS Consecutive patients who had 19-G EBUS-TBNA and EBUS-IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS-TBNA samples (cell block), then, at least 1 month later, both samples from EBUS-TBNA and from EBUS-IFB together. RESULTS Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS-TBNA alone and 94% (49/52) when combined with EBUS-IFB (p = 0.023). Malignancy was diagnosed with EBUS-TBNA combined with EBUS-IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS-TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS-IFB and 0.87 for EBUS-TBNA alone. Nonmalignant condition was diagnosed with EBUS-TBNA combined with EBUS-IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS-TBNA alone (p = 0.07). CONCLUSION The use of EBUS-IFB combined with 19-G EBUS-TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology.
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Affiliation(s)
- Samy Lachkar
- CHU Rouen, Department of Pneumology, Rouen, France
| | - Quentin Faur
- CHU Rouen, Department of Pathology, Rouen, France
- Normandie University, UNIROUEN, Inserm U1245, Rouen University Hospital, Rouen, France
| | - Florent Marguet
- CHU Rouen, Department of Pathology, Rouen, France
- Normandie University, UNIROUEN, Inserm U1245, Rouen University Hospital, Rouen, France
| | - Liana Veresezan
- Centre Henri Becquerel, Department of Pathology, Rouen, France
| | - Michael Bubenheim
- CHU Rouen, Department of Clinical Research and Innovation, Rouen, France
| | - Mathieu Salaün
- CHU Rouen, Department of Pneumology, Rouen, France
- LITIS Lab QuantIF team EA4108, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, Univ Rouen Normandie, Rouen, France
| | | | - Jean-Christophe Sabourin
- CHU Rouen, Department of Pathology, Rouen, France
- Normandie University, UNIROUEN, Inserm U1245, Rouen University Hospital, Rouen, France
| | - Florian Guisier
- CHU Rouen, Department of Pneumology, Rouen, France
- LITIS Lab QuantIF team EA4108, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, Univ Rouen Normandie, Rouen, France
| | - Nicolas Piton
- CHU Rouen, Department of Pathology, Rouen, France
- Normandie University, UNIROUEN, Inserm U1245, Rouen University Hospital, Rouen, France
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14
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Babey H, Jamme P, Curcio H, Assié JB, Veillon R, Doubre H, Pérol M, Guisier F, Huchot E, Decroisette C, Falchero L, Corre R, Cortot A, Chouaïd C, Descourt R. Real-World Treatment Outcomes of MET Exon14 Skipping in Non-small Cell Lung Cancer: GFPC 03-18 Study. Target Oncol 2023:10.1007/s11523-023-00976-4. [PMID: 37310660 DOI: 10.1007/s11523-023-00976-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND MET-targeted tyrosine kinase inhibitors (TKIs) demonstrated efficacy in advanced non-small cell lung cancer (aNSCLC) with MET exon14 skipping mutations (METexon14); yet, data on the management of these patients in clinical practice is sparse. OBJECTIVE The aim of this study was to describe the management of METexon14 aNSCLC patients. PATIENTS AND METHODS This real-life, retrospective study analyzed the management of METexon14 aNSCLC. The primary endpoint was the median overall survival (mOS). Secondary endpoints were to assess investigator-progression-free survival (PFS) and mOS in different subgroups: patients treated with (a) crizotinib, regardless of treatment line; (b) anti-MET TKIs (crizotinib, tepotinib, capmatinib); and (c) immunotherapy. RESULTS A total of 118 patients were included between December 2015 and January 1, 2020 in 13 centers. Median age was 73 years, 62.7% were female, 83.9% had adenocarcinoma, 92.4% at stage IV, and 27% had more than three metastatic sites. The majority of the patients (106, 89.8%) received at least one systemic treatment; 73% received at least one anti-MET TKI: crizotinib (68.6%), tepotinib (16%), capmatinib (10%). Only 10% received two anti-MET TKIs in their treatment sequences. With a median follow-up of 16 months (95% CI 13.6-29.7), mOS was 27.1 months (95% CI 18-31.4). There was no significant difference between mOS of patients treated and never treated with crizotinib, 19.7 (95% CI 13.6-29.7) and 28 (95% CI 16.4-NR) months, respectively (p = 0.16); mOS of the TKI cohort and of the TKI-naïve patient cohort were 27.1 (95% CI 18-29.7) and 35.6 (95% CI 8.6-NR) months respectively, with no significant difference (p = 0.7). CONCLUSIONS In this real-life study, there was no evidence of benefit in mOS with anti-MET TKIs.
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Affiliation(s)
- Hélène Babey
- Institut de Cancérologie, Hôpital Morvan, CHU de Brest, Brest, France
| | | | | | - Jean Baptiste Assié
- Service de Pneumologie, Pneumologie, Centre Hospitalier Intercommunal, CHI Créteil, 40, avenue de Verdun, 94010, Créteil Cedex, France
| | - Remi Veillon
- Oncologie thoracique, CHU de Bordeaux, Bordeaux, France
| | | | | | | | - Eric Huchot
- CHU Saint Pierre de La Réunion, Saint-Pierre, La Réunion, France
| | | | | | | | | | - Christos Chouaïd
- Service de Pneumologie, Pneumologie, Centre Hospitalier Intercommunal, CHI Créteil, 40, avenue de Verdun, 94010, Créteil Cedex, France.
| | - Renaud Descourt
- Institut de Cancérologie, Hôpital Morvan, CHU de Brest, Brest, France
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Lachkar S, Roger M, Vergnon JM, Crutu A, Febvre M, Mehdaoui A, Gervais R, Geriniere L, Arbib F, Dayen C, Trosini-Desert V, Perrin J, Mispelaere D, Thiberville L, Guisier F, Salaun M. Endoscopic resection of tracheal and bronchial granular cell tumours: A national multicentre retrospective study. Respirology 2023. [PMID: 37301541 DOI: 10.1111/resp.14532] [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: 11/24/2022] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Samy Lachkar
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Maxime Roger
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Jean-Michel Vergnon
- Department of Respiratory Care, St Etienne University Hospital, St Etienne, France
| | - Adrian Crutu
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Michel Febvre
- Pulmonology Department, Hôpital Tenon, AP-HP, Paris, France
| | - Anas Mehdaoui
- Department of Pulmonology, Evreux Hospital, Evreux, France
| | - Radj Gervais
- Department of Oncology, François Baclesse Center, Caen, France
| | - Laurence Geriniere
- Department of Pneumology, Centre Hospitalier Lyon-Sud, HCL, Lyon, France
| | - Francois Arbib
- Department of Respiratory Medicine, University Hospital of Grenoble Alpes, Grenoble, France
| | - Charles Dayen
- Respiratory Medicine Department, Hôpital de Saint-Quentin, Saint-Quentin, France
| | - Valery Trosini-Desert
- Department of Respiratory and Intensive Care Medicine, Salpêtrière Hospital, Paris, France
| | - Julie Perrin
- Pneumology, Groupe Hospitalier UNEOS, Metz, France
| | | | - Luc Thiberville
- Department of Pneumology and Inserm CIC-CRB 1404, LITIS Lab QuantIF team EA4108, University Rouen Normandie, CHU Rouen, Rouen, France
| | - Florian Guisier
- Department of Pneumology and Inserm CIC-CRB 1404, LITIS Lab QuantIF team EA4108, University Rouen Normandie, CHU Rouen, Rouen, France
| | - Mathieu Salaun
- Department of Pneumology and Inserm CIC-CRB 1404, LITIS Lab QuantIF team EA4108, University Rouen Normandie, CHU Rouen, Rouen, France
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16
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Gendarme S, Zebachi S, Corre R, Greillier L, Justeau G, Bylicki O, Decroisette C, Auliac JB, Guisier F, Geier M, Ricordel C, Frelaut M, Paillaud E, Chouaïd C, Canouï-Poitrine F. Predictors of three-month mortality and severe chemotherapy-related adverse events in patients aged 70 years and older with metastatic non-small-cell lung cancer: A secondary analysis of ESOGIA-GFPC-GECP 08-02 study. J Geriatr Oncol 2023:101506. [PMID: 37211514 DOI: 10.1016/j.jgo.2023.101506] [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: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Predictors for mortality and toxicity in older patients with cancer are mainly studied in cohorts with various cancers at different stages. This study aims to identify predictive geriatric factors (PGFs) for early death and severe chemotherapy related adverse events (CRAEs) in patients aged ≥70 years with metastatic non-small-cell lung cancer (mNSCLC). MATERIAL AND METHODS This is a secondary analysis of the multicenter, randomized, phase 3 ESOGIA trial that compared, for patients ≥70 years with mNSCLC, a treatment algorithm based on performance status and age to another algorithm based on geriatric assessment. To identify PGFs of three-month mortality and grade 3, 4, or 5 CRAEs, multivariate Cox models and logistic models, adjusted for treatment group and center, and stratified by randomization arm, were constructed. RESULTS Among 494 included patients, 145 (29.4%) had died at three months and 344 (69.6%) had severe chemotherapy toxicity. For three-month mortality, multivariate analyses retained mobility (Test Get up and Go), instrumental activity of daily living (IADL) dependence and weight loss as PGFs. The combined effect of IADL ≤2/4 and weight loss ≥3 kg was strongly associated with three-month mortality (adjusted hazard ratio: 5.71 [95% confidence interval [CI]: 2.64-12.32]). For chemotherapy toxicity, Charlson Comorbidity Index ≥2 was independently associated with grade3, 4, or 5 CRAEs (adjusted odds ratio [95% CI]: 1.94 [1.06-3.56]). DISCUSSION Mobility, IADL dependence, and weight loss were predictive of three-month mortality in a population aged ≥70 years treated for mNSCLC, while comorbidities were independently associated with severe chemotherapy toxicity.
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Affiliation(s)
- Sébastien Gendarme
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France.
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
| | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, 14 Av. Yves Thépot, 29000 Quimper, France
| | - Laurent Greillier
- Aix-Marseille Université, AP-HM, INSERM, CNRS, CRCM, Hôpital Nord, Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Grégoire Justeau
- CHU d'Angers, Service de Pneumologie, 4 Rue Larrey, 49100 Angers, France
| | - Olivier Bylicki
- HIA Sainte-Anne, Service de Pneumologie, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Chantal Decroisette
- CH d'Annecy, Service de Pneumologie, 1, avenue de l'Hôpital, Metz-Tessy, 74374 Annecy, France
| | - Jean-Bernard Auliac
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, CHU Rouen, France; Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB INSERM 1404 F, 76000, Rouen, France
| | - Margaux Geier
- CHU Morvan, Service de Pneumologie, 2, avenue Foch, 29200 Brest, France
| | - Charles Ricordel
- CHU Rennes, Service de Pneumologie, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Maxime Frelaut
- Gustave Roussy, Département d'Oncologie Médicale, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gériatrie, 20, rue Leblanc, 75908 Paris Cedex 15, France
| | - Christos Chouaïd
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
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17
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Bylicki O, Tomasini P, Radj G, Guisier F, Monnet I, Ricordel C, Bigay-Game L, Geier M, Chouaid C, Daniel C, Swalduz A, Toffart AC, Doubre H, Peloni JM, Moreau D, Subtil F, Grellard JM, Castera M, Clarisse B, Martins-Lavinas PH, Decroisette C, Greillier L. Atezolizumab with or without bevacizumab and platinum-pemetrexed in patients with stage IIIB/IV non-squamous non-small cell lung cancer with EGFR mutation, ALK rearrangement or ROS1 fusion progressing after targeted therapies: A multicentre phase II open-label non-randomised study GFPC 06-2018. Eur J Cancer 2023; 183:38-48. [PMID: 36801605 DOI: 10.1016/j.ejca.2023.01.014] [Citation(s) in RCA: 6] [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: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous reports showed limited efficacy of immune checkpoint inhibitors as single-agent treatment for non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation or ALK/ROS1 fusion. We aimed at evaluating the efficacy and safety of immune checkpoint inhibitor combined with chemotherapy and bevacizumab (when eligible) in this patient subgroup. METHODS We conducted a French national open-label multicentre non-randomised non-comparative phase II study in patients with stage IIIB/IV NSCLC, oncogenic addiction (EGFR mutation or ALK/ROS1 fusion), with disease progression after tyrosine kinase inhibitor and no prior chemotherapy. Patients received platinum, pemetrexed, atezolizumab, bevacizumab (PPAB cohort) or, if not eligible to bevacizumab, platinum-pemetrexed-atezolizumab (PPA cohort). The primary end-point was the objective response rate (RECIST v1.1) after 12 weeks, evaluated by blind independent central review. RESULTS 71 patients were included in PPAB cohort and 78 in PPA cohort (mean age, 60.4/66.1 years; women 69.0%/51.3%; EGFR mutation, 87.3%/89.7%; ALK rearrangement, 12.7%/5.1%; ROS1 fusion, 0%/6.4%, respectively). After 12 weeks, objective response rate was 58.2% (90% confidence interval [CI], 47.4-68.4) in PPAB cohort and 46.5% (90% CI, 36.3-56.9) in PPA cohort. Median progression-free survival and overall survival were 7.3 (95% CI 6.9-9.0) months and 17.2 (95% CI 13.7-NA) months in PPAB cohort and 7.2 (95% CI 5.7-9.2) months and 16.8 (95% CI 13.5-NA) months in PPA cohort, respectively. Grade 3-4 adverse events occurred in 69.1% of patients in PPAB cohort and 51.4% in PPA cohort; Grade 3-4 atezolizumab-related adverse events occurred in 27.9% and 15.3%, respectively. CONCLUSION Combination approach with atezolizumab with or without bevacizumab and platinum-pemetrexed achieved promising activity in metastatic EGFR-mutated or ALK/ROS1-rearranged NSCLC after tyrosine kinase inhibitor failure, with acceptable safety profile.
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Affiliation(s)
- Olivier Bylicki
- Department of Pneumology, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
| | - Pascale Tomasini
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Gervais Radj
- Department of Medical Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Florian Guisier
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Charles Ricordel
- Department of Pneumology, CHU Rennes, Univ Rennes 1, INSERM, OSS (Oncogenesis Stress Signaling), UMR_S 1242, CLCC Eugene Marquis, F-35000 Rennes, France
| | - Laurence Bigay-Game
- Department of Pneumology & Thoracic Oncology, CHU Toulouse-Hôpital Larrey, Toulouse, France
| | | | - Christos Chouaid
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Catherine Daniel
- Thoracic Oncology Service, Thorax Institute Curie Montsouris, Institut Curie, Paris, France
| | - Aurelie Swalduz
- Department of Pneumology, Comprehensive Cancer Centre Léon Bérard, Lyon, France
| | | | | | - Jean-Michel Peloni
- Department of Pneumology, Maison de Santé Protestante de Bordeaux-Bagatelle, Talence, France
| | - Diane Moreau
- Department of Pneumology and Oncology, Medical University of Felix Guyon, Reunion Island, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jean-Michel Grellard
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Marie Castera
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Benedicte Clarisse
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Pedro-Henrique Martins-Lavinas
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Chantal Decroisette
- Department of Pneumology & Thoracic Oncology, CH Annecy-Genevois, 74370 Metz-Tessy, France
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
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18
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Vergnenegre A, Monnet I, Ricordel C, Bizieux A, Curcio H, Bernardi M, Corre R, Guisier F, Hominal S, Le Garff G, Bylicki O, Locher C, Geier M, Chouaïd C, Robinet G. Safety and efficacy of second-line metronomic oral vinorelbine-atezolizumab combination in stage IV non-small-cell lung cancer: An open-label phase II trial (VinMetAtezo). Lung Cancer 2023; 178:191-197. [PMID: 36868180 DOI: 10.1016/j.lungcan.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of second-line metronomic oral vinorelbine-atezolizumab combination for stage IV non-small-cell lung cancer. METHODS This was a multicenter, open-label, single-arm Phase II study performed in patients with advanced NSCLC without activating EGFR mutation or ALK rearrangement who progressed after first-line platinum-doublet chemotherapy. Combination treatment was atezolizumab (1200 mg IV day 1, every 3 weeks) and oral vinorelbine (40 mg, 3 times by week). The primary outcome was progression-free survival (PFS) during the 4-month follow-up from the first dose of treatment. Statistical analysis was based on the exact single-stage Phase II design defined by A'Hern. Based on literature data, the Phase III trial threshold was set at 36 successes in 71 patients. RESULTS 71 patients were analyzed (median age, 64 years; male, 66.2%; ex-smokers/active smokers, 85.9%; ECOG performance status 0-1, 90.2%; non-squamous NSCLC, 83.1%; PD-L1 ≥ 50%, 4.4%). After a median follow-up of 8.1 months from treatment initiation, 4-month PFS rate was 32% (95% CI, 22-44), i.e. 23 successes out 71 patients. OS rate was 73.2% at 4 months and 24.3% at 24 months. Median PFS and OS were 2.2 (95% CI, 1.5-3.0) months and 7.9 (95% CI, 4.8-11.4) months, respectively. Overall response rate and disease control rate at 4 months were 11% (95% CI, 5-21) and 32% (95% CI, 22-44), respectively. No safety signal was evidenced. CONCLUSION Metronomic oral vinorelbine-atezolizumab in the second-line setting did not achieve the predefined PFS threshold. No new safety signal was reported for vinorelbine-atezolizumab combination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Margaux Geier
- Institut de Cancérologie et d'Hématologie, Brest, France
| | | | - Gilles Robinet
- Institut de Cancérologie et d'Hématologie, Brest, France
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19
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Aldea M, Marinello A, Duruisseaux M, Zrafi W, Conci N, Massa G, Metro G, Monnet I, Gomez Iranzo P, Tabbo F, Bria E, Guisier F, Vasseur D, Lindsay CR, Ponce-Aix S, Cousin S, Citarella F, Fallet V, Minatta JN, Eisert A, de Saint Basile H, Audigier-Valette C, Mezquita L, Calles A, Mountzios G, Tagliamento M, Remon Masip J, Raimbourg J, Terrisse S, Russo A, Cortinovis D, Rochigneux P, Pinato DJ, Cortellini A, Leonce C, Gazzah A, Ghigna MR, Ferrara R, Dall'Olio FG, Passiglia F, Ludovini V, Barlesi F, Felip E, Planchard D, Besse B. RET-MAP: An International Multicenter Study on Clinicobiologic Features and Treatment Response in Patients With Lung Cancer Harboring a RET Fusion. J Thorac Oncol 2023; 18:576-586. [PMID: 36646211 DOI: 10.1016/j.jtho.2022.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 05/24/2022] [Revised: 11/05/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Nearly 1% to 2% of NSCLCs harbor RET fusions. Characterization of this rare population is still incomplete. METHODS This retrospective multicenter study included patients with any-stage RET positive (RET+) NSCLC from 31 cancer centers. Molecular profiling included DNA/RNA sequencing or fluorescence in situ hybridization analyses. Clinicobiological features and treatment outcomes (per investigator) with surgery, chemotherapy (CT), immune checkpoint blockers (ICBs), CT-ICB, multityrosine kinase inhibitors, and RET inhibitors (RETis) were evaluated. RESULTS For 218 patients included between February 2012 and April 2022, median age was 63 years, 56% were females, 93% had adenocarcinoma, and 41% were smokers. The most frequent fusion partner was KIF5B (72%). Median tumor mutational burden was 2.5 (range: 1-4) mutations per megabase, and median programmed death-ligand 1 expression was 10% (range: 0%-55%). The most common metastatic sites were the lung (50%), bone (43%), and pleura (40%). Central nervous system metastases were found at diagnosis of advanced NSCLC in 21% of the patients and at last follow-up or death in 31%. Overall response rate and median progression-free survival were 55% and 8.7 months with platinum doublet, 26% and 3.6 months with single-agent CT, 46% and 9.6 months with CT-ICB, 23% and 3.1 months with ICB, 37% and 3 months with multityrosine kinase inhibitor, and 76% and 16.2 months with RETi, respectively. Median overall survival was longer in patients treated with RETi versus no RETi (50.6 mo [37.7-72.1] versus 16.3 mo [12.7-28.8], p < 0.0001). CONCLUSIONS Patients with RET+ NSCLC have mainly thoracic and bone disease and low tumor mutational burden and programmed death-ligand 1 expression. RETi markedly improved survival, whereas ICB may be active in selected patients.
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Affiliation(s)
- Mihaela Aldea
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France
| | - Arianna Marinello
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Department of Medical Oncology, Humanitas Research Hospital, Milan, Italy
| | - Michael Duruisseaux
- Respiratory Department and Early Phase, Louis Pradel Hospital, Hospices Civils de Lyon; Cancer Research Center of Lyon (CRCL), INSERM 1052, CNRS 5286; Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Wael Zrafi
- Department of Biostatistics and Bioinformatics, Gustave Roussy, Villejuif, France
| | - Nicole Conci
- Department of Medical Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) University Hospital of Bologna, Bologna, Italy
| | - Giacomo Massa
- Department of Medical Oncology, National Cancer Institut, Milan, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Isabelle Monnet
- Pneumology and Thoracic Oncology Department, Intercommunal Hospital of Creteil (CHI), Creteil, France
| | | | - Fabrizio Tabbo
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Emilio Bria
- Department of Medical Oncology, Comprehensive Cancer Center, IRCCS Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Florian Guisier
- Department of Medical Oncology, Rouen University Hospital, Rouen, France
| | - Damien Vasseur
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Colin R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Santiago Ponce-Aix
- Department of Medical Oncology, University Hospital October 12, Madrid, Spain
| | - Sophie Cousin
- Department of Medical Oncology, Bergonié Institut, Bordeaux, France
| | | | - Vincent Fallet
- Department of Pneumology and Thoracic Oncology, Tenon Hospital, Assistance Publique Hôpitaux de Paris and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | | | - Anna Eisert
- Department of Medical Oncology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Calles
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giannis Mountzios
- 4th Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy
| | - Jordi Remon Masip
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain
| | - Judith Raimbourg
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France
| | - Safae Terrisse
- Department of Medical Oncology, Saint Louis Hospital, Paris, France
| | - Alessandro Russo
- Department of Medical Oncology, Papardo Hospital, Messina, Italy
| | - Diego Cortinovis
- Department of Medical Oncology, San Gerardo Hospital, Monza, Italy
| | - Philippe Rochigneux
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, United Kingdom; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Camille Leonce
- Department of Molecular Pathology, Louis-Pradel Hospital, Lyon, France
| | - Anas Gazzah
- Department of Drug Development Department, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Maria-Rosa Ghigna
- Department of Pathology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Roberto Ferrara
- Department of Medical Oncology, National Cancer Institut, Milan, Italy
| | | | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Vienna Ludovini
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Fabrice Barlesi
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Planchard
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France.
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Gervais R, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Decroisette C. First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study). Cancer Immunol Immunother 2023; 72:91-99. [PMID: 35729418 DOI: 10.1007/s00262-022-03232-2] [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: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
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Affiliation(s)
- Renaud Descourt
- Oncology Department, Brest University Hospital, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Jean-Bernard Auliac
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France
| | - Lionel Falchero
- Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France
| | - Radj Gervais
- Oncology Department, Caen François-Baclesse Cancer Center, Caen, France
| | - Rémi Veillon
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Florian Guisier
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | | | | | - Marie Bernardi
- Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Pierre Fournel
- Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Hélène Doubre
- Pneumology Department, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France.
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21
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Guisier F, Descourt R, Babey H, Huchot E, Falchero L, Veillon R, Cortot AB, Tissot C, Chouaid C, Decroisette C. Brief Report: First-line Pembrolizumab in Metastatic Non-Small Cell Lung Cancer Habouring MET Exon 14 Skipping Mutation and PD-L1 ≥50% (GFPC 01-20 Study). Clin Lung Cancer 2022; 23:e545-e549. [PMID: 36210290 DOI: 10.1016/j.cllc.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Florian Guisier
- Department of Pneumology and Inserm CIC-CRB 1404, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Rouen, France.
| | - Renaud Descourt
- Institut de cancérologie, Hopital Morvan, CHRU Brest, Brest, France
| | - Helene Babey
- Institut de cancérologie, Hopital Morvan, CHRU Brest, Brest, France
| | - Eric Huchot
- CHU sud Reunion, Service de Pneumologie, Saint-Pierre, France
| | - Lionel Falchero
- L'Hôpital Nord-Ouest, Service de Pneumologie et Cancérologie Thoracique, Villefranche Sur Saône, France
| | - Remi Veillon
- CHU Bordeaux, service des maladies respiratoire, Bordeaux, France
| | - Alexis B Cortot
- CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Univ. Lille, Plasticity and Resistance to Therapies, Lille, France
| | - Claire Tissot
- Department of Medical Oncology, Institut de Cancérologie Lucien-Neuwirth, Saint-Etienne, France
| | - Christos Chouaid
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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22
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Marinello A, Vasseur D, Conci N, Fallet V, Audigier-Valette C, Cousin S, Tabbò F, Guisier F, Russo A, Calles Blanco A, Metro G, Massa G, Citarella F, Eisert A, Iranzo Gomez P, Tagliamento M, Mezquita L, Lindsay C, Ponce S, Aldea M. 1007P Mechanisms of primary and secondary resistance to RET inhibitors in patients with RET-positive advanced NSCLC. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1133] [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: 11/29/2022] Open
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23
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Ricordel C, Anota A, Bernardi M, Falchero L, Auliac J, Greillier L, Bylicki O, De Chabot G, Demaegdt A, Vergnenegre A, Decroisette C, Martel-Lafay I, Chouaid C, Guisier F. 962P Quality of life at diagnosis for unresectable stage III NSCLC: Initial results from the national prospective study OBSTINATE (GFPC 06-2019). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1088] [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: 11/29/2022] Open
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24
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Mehlman C, Swalduz A, Monnet I, Morin C, Guisier F, Curcio H, Du Rusquec P, Cortot A, Gounant V, Abbar B, Duchemann B, Giroux-Leprieur E, Pierret T, Quilot F, Cadranel J, Fallet V. 995P Effectiveness of combination of osimertinib with another targeted therapy in advanced EGFR mutated non-small cell lung cancer harbouring other oncogenic drivers: The real-world COMPOSIT study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1121] [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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25
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Auliac J, Simmoneau Y, Thomas P, Guisier F, Bylicki O, Curcio H, Swalduz A, Wislez M, Geier M, J. Le Treut, Decroisette C, Falchero L, Tricard J, Moreau D, Huchot E, De Chabot G, Leroy K, Mansuet AL, Chouaid C, Greillier L. 937P Incidence and outcomes of EGFR mutated non-small cell lung cancer treated with surgery: EXERPOS GFPC study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1063] [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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26
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Guisier F, Deslee G, Birembaut P, Escarguel B, Chapel F, Bota S, Métayer J, Lachkar S, Capron F, Homasson JP, Taulelle M, Quintana M, Raspaud C, Messelet D, Benzaquen J, Hofman P, Baddredine J, Paris C, Cales V, Laurent P, Vignaud JM, Ménard O, Copin MC, Ramon P, Bouchindhomme B, Tavernier JY, Quintin I, Quiot JJ, Galateau-Sallé F, Zalcman G, Piton N, Thiberville L. Endoscopic follow-up of low-grade precancerous bronchial lesions in high-risk patients: long-term results of the SELEPREBB randomised multicentre trial. Eur Respir J 2022; 60:13993003.01946-2021. [PMID: 35236723 DOI: 10.1183/13993003.01946-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/15/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND 3-9% of low-grade preinvasive bronchial lesions progress to cancer. This study assessed the usefulness of an intensive bronchoscopy surveillance strategy in patients with bronchial lesions up to moderate squamous dysplasia. METHODS SELEPREBB (ClinicalTrials.gov NCT00213603) was a randomised study conducted in 17 French centres. After baseline lung computed tomography (CT) and autofluorescence bronchoscopy (AFB) to exclude lung cancer and bronchial severe squamous dysplasia or carcinoma in situ (CIS), patients were assigned to standard surveillance (arm A) with CT and AFB at 36 months or to intensive surveillance (arm B) with AFB every 6 months. Further long-term data were obtained with a median follow-up of 4.7 years. RESULTS 364 patients were randomised (A: 180, B: 184). 27 patients developed invasive lung cancer and two developed persistent CIS during the study, with no difference between arms (OR 0.63, 95% CI 0.20-1.96, p=0.42). Mild or moderate dysplasia at baseline bronchoscopy was a significant lung cancer risk factor both at 3 years (8 of 74 patients, OR 6.9, 95% CI 2.5-18.9, p<0.001) and at maximum follow-up (16 of 74 patients, OR 5.9, 95% CI 2.9-12.0, p<0.001). Smoking cessation was significantly associated with clearance of bronchial dysplasia on follow-up (OR 0.12, 95% CI 0.01-0.66, p=0.005) and with a reduced risk of lung cancer at 5 years (OR 0.15, 95% CI 0.003-0.99, p=0.04). CONCLUSION Patients with mild or moderate dysplasia are at very high risk for lung cancer at 5 years, with smoking cessation significantly reducing the risk. Whereas intensive bronchoscopy surveillance does not improve patient outcomes, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programmes.
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Affiliation(s)
- Florian Guisier
- Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France
| | - Gaëtan Deslee
- Dept of Pneumology, CHU de Reims, Inserm UMR 1250, Université de Reims-Champagne Ardenne, Reims, France
| | | | | | - Françoise Chapel
- Laboratoire d'Anatomie Pathologique, CHI Toulon La Seyne sur Mer, Toulon, France
| | | | | | | | | | | | | | | | | | - Daniel Messelet
- Laboratoire d'Anatomie et Cytologie Pathologiques, Toulouse, France
| | - Jonathan Benzaquen
- Dept of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France.,Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, FHU OncoAge, CNRS UMR7284, INSERM U1081, Nice, France
| | - Paul Hofman
- Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, CNRS, INSERM, Nice, France.,Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, FHU OncoAge, BB-0033-00025, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Christophe Paris
- INSERM U1085 IRSET and Service de Santé au Travail et de Pathologie Professionnelle et Environnementale, CHRU Pontchaillou, Rennes, France
| | - Valérie Cales
- Laboratoire d'Anatomie Pathologique, CH de Pau, Pau, France
| | | | | | - Olivier Ménard
- Service de Pneumologie, CHU Nancy, Hôpital Brabois, Vandoeuvre les Nancy, France
| | | | - Philippe Ramon
- Clinique des Maladies Respiratoires, CHRU Lille, Hôpital Calmette, Lille, France
| | | | | | - Isabelle Quintin
- Service d'Anatomie Pathologique, CHU Brest, Hôpital Morvan, Brest, France
| | | | - Françoise Galateau-Sallé
- Laboratoire d'Anatomie Pathologique, CHU de Caen, Caen, France.,Dept of BioPathology Centre Leon Berard, Lyon, France
| | - Gérard Zalcman
- Service de Pneumologie, CHU de Caen, Caen, France.,Thoracic Oncology Dept, Université de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Nicolas Piton
- Service de Pathologie, Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Rouen, France
| | - Luc Thiberville
- Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France
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Decroisette C, Monnet I, Ricordel C, Demaegdt A, Falchero L, Bylicki O, Geier M, Justeaux G, Bernardi M, Andre M, Guisier F, Fournel P, Vieillot S, Hauss P, Schott R, Crequit J, Auliac J, Chouaid C, Greillier L. 1035P A phase II trial of nivolumab and denosumab association as second-line treatment for stage IV non-small-cell lung cancer (NSCLC) with bone metastases: DENIVOS study (GFPC 06-2017). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1161] [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: 11/28/2022] Open
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28
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Lachkar S, Perrot L, Gervereau D, De Marchi M, Morisse Pradier H, Dantoing E, Piton N, Thiberville L, Guisier F, Salaün M. Radial-EBUS and virtual bronchoscopy planner for peripheral lung cancer diagnosis: How it became the first-line endoscopic procedure. Thorac Cancer 2022; 13:2854-2860. [PMID: 36054681 PMCID: PMC9575082 DOI: 10.1111/1759-7714.14629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 01/05/2023] Open
Abstract
Background Various advanced bronchoscopy methods have been developed to reach peripheral lung lesions (PLL). In a large cohort, we aimed to assess a standardized procedure of first‐line radial‐endobronchial ultrasound (r‐EBUS) and virtual bronchoscopy planner for the diagnosis of peripheral lung cancer. Methods This retrospective, single center study included patients who had r‐EBUS‐guided bronchoscopy for the diagnosis of a PLL between 2008 and 2019. Cases without a final diagnosis of cancer or follow‐up were excluded. Results Between 2008 and 2019, 2735 patients had a r‐EBUS procedure, among whom 1627 had a final diagnosis of cancer and were included in the present study. Over the 12‐year study period, r‐EBUS became the first‐line endoscopic procedure to assess PLL (25% as first‐line bronchoscopy in 2008 vs. 92% in 2019). The frequency of the bronchus sign decreased from 2009 to 2019 (100% to 80%; p = 0.001), whereas US visualization of the lesion remained stable (88%). The median number of biopsies increased from two (2008 to 2014) to four (2015 to 2019) (p < 0.0001), with the same diagnostic efficiency (74% total and 80% when a bronchus sign was present). Of the 651 adenocarcinomas, molecular analysis was possible in 86%. PD‐L1 expression analysis was possible in 81% of cases. During the study period, the lifetime of the radial probe increased from 57 procedures to 77 procedures/probe. Conclusion Because r‐EBUS and VB planner is easy to perform under local anesthesia, inexpensive and efficient it can be used as a first‐line procedure to assess peripheral lung cancer.
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Affiliation(s)
- Samy Lachkar
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Loic Perrot
- Department of Pneumology, CHU Rouen, Rouen, France
| | | | | | | | | | - Nicolas Piton
- Department of Pathology, CHU Rouen, Rouen, France.,France and Normandie University, UNIROUEN, Inserm U1245, Rouen University Hospital, Rouen, France
| | - Luc Thiberville
- Department of Pneumology and Inserm CIC-CRB, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Rouen, France
| | - Florian Guisier
- Department of Pneumology and Inserm CIC-CRB, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Rouen, France
| | - Mathieu Salaün
- Department of Pneumology and Inserm CIC-CRB, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Rouen, France
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Aldea M, Marinello A, Zrafi W, Tabbo F, Guisier F, Vasseur D, Fallet V, Audigier-Valette C, Mezquita L, Calles A, Mountzios G, Tagliamento M, Raimbourg J, Terrisse S, Novello S, Ghigna MR, Barlesi F, Planchard D, Besse B. Abstract 4019: RET-MAP: An international multi-center study of patients with advanced non-small cell lung cancer and RET fusions. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: RET fusions (RET+) are identified in nearly 1% of advanced NSCLC (aNSCLC). We evaluated characteristics and outcomes of patients (pts) with RET+ aNSCLC.
Methods: This is an international, multicenter, retrospective study evaluating clinical, biological, pathological and radiological data of pts with RET+ aNSCLC. Objective response rates (ORR), duration of response (DOR) and progression-free survival (PFS) were evaluated under double or single agent chemotherapy (CT), immunotherapy (ICI), CT-ICI, multityrosine kinase inhibitors (MTKi) and RET inhibitors (RETi). Overall survival (OS) was calculated from the start of first line therapy and compared between pts treated or not by RETi, after stratification by number of treatment lines.
Results: A total of 71 pts was included from 11 centers. Median age was 60 [IQR 47-69], 58% were female, 93% had adenocarcinoma, 2 pts (3%) had squamous and 2 (3%) neuroendocrine carcinoma, 38 (53.5%) were tobacco consumers (median 18.5 PY [7.8-31.3]), 50 (70%) had stage IV disease at diagnosis. Fusion partners were KIF5B (35/49, 71%), CCDC6 (9/49, 18%), others (5/49, 10%). Median TMB was 2.76 [2.0-8.5], median PD-L1 5% [0-29]. The most frequent co-mutation was TP53 (18/58 cases, 31%). Median number of metastatic sites was 2 [1-3], most commonly lung (48%), bone (45%), pleura (41%) and nodes (35%). Brain metastases were found in 18% of cases at diagnosis and in 31% at last follow-up or death. Table reports outcomes by treatment. mOS was 50.6 months [95%CI 37.6 - NR]. Fifty-two pts received 1st generation RETi. The use of RETi improved OS in pts treated with ≤2 lines of therapy (NR vs 17.8 months, p=0.024) and in those receiving >2 lines (50.6 vs 12.7 months, p=0.0037). Pts responding to ICI had a median PD-L1 of 85% [15.5-90].
Conclusions: Pts with RET+ aNSCLC have mainly thoracic and bone disease. Despite smoking history, median TMB and PD-L1 expression are low. ICI may have a significant activity in selected cases. RETi improve OS.
Outcomes by treatment First use of Doublet CT (N=46) Single agent CT (N=12) CT-ICI (N=9) ICI (N=19) MTKi (N=9) RETi (N=52) Line of treatment (median, range) 1 [1-1] 2 [2-3] 1 [1-2] 2 [2-3] 3 [1.5-3.5] 2 [1-3] ORR (N,%) 25/40 (62.5%) 3/12 (25%) 3/9 (33%) 7/17 (41%) 4/8 (50%) 36/45 (80%) mPFS (months, 95%CI) 7.89 [6.18-14] 2.81 [2.43-NR] 5.62 [2.79-NR] 3.71 [2.99-11.5] 2.76 [1.51-NR] 24.7 [16.2-NR] mDOR (months,95%CI) 11.83 [7.06-15.6] 8.90 [4.21-NR] 14.47 [10.25-NR] 20.47 [11.3-NR] 8.18 [1.64-NR] 24.74 [17.12-NR] Stopped for toxicity (N,%) 7/46 (15%) 1/12 (8%) 2/9 (22%) 4/18 (22%) 1/9 (11%) 14/50 (28%)
Citation Format: Mihaela Aldea, Arianna Marinello, Wael Zrafi, Fabrizio Tabbo, Florian Guisier, Damien Vasseur, Vincent Fallet, Clarisse Audigier-Valette, Laura Mezquita, Antonio Calles, Giannis Mountzios, Marco Tagliamento, Judith Raimbourg, Safae Terrisse, Silvia Novello, Maria-Rosa Ghigna, Fabrice Barlesi, David Planchard, Benjamin Besse. RET-MAP: An international multi-center study of patients with advanced non-small cell lung cancer and RET fusions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4019.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonio Calles
- 7Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lena H, Monnet I, Bylicki O, Audigier-Valette C, Falchero L, Vergnenegre A, Demontrond P, Greillier L, Geier M, Guisier F, Decroisette C, Locher C, Corre R, Cropet C, Chouaid C, Ricordel C. Randomized phase III study of nivolumab and ipilimumab versus carboplatin-based doublet in first-line treatment of PS 2 or elderly (≥ 70 years) patients with advanced non–small cell lung cancer (Energy-GFPC 06-2015 study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
9011 Background: Combination of anti-PD1 and CTLA4 have showed superiority to chemotherapy (CT) in advanced non–small cell lung cancer (NSCLC), but data for fit elderly or PS2 patients are scarce. Methods: eNErgy compared the combination of nivolumab ipilimumab (N-I) to a platinum doublet in elderly or PS2 patients with advanced NSCLC. Primary endpoint was overall survival (OS), secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. Main inclusion criteria were: stage IV histologically proven NSCLC, age ≥ 70 y, and PS 0/1/2 or age < 70 and PS2, EGFR ALK/ROS1 negative, judged fit enough to receive a platinum doublet. The main exclusion criteria were active cerebral metastasis or contraindication to N-I. Patients were randomly selected 1/1, stratified by age (≥ 70 vs. < 70 y), PS (0/1 vs. 2), and histology (squamous vs. no-squamous). Nivolumab (240 mg, 2w), ipilimumab, 1 mg/kg, 6w, was administrated until progression or unacceptable toxicity. CT was planned for 4 cycles, with carboplatin (AUC5) and pemetrexed (500 mg/m2, 3w) or paclitaxel (90 mg/m2, d1,d8, d15); 242 patients had to be randomized to detect a treatment effect hazard ratio (HR) on OS of 0.65, with a 85% power at a 2-sided alpha level of 5%. Results: A preplanned interim analysis carried out after observation of 33% of deaths, out of 174 randomized patients, showed a risk of futility especially for PS 2 patients, HR: 1.8 (95% CI, 0.99-3.3). This led to a halt in randomization but continued follow-up of the 204 patients randomized at the time of the decision. The current final analysis is carried out 18 months after the inclusion of the last patient: men, 71%, median age 74 (51-89, PS 0/1/2 in 30%, 37.5%, and 36.6% respectively), smokers or former smokers in 25.5 and 64.4%, with 62% adenocarcinoma. The median OS of N-I and chemo arms were 14.7 (95% CI, 8.0-19.7) and 9.9 (95% CI, 7.7-12.3) months, HR 0.85, 95% CI, 0.62-1.16. The subgroup analyses showed a significant benefit of the association N-I compared to CT for elderly PS 0/1 patients, with median OS of 22.6 (95% CI, 18.1-36) vs. 11.8 (95% CI, 8.9-20.5) months, p = 0.02. In PS2 patients, median OS of N-I and CT arms was 2.9 (1.4-4.8) vs. 6.1 (3.5-10.4) months (p = 0.22). Median PFS was significantly in favor of N-I arm in the entire population: 5.5 (2.8-8.7) vs. 4.6 (3.5-5.6); p = 0.015. Safety was similar with 31.4% of patients with grade ≥ 3 related SAES in N-I arm vs. 49.5% for CT. Treatment was discontinued for toxicity in 28.6% in N-I arm vs. 22.3% of patients in CT arm. Conclusions: Despite no statistically significant benefit in OS observed in the entire population, there was a clinical signal of efficacy of N-I combination over platinum doublet in elderly NSCLC patients PS 0-1 with a significant benefit of OS of 22.6 months vs. 11.8 for CT arm. Clinical trial information: NCT03351361.
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Affiliation(s)
- Herve Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | | | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | | | | | | | | | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, Quimper, France
| | - Claire Cropet
- Unite de Biostatistique et d'Evaluation des Therapeutiques-Direction de la Recherche et d l'Innovation, Centre Leon Berard, Lyon, France
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Montagne F, Chaari Z, Bottet B, Sarsam M, Mbadinga F, Selim J, Guisier F, Gillibert A, Baste JM. Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel) 2022; 14:cancers14112611. [PMID: 35681593 PMCID: PMC9179652 DOI: 10.3390/cancers14112611] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat lung cancer. Both VATS and RATS allow anatomical resection associated with radical lymph node dissection. However, RATS, unlike VATS, allows the thoracic surgeon to mimic an open approach and to perform lung resection. We hypothesized that the technical advantages of RATS, compared with VATS, would allow more precise resection, with “better lymph node dissection” which could increase survival compared to VATS. Nevertheless, VATS, and RATS nodal up-staging are still debated, with conflicting results and in our study, as well as in the medical literature, RATS failed to show its superiority over VATS in resectable non-small cell lung cancer. Abstract Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. Methods: This retrospective cohort study included patients treated for resectable NSCLC performed by RATS or VATS, in our tertiary care center from 2012 to 2019. Patients’ data were prospectively recorded and reviewed in the French EPITHOR database. Primary outcomes were 5-year DFS for lobectomy and 3-year DFS for segmentectomy, compared by propensity-score adjusted difference of Kaplan–Meier estimates. Results: Among 844 lung resections, 436 VATS and 234 RATS lobectomies and 46 VATS and 128 RATS segmentectomies were performed. For lobectomy, the adjusted 5-year DFS was 60.9% (95% confidence interval (CI) 52.9–68.8%) for VATS and 52.7% (95%CI 41.7–63.7%) for RATS, with a difference estimated at −8.3% (−22.2–+4.9%, p = 0.24). For segmentectomy, the adjusted 3-year DFS was 84.6% (95%CI 69.8–99.0%) for VATS and 72.9% (95%CI 50.6–92.4%) for RATS, with a difference estimated at −11.7% (−38.7–+7.8%, p = 0.21). Conclusions: RATS failed to show its superiority over VATS for resectable NSCLC.
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Affiliation(s)
| | - Zied Chaari
- Department of Thoracic and Cardiovascular Surgery, University of Sfax, Habib Bourguiba University Hospital, Sfax 3029, Tunisia;
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Frankie Mbadinga
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Jean Selim
- Department of Anesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
| | - Florian Guisier
- Thoracic Oncology and Respiratory Intensive Care Unit, Department of Pneumology, Rouen University Hospital, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, EA4108 LITIS Lab, QuantiF Team and INSERM CIC-CRB 1404, F-76183 Rouen, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F-76000 Rouen, France;
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
- Correspondence: ; Tel.: +33-(2)-32888704
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Marinello A, Duruisseaux M, Zrafi W, Dall'Olio F, Massa G, Iranzo P, Tabbò F, Guisier F, Lindsay C, Fallet V, Audigier-Valette C, Mezquita L, Calles A, Mountzios G, Tagliamento M, Raimbourg J, Terrisse S, Planchard D, Besse B, Aldea M. 34P RET-MAP: An international multi-center study on clinicopathologic features and treatment response in patients with NSCLC and RET fusions. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gendarme S, Bylicki O, Chouaid C, Guisier F. ROS-1 Fusions in Non-Small-Cell Lung Cancer: Evidence to Date. Curr Oncol 2022; 29:641-658. [PMID: 35200557 PMCID: PMC8870726 DOI: 10.3390/curroncol29020057] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
The ROS-1 gene plays a major role in the oncogenesis of numerous tumors. ROS-1 rearrangement is found in 0.9–2.6% of non-small-cell lung cancers (NSCLCs), mostly lung adenocarcinomas, with a significantly higher rate of women, non-smokers, and a tendency to a younger age. It has been demonstrated that ROS-1 is a true oncogenic driver, and tyrosine kinase inhibitors (TKIs) targeting ROS-1 can block tumor growth and provide clinical benefit for the patient. Since 2016, crizotinib has been the first-line reference therapy, with two-thirds of the patients’ tumors responding and progression-free survival lasting ~20 months. More recently developed are ROS-1-targeting TKIs that are active against resistance mechanisms appearing under crizotinib and have better brain penetration. This review summarizes current knowledge on ROS-1 rearrangement in NSCLCs, including the mechanisms responsible for ROS-1 oncogenicity, epidemiology of ROS-1-positive tumors, methods for detecting rearrangement, phenotypic, histological, and molecular characteristics, and their therapeutic management. Much of this work is devoted to resistance mechanisms and the development of promising new molecules.
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Affiliation(s)
- Sébastien Gendarme
- INSERM, IMRB (Clinical Epidemiology and Ageing Unit), University Paris Est Créteil, F-94010 Créteil, France;
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, F-94010 Créteil, France
- Correspondence:
| | - Olivier Bylicki
- Respiratory Disease Unit, HIA Sainte-Anne, 2, Boulevard Saint-Anne, F-83000 Toulon, France;
| | - Christos Chouaid
- INSERM, IMRB (Clinical Epidemiology and Ageing Unit), University Paris Est Créteil, F-94010 Créteil, France;
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, F-94010 Créteil, France
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
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Lachkar S, Gervereau D, Lanquetuit M, Thiberville L, Pradier HM, Roger M, Bota S, Guisier F, Salaün M. Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia. J Thorac Dis 2022; 14:3205-3210. [PMID: 36245621 PMCID: PMC9562512 DOI: 10.21037/jtd-22-461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/11/2022] [Indexed: 12/02/2022]
Abstract
Background Patients undergoing flexible bronchoscopy under local anesthesia usually experience anxiety before and during the procedure. Different non-pharmacological techniques, including music and hypnosis, are used to distract patients’ attention, and to reduce anxiety. The new technique “virtual reality hypnosis (VRH)”, defined as a hypnotic induction suggestion delivered by personalized virtual reality software, can generate a simulation of a lifelike environment. No study has described the use of VRH during bronchoscopy. The objective is to investigate the anxiety reducing effect and the satisfaction of patients, physicians, and nurses using VRH during bronchoscopy. Methods VRH was proposed to all patients who experienced anxiety before undergoing flexible bronchoscopy under local anesthesia. Local anesthesia was performed using 5% lidocaine spray only. No sedation was used. After the procedure, patients, physicians and nurses filled a standardized satisfaction form. Results Twenty consecutive patients who reported pre-procedure anxiety were included. The sex ratio was 16 women/4 men, the median age was 65 years. Eight patients (40%) had undergone a previous bronchoscopy under local anesthesia. The median duration of the procedure was 10 minutes, and all procedures were completed. The median level of anxiety of patients decreased from 9/10 before the procedure to 4/10 during the procedure. The median satisfaction rate regarding the use of VRH was 10/10. All patients agreed to use VRH again in case of a new bronchoscopy procedure. Conclusions This preliminary report has shown that VRH was useful to reduce patients’ anxiety during bronchoscopy under local anesthesia. VRH was easily implemented in the routine practice.
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Affiliation(s)
- Samy Lachkar
- Department of Pneumology, CHU Rouen, Rouen, France
| | | | | | | | | | - Maxime Roger
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Suzanna Bota
- Department of Pneumology, CHU Rouen, Rouen, France
| | - Florian Guisier
- Department of Pneumology, LITIS Lab QuantIF Team EA4108, UNIROUEN, Normandie University, CHU Rouen, Rouen, France
- Inserm CIC-CRB 1404, Rouen, France
| | - Mathieu Salaün
- Department of Pneumology, LITIS Lab QuantIF Team EA4108, UNIROUEN, Normandie University, CHU Rouen, Rouen, France
- Inserm CIC-CRB 1404, Rouen, France
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Lachkar S, Salaün M, Perrot L, Gervereau D, De Marchi M, Le Bouar G, Morisse-Pradier H, Dominique S, Piton N, Guisier F, Thiberville L. Virtual Bronchoscopy Planner and Radial-EBUS Guided Biopsy for Organizing Pneumonia Diagnosis. J Clin Med 2021; 11:jcm11010104. [PMID: 35011844 PMCID: PMC8745414 DOI: 10.3390/jcm11010104] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP. Methods: All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed. Results: 2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively (p < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3–94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group (p < 0.0001). No severe complications were reported. Conclusion: r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.
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Affiliation(s)
- Samy Lachkar
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
- Correspondence:
| | - Mathieu Salaün
- EA4108 LITIS Lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, Normandie Univ, F-76000 Rouen, France; (M.S.); (F.G.); (L.T.)
| | - Loic Perrot
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Diane Gervereau
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Marielle De Marchi
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Gurvan Le Bouar
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Helene Morisse-Pradier
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Stephane Dominique
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France; (L.P.); (D.G.); (M.D.M.); (G.L.B.); (H.M.-P.); (S.D.)
| | - Nicolas Piton
- Department of Cytology and Pathology, Rouen University Hospital, F-76000 Rouen, France;
| | - Florian Guisier
- EA4108 LITIS Lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, Normandie Univ, F-76000 Rouen, France; (M.S.); (F.G.); (L.T.)
| | - Luc Thiberville
- EA4108 LITIS Lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, Normandie Univ, F-76000 Rouen, France; (M.S.); (F.G.); (L.T.)
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Dehem A, Mazieres J, Chour A, Guisier F, Ferreira M, Boussageon M, Girard N, Moro-Sibilot D, Cadranel J, Zalcman G, Ricordel C, Wislez M, Munck C, Poulet CH, Gauvain C, Descarpentries C, Wasielewski E, Cortot A, Baldacci S. 1341P NRAS mutated non-small cell lung cancer (NSCLC) patients: Characteristics and outcomes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1942] [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: 10/20/2022] Open
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Descourt R, Pérol M, Rousseau-Bussac G, Planchard D, Mennecier B, Wislez M, Cadranel J, Cortot A, Guisier F, Galland L, Do P, Schott R, Dansin E, Arrondeau J, Auliac J, Chouaid C. 1200P BrigALK2 study: A multicentric real-world study evaluating brigatinib in ALK positive advanced pre-treated non-small cell lung cancers: Long-term follow-up with focus on lorlatinib efficacy after brigatinib. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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Descourt R, Chouaid C, Pérol M, Besse B, Greillier L, Bylicki O, Ricordel C, Guisier F, Gervais R, Schott R, Auliac JB, Robinet G, Decroisette C. First-line pembrolizumab with or without platinum doublet chemotherapy in non-small-cell lung cancer patients with PD-L1 expression ≥50. Future Oncol 2021; 17:3007-3016. [PMID: 34156285 DOI: 10.2217/fon-2020-1202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pembrolizumab plus chemotherapy is currently used in the first-line treatment of advanced non-small-cell lung cancer without EGFR mutations or ALK rearrangements, regardless of PD-L1 expression status. A study comparing chemotherapy plus pembrolizumab versus pembrolizumab alone has never been performed in patients with PD-L1 ≥50%. The aim of this trial is to perform such a comparison as first-line treatment in patients not eligible for locally advanced treatment who have expression of PD-L1 on ≥50% of tumor cells. The expected results are a reduction in the risk of early progression. A higher objective tumor response is also expected with the combination of chemotherapy and pembrolizumab compared with pembrolizumab alone. The study will allow a direct comparison of the proportion of patients who derive long-term benefit from the treatment. Clinical trial number: EudraCT (2020-002626-86); ClinicalTrials.gov (NCT04547504).
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Affiliation(s)
- Renaud Descourt
- Cancer institue, A. Morvan Hospital, CHRU, 29200, Brest, France
| | - Christos Chouaid
- Department of Pneumology, CHI Créteil, 94000, Créteil, France.,Inserm U955, UPEC, IMRB, équipe CEpiA, 94000, Créteil, France
| | | | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy, Villejuif, Université Paris-Saclay, Orsay, 94805, Villejuif, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology & Therapeutic Innovations, APHM, Hôpital Nord, Aix-Marseille, University, 13000, Marseille, France
| | - Olivier Bylicki
- Department of Pneumology, Military hospital, Sainte-Anne, 83800, Toulon, France
| | | | - Florian Guisier
- Pneumology, Thoracic Oncology & Respiratory Intensive Care Medicine & CIC INSERM U 1404, Rouen University Hospital, 76000, Rouen, France
| | - Radj Gervais
- Francois Baclesse Anticancer Center, 14000, Caen, France
| | - Roland Schott
- Paul Strauss Anticancer Center, 67000, Strasbourg, France
| | | | - Gilles Robinet
- Cancer institue, A. Morvan Hospital, CHRU, 29200, Brest, France
| | - Chantal Decroisette
- Department of Pneumology & Thoracic Oncology, CH Annecy-Genevois, 74370, Metz-Tessy, France
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Demontrond P, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaid C, Decroisette C. First-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥ 50%) advanced non-small cell lung cancer (aNSCLC) in the real world: A national French bispective multicentric cohort—ESCKEYP trial (GFPC 05-2018). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9091] [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
9091 Background: To determine real-world outcomes with first line pembrolizumab monotherapy, for aNSCLC with PD-L1 TPS ≥50%. Methods: Bispective, national and multicentric study including consecutively aNSCLC patients who initiated first-line pembrolizumab monotherapy from May 5, 2017 (marketing authorization of pembrolizumab monotherapy in France) to Nov 22, 2019 (marketing authorization of pembrolizumab-chemotherapy for non-squamous aNSCLC). Data were collected on medical charts. Responses were locally assessed according to RECIST v1.1; overall survival (OS) and real-world progression-free survival (rwPFS) were assessed by Kaplan-Meier method. Results: 845 patients (pts) were included by 33 centres: 67.8% were men, PS 0/1/≥2: 25.5%/46.9%/27.6%, active/former/nonsmokers: 39.1%/51.7%/6.4%, adenocarcinoma: 70.8%; stage IV at diagnosis: 91.6%; median number of metastatic sites at baseline: 2±1 (brain (20.8%), liver (13.9%) and bone (35%)); KRAS mutated: 27.7%, PDL1 TPS > 75%: 53.7% At the cut off date (31 December 2020), on the 783/845 (92.7%) evaluable pts, CR, PR, disease stabilization and progression were reported on 4.7%, 42.6%, 24.1% and 28.6% of cases, respectively; 588 (69.6%) pts had discontinued pembrolizumab, 390 (66.4%) had a first disease progression; 320/390 (82.1%) received a second line treatment, mainly platinum-based chemotherapy (90.6%). With a median follow up of 25,8 [95%CI: 24,8-26,7] months, median rwPFS and median OS were 8,2 [95%CI: 6,9-9,5] and 22,6 [95%CI: 18,5-27,4] months, respectively; 6, 12, 18-months survival rates were 76,8%, 64,8% and 54,3%. 835 adverse events were reported in 48% of the patients, grade ≥3 in 13.8% of cases, mainly asthenia, colitis, pneumonitis. For evaluable patients receiving a platinum-based doublet in second line (266/290, 89%), CR, PR, disease stabilization and progression were reported on 1.9%, 41%, 35.3% and 21.8% of cases, respectively. Uni and multivariate analysis of factors related to OS will be presented at the congress. Conclusions: Despite a less stringent selection of patients, pembrolizumab as a single agent achieves similar tumor shrinkage, rwPFS and OS than those of pivotal clinical trials.
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Affiliation(s)
- Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | - Remi Veillon
- CHU Bordeaux, Service Des Maladies Respiratoires, Bordeaux, France
| | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
| | | | | | | | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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Piton N, Lanic MD, Marguet F, Lamy A, Blanchard F, Guisier F, Viennot M, Salaün M, Thiberville L, Jardin F, Sabourin JC, Ruminy P. An improved assay for detection of theranostic gene translocations and MET exon 14 skipping in thoracic oncology. J Transl Med 2021; 101:648-660. [PMID: 33495574 DOI: 10.1038/s41374-021-00536-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/15/2023] Open
Abstract
Theranostic translocations may be difficult to detect by routine techniques, especially when specimens are exiguous. We recently demonstrated in a series of translocated lung adenocarcinomas that LD-RT-PCR (ligation-dependent reverse transcription polymerase chain reaction) assay could identify ALK, ROS1 and RET rearrangements with 64% sensitivity and 100% specificity. Here, we report an upgraded version of this assay used in a routine prospective cohort of lung carcinomas. Newly diagnosed lung carcinomas referred to the Rouen molecular platform between 15/05/2018 and 15/05/2019 for ALK and ROS1 IHC, genotyping (SNaPshot© +/- high-throughput genotyping) and sometimes FISH (standard routine process) were tested prospectively in parallel with the LD-RT-PCR assay designed to detect at one go ALK, ROS1 and RET translocations and MET exon 14 skipping. 413 tumors from 396 patients were included. LD-RT-PCR had a global sensitivity of 91.43% (standard routine process: 80%), with a specificity of 100%. It detected 15/18 ALK and 4/4 ROS1 translocated tumors, but also 6/6 tumors with MET exon 14 skipping retrieved by genotyping. In addition, it retrieved 7 alterations missed by the routine process, then confirmed by other means: 5 MET exon 14 skipping and 2 RET translocated tumors. Finally, it allowed to deny an effect on MET exon 14 skipping for 8 mutations detected by routine genotyping. We successfully implemented LD-RT-PCR in routine analysis. This technique is cheap, fast, sensitive, specific, and easily upgradable (e.g., NTRK translocations), but still requires IHC to be performed in parallel. Owing to its advantages, we recommend considering it, in parallel with IHC and genotyping, as an excellent cost-effective alternative, for the systematic testing of lung adenocarcinoma, to FISH and to more expensive and complex assays such as RNA-seq.
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Affiliation(s)
- Nicolas Piton
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital, Department of Pathology, F76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France, F-76000, Rouen, France.
| | - Marie-Delphine Lanic
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, Rouen, France
| | - Florent Marguet
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital, Department of Pathology, F76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France, F-76000, Rouen, France
| | - Aude Lamy
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital, Department of Pathology, F76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France, F-76000, Rouen, France
| | - France Blanchard
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital, Department of Pathology, F76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France, F-76000, Rouen, France
| | - Florian Guisier
- Normandie Univ, UNIROUEN, EA4108 LITIS lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, F-76000, Rouen, France
| | - Mathieu Viennot
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, Rouen, France
| | - Mathieu Salaün
- Normandie Univ, UNIROUEN, EA4108 LITIS lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, F-76000, Rouen, France
| | - Luc Thiberville
- Normandie Univ, UNIROUEN, EA4108 LITIS lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, F-76000, Rouen, France
| | - Fabrice Jardin
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, Rouen, France
| | - Jean-Christophe Sabourin
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital, Department of Pathology, F76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France, F-76000, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, Rouen, France
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Auliac JB, Guisier F, Bizieux A, Assouline P, Bernardini M, Lamy R, Justeau G, François G, Damotte D, Chouaïd C. Impact of Programmed Death Ligand 1 Expression in Advanced Non-Small-Cell Lung Cancer Patients, Treated by Chemotherapy (GFPC 06-2015 Study). Onco Targets Ther 2020; 13:13299-13305. [PMID: 33408480 PMCID: PMC7779294 DOI: 10.2147/ott.s288825] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Few data have been published on the clinical and histopathological characteristics of advanced non-small–cell lung cancer (NSCLC) patients with high PD-L1 expression versus intermediate or none and the prognostic value of PD-L1 expression for patients treated with chemotherapy is unknown. This study was undertaken to prospectively assess the prognostic value of tumor-cell (TC) and immune-cell (IC) PD-L1 expressions for advanced NSCLC patients. Methods It was a prospective, multicenter study on advanced NSCLC patients, with performance status 0/1, scheduled, consecutively, to receive first-line platin-based chemotherapy. PD-L1 expression was determined immunochemically (Dako Autostainer and monoclonal antibody 22C3) and its impact on progression-free survival (PFS) and overall survival (OS) assessed. Results Among 198 patients screened in 19 centers, 140 were included median age: 66.5 ± 10 years; 76.4% men; 79.3% Caucasians; 10.7% nonsmokers; 63.6% adenocarcinomas; <1%, 1–50% and ≥50% TC PD-L1–expression rates were 47.1%, 25.7% and 27.2% of patients, respectively; respective null, intermediate and high rates on ICs were 35.7%, 38.6% and 25.7%. Second- and third-line chemotherapies were administered to 58.6% and 26.4% of the patients, respectively. None received immunotherapy. First-, second- and third-line median (95% CI) PFS lasted 4.6 (3.6–5.2), 3.7 (2.3–4.7) and 2.2 (1.5–4.3) months, respectively; median OS was 16.9 (11.4–19.9) months. No significant PFS and OS differences were observed according to TC or IC PD-L1 expression. Conclusion According to the results of this prospective, multicenter study, neither TC nor IC PD-L1 expression appears to be prognostic for chemotherapy-managed advanced NSCLC patients.
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Affiliation(s)
- Jean-Bernard Auliac
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Florian Guisier
- Pulmonology, Thoracic Oncology and Respiratory Department, Rouen University Hospital, Rouen, France
| | - Acya Bizieux
- Pneumology Department, Centre Hospitalier de Vendée, La Roche-sur-Yon, France
| | - Pascal Assouline
- Pneumology Department, Centre Hospitalier de Bligny, Bligny, France
| | - Marie Bernardini
- Pneumology Department, Centre Hospitalier d'Aix-En-Provence, Aix-en-Provence, France
| | - Régine Lamy
- Pneumology Department, Centre Hospitalier de Bretagne-Sud, Lorient, France
| | - Grégoire Justeau
- Pneumology Department, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Geraldine François
- Pneumology Department, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Diane Damotte
- Department of Pathology, Hôpital Cochin, APHP, Paris, France.,University Paris Descartes, Paris, France
| | - Christos Chouaïd
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Inserm U955, UPEC, IMRB, Équipe CEpiA, Créteil, France
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Herbreteau G, Langlais A, Greillier L, Audigier-Valette C, Uwer L, Hureaux J, Moro-Sibilot D, Guisier F, Carmier D, Madelaine J, Otto J, Souquet PJ, Gounant V, Merle P, Molinier O, Renault A, Rabeau A, Morin F, Denis MG, Pujol JL. Circulating Tumor DNA as a Prognostic Determinant in Small Cell Lung Cancer Patients Receiving Atezolizumab. J Clin Med 2020; 9:E3861. [PMID: 33261056 PMCID: PMC7760916 DOI: 10.3390/jcm9123861] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The IFCT-1603 trial evaluated atezolizumab in small cell lung cancer (SCLC). The purpose of the present study was to determine whether circulating tumor DNA (ctDNA), prospectively collected at treatment initiation, was associated with the prognosis of SCLC, and whether it identified patients who benefited from atezolizumab. METHODS 68 patients were included in this study: 46 patients were treated with atezolizumab and 22 with conventional chemotherapy. Circulating DNA was extracted from plasma and NGS (Next Generation Sequencing) looked for mutations in the TP53, RB1, NOTCH1, NOTCH2, and NOTCH3 genes. ctDNA was detectable when at least one somatic mutation was identified, and its relative abundance was quantified by the variant allele fraction (VAF) of the most represented mutation. RESULTS We found that 49/68 patients (70.6%) had detectable baseline ctDNA. The most frequently identified mutations were TP53 (32/49; 65.3%) and RB1 (25/49; 51.0%). Patients with detectable ctDNA had a significantly lower disease control rate at week 6 compared with patients with no detectable ctDNA, regardless of the nature of the treatment. Detection of ctDNA was associated with a poor OS prognosis. The detection of ctDNA at a relative abundance greater than the median value was significantly associated with poor overall survival (OS) and progression free survival (PFS). Interestingly, the benefit in overall survival (OS) associated with low ctDNA was more pronounced in patients treated with atezolizumab than in patients receiving chemotherapy. Among patients whose relative ctDNA abundance was below the median, those treated with atezolizumab tended to have higher OS than those in the chemotherapy arm. CONCLUSION ctDNA is strongly associated with the prognosis of SCLC patients treated with second-line immunotherapy. Its analysis seems justified for future SCLC clinical trials.
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Affiliation(s)
- Guillaume Herbreteau
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, 44093 Nantes, France;
| | - Alexandra Langlais
- IFCT Intergroupe Francophone de Cancérologie Thoracique, 10 Rue de la Grange Batelière, 75009 Paris, France; (A.L.); (F.M.)
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Assistance Publique—Hôpitaux de Marseille, Aix Marseille University, 13015 Marseille, France;
| | - Clarisse Audigier-Valette
- Department of Thoracic Oncology, 54 Rue Henri Sainte Claire Deville, CHITS CH Sainte Musse, 83000 Toulon, France;
| | - Lionel Uwer
- Institut de Cancérologie de Lorraine Alexis Vautrin, 6 Avenue de Bourgogne, 54519 Vandoeuvre-les-Nancy, France;
| | - José Hureaux
- Pôle Hippocrate, Angers University Hospital, 49933 Angers, France;
| | | | - Florian Guisier
- Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care, Rouen University Hospital, 76000 Rouen, France;
| | - Delphine Carmier
- Service de Pneumologie CHRU Hôpitaux de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000 Tours, France;
| | - Jeannick Madelaine
- Service de Pneumologie, CHU Caen Normandie, Av de La Côte de Nacre, 14000 Caen, France;
| | - Josiane Otto
- Pôle Médecine, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France;
| | - Pierre-Jean Souquet
- Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310 Pierre-Benite, France;
| | - Valérie Gounant
- Department of Thoracic Oncology, Bichat Claude Bernard Hospital, 75018 Paris, France;
| | - Patrick Merle
- Service de Pneumologie, 58 Rue Montalembert, CHU G Montpied, 63000 Clermont Ferrand, France;
| | - Olivier Molinier
- Service de Pneumologie, Centre Hospitalier, 194 Avenue Rubillard, 72037 Le Mans, France;
| | - Aldo Renault
- Service de Pneumologie, Centre Hospitalier, 4 Boulevard Hauterive, 64000 Pau, France;
| | - Audrey Rabeau
- Service de Pneumologie, Centre Hospitalier, Université Paul Sabatier, 31300 Toulouse, France;
| | - Franck Morin
- IFCT Intergroupe Francophone de Cancérologie Thoracique, 10 Rue de la Grange Batelière, 75009 Paris, France; (A.L.); (F.M.)
| | - Marc G Denis
- Department of Biochemistry, Nantes University Hospital, 9 Quai Moncousu, 44093 Nantes, France;
| | - Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, 34090 Montpellier, France
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Arpin D, Charpentier MC, Bernardi M, Monnet I, Boni A, Watkin E, Goubin-Versini I, Lamy R, Gérinière L, Geier M, Forest F, Gervais R, Madrosyk A, Guisier F, Serrand C, Locher C, Decroisette C, Fournel P, Auliac JB, Jeanfaivre T, Letreut J, Doubre H, Francois G, Piton N, Chouaïd C, Damotte D. PD-L1-expression patterns in large-cell neuroendocrine carcinoma of the lung: potential implications for use of immunotherapy in these patients: the GFPC 03-2017 "EPNEC" study. Ther Adv Med Oncol 2020; 12:1758835920937972. [PMID: 32684990 PMCID: PMC7343361 DOI: 10.1177/1758835920937972] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/05/2020] [Indexed: 01/11/2023] Open
Abstract
Background Few data are available on programmed cell-death-protein-1-ligand-1 (PD-L1) expression on large-cell neuroendocrine carcinomas of the lung (LCNECs). We analyzed PD-L1 expression on tumor (TCs) and inflammatory cells (ICs) from LCNEC patients to assess relationships between this expression, clinical characteristics, and disease outcomes. Methods PD-L1 expression was determined by immunohistochemistry with monoclonal antibody 22C3 in consecutive LCNEC patients managed in 17 French centers between January 2014 and December 2016. Results After centralized review, only 68 out of 105 (64%) patients had confirmed LCNEC diagnoses. Median overall survival (OS) (95% CI) was 11 (7-16) months for all patients, 7 (5-10), 21 (10-not reached) and not reached months for metastatic, stage III and localized forms (p = 0.0001). Respectively, 11% and 75% of the tumor samples were TC+ and IC+, and 66% had a TC-/IC+ profile. Comparing IC+ versus IC- metastatic LCNEC, the former had significantly longer progression-free survival [9 (4-13) versus 4 (1-8) months; p = 0.03], with a trend towards better median OS [12 (7-18) versus 9.5 (4-14) months; p = 0.21]. Compared to patients with TC- tumors, those with TC+ LCNECs tended to have non-significantly shorter median OS [4 (1-6.2) versus 11 (8-18) months, respectively]. Median OS was significantly shorter for patients with TC+/IC- metastatic LCNECs than those with TC-IC+ lesions (2 versus 8 months, respectively; p = 0.04). Conclusion TC-/IC+ was the most frequent PD-L1-expression profile for LCNECs, a pattern quite specific compared with non-small-cell lung cancer and small-cell lung cancer. IC PD-L1 expression seems to have a prognostic role.
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Affiliation(s)
- Dominique Arpin
- Department of Pneumology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | | | - Marie Bernardi
- Department of Pneumology, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Emmanuel Watkin
- Departement of pathology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | | | - Régine Lamy
- Department of Pneumology, Centre Hospitalier Bretagne-Sud, Lorient, France
| | - Laurence Gérinière
- Department of Pneumology, Centre Hospitalier Lyon-Sud, HCL, Lyon, France
| | - Margaux Geier
- Department of Medical Oncology, CHU Morvan, Brest, France
| | - Fabien Forest
- Department of Pathology, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Radj Gervais
- Department of Medical Oncology, Centre Francois-Baclesse, Caen, France
| | - Anne Madrosyk
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Florian Guisier
- Department of Pneumology, CHU Charles-Nicolle, Rouen, France
| | - Cécile Serrand
- Department of Pneumology, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Chrystèle Locher
- Department of Pneumology, Grand Hôpital de L'Est Francilien, site de Meaux, Meaux, France
| | | | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancérologie Lucien-Neuwirth, Saint-Etienne, France
| | - Jean-Bernard Auliac
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Jacques Letreut
- Department of Pneumology, Hopital Européen, Marseille, France
| | - Hélène Doubre
- Department of Pneumology, Hôpital Foch, Surennes, France
| | | | - Nicolas Piton
- Department of Pathology, CHU Charles-Nicolle, Rouen, France
| | - Christos Chouaïd
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, Créteil, 94010, France
| | - Diane Damotte
- Department of Pathology, Cochin Hospital APHP, Paris, France
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Lachkar S, Couraud S, Salaün M, Roger M, Bota S, Guisier F, Thiberville L. Self-expanding metallic Y-stent compared to silicone Y-stent for malignant lesions of the main carina: A single center retrospective study. Respir Med Res 2020; 78:100767. [PMID: 32498021 DOI: 10.1016/j.resmer.2020.100767] [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: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bifurcation stents are often required in patients with malignant airway obstruction or fistulization involving the main carina. The silicone Y stent is the most used but remains challenging to place. The self-expanding metallic Y (SEM) stent appears easy to use. The objective is to report the feasibility, efficacy, and tolerance of SEM Y stent compared to silicone Y stent in patients with malignant tumors involving the main carina. PATIENTS AND METHODS This retrospective single center study was performed between May 2004 and May 2017. All patients with malignant carina involvement treated with a bronchial Y stent were included. RESULTS Forty silicone Y stents and 38 SEM Y stents were placed. Seven stenting placements failed in the silicone Y group but none in the SEM Y stent group (P=0.008). The median duration of the procedure was 80min (25-210) in the silicone Y group and.50min (25-110min) in the SEM Y group (P=0.001). There was no significant difference in terms of early or late complications between the 2 groups. Nine silicone Y stents (26.5%) and 7 SEM Y stents (18.4%) were removed (P=0.4). The median survival time following stent insertion was 171 days (Interquartile range (IQR): 53-379) in the silicone Y group and 104 days (IQR: 53-230) in the SEM Y group. CONCLUSION If silicone Y stent remains the best solution for benign obstruction, SEM Y stent seems to be an easy alternative with no difference in terms of complication or ablation for malignant lesions involving the main carina.
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Affiliation(s)
- S Lachkar
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
| | - S Couraud
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - M Salaün
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
| | - M Roger
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - S Bota
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - F Guisier
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
| | - L Thiberville
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
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Gobbini E, Toffart AC, Pérol M, Assié JB, Duruisseaux M, Coupez D, Dubos C, Westeel V, Delaunay M, Guisier F, Veillon R, Gounant V, Giroux Leprieur E, Vanel FR, Chaabane N, Dansin E, Babey H, Decroisette C, Barlesi F, Daniel C, Fournel P, Mezquita L, Oulkhouir Y, Canellas A, Duchemann B, Molinier O, Alcazer V, Moro-Sibilot D, Levra MG. Immune Checkpoint Inhibitors Rechallenge Efficacy in Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2020; 21:e497-e510. [PMID: 32605892 DOI: 10.1016/j.cllc.2020.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/30/2020] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICPi) rechallenge could represent an attractive option in non-small-cell lung cancer (NSCLC), yet no sufficient data supporting this strategy are available. This retrospective observational multicenter national study explored the efficacy of anti-programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) rechallenge in advanced NSCLC patients, looking for potential clinical features associated with greater outcomes. PATIENTS AND METHODS We retrospectively collected data from 144 advanced NSCLC patients whose disease was rechallenged with ICPis after ≥ 12 weeks of discontinuation. The progression-free survival (PFS) and overall survival (OS) were calculated from first or second ICPi initiation to disease progression (PFS1 and PFSR, respectively), death, or last follow-up (OS1, OSR), respectively. RESULTS The median (interquartile range) age was 63 (58-70) years. Most patients were male (67%) and smokers (87%). Most had adenocarcinomas (62%) and/or stage IV disease at diagnosis (66%). The best response at rechallenge was not associated with that under the first ICPi (P = 1.10-1). The median (95% confidence interval) PFS1 and PFSR were 13 (10-16.5) and 4.4 (3-6.5) months, respectively. The median (95% confidence interval) OS1 and OSR were 3.3 (2.9-3.9) and 1.5 (1.0-2.1) years, respectively. Longer PFSR and OSR were found in patients discontinuing first ICPi because of toxicity or clinical decision, those not receiving systemic treatment between the two ICPis, and those with good Eastern Cooperative Oncology Group performance status at rechallenge. Only performance status proved to affect outcomes at multivariate analysis. CONCLUSION Patients discontinuing first ICPi because of toxicity or clinical decision, those able to maintain a treatment-free period, and those with good performance status may be potential candidates for rechallenge.
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Affiliation(s)
- Elisa Gobbini
- Thoracic Oncology Unit SHUPP, CHU Grenoble-Alpes, Grenoble, France; Cancer Research Center Lyon, Center Léon Bérard, Lyon, France.
| | | | - Maurice Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Michaël Duruisseaux
- Unité de Recherche Commune en Oncologie Thoracique (URCOT), Hospices Civils de Lyon Cancer Institute, Lyon, France; Anticancer Antibodies Laboratory, Cancer Research Center of Lyon, Inserm 1052, CNRS 5286, Lyon, France; Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Dahna Coupez
- Thoracic Oncology Unit, CHU Nantes, Nantes, France
| | - Catherine Dubos
- Thoracic Oncology Unit, Center François Baclesse, Caen, France
| | | | | | - Florian Guisier
- Pneumology, Thoracic Oncology, and Respiratory Intensive Care Unit, CHU Rouen, Rouen, France
| | - Rémi Veillon
- Respiratory Diseases Department, F-33000, CHU Bordeaux, Bordeaux, France
| | - Valérie Gounant
- Thoracic Oncology Department, CIC 1425 INSERM, Center Bichat, Paris, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Pare, Paris, France
| | | | - Nouha Chaabane
- Pulmonology Service, AP-HP Paris Center University Hospitals, Cochin Hospital, Paris, France
| | - Eric Dansin
- Thoracic Oncology Unit, Center Oscar Lambret, Lille, France
| | - Hélène Babey
- Thoracic Oncology Unit, CHRU Brest, Brest, France
| | | | - Fabrice Barlesi
- Aix-Marseille Université, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Catherine Daniel
- Thoracic Oncology Unit, Institute Curie, Paris/Saint Cloud, France
| | - Pierre Fournel
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint, France
| | - Laura Mezquita
- Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif, France
| | | | - Anthony Canellas
- Pulmonology Unit, APHP Hôpital Tenon and GRC 04 Theranoscan Sorbonne University, Paris, France
| | | | | | - Vincent Alcazer
- Cancer Research Center Lyon, Center Léon Bérard, Lyon, France
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Domblides C, Leroy K, Monnet I, Mazières J, Barlesi F, Gounant V, Baldacci S, Mennecier B, Toffart AC, Audigier-Valette C, Doucet L, Giroux-Leprieur E, Guisier F, Ricordel C, Molinier O, Perol M, Pichon E, Robinet G, Templement-Grangerat D, Ruppert AM, Rabbe N, Antoine M, Wislez M. Efficacy of Immune Checkpoint Inhibitors in Lung Sarcomatoid Carcinoma. J Thorac Oncol 2020; 15:860-866. [PMID: 31991225 DOI: 10.1016/j.jtho.2020.01.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have improved cancer prognosis but have not been evaluated specifically in sarcomatoid carcinoma (SC), a rare lung cancer subtype with poor prognosis. As such, our study sought to retrospectively assess the efficacy of ICI in SC. METHODS All consecutive patients with centrally confirmed SC treated using ICI as a second-line treatment or beyond between 2011 and 2017 were enrolled. Programmed death-ligand 1 (PD-L1) tumor expression was assessed using immunohistochemistry (SP263 clone) and the tumor mutational burden (TMB) with the Foundation One panel. TMB was considered high if it was greater than or equal to 10 mutations per megabase. RESULTS Overall, 37 patients with SC were evaluated, predominantly men (73%) with a median age of 63.2 years (36.8-79.7) and who were current or former smokers (94.6%). Immunotherapy (nivolumab, 86.5% of cases) was given as a second-line treatment in 54% of the patients and as third-line treatment or beyond in 46% of the patients. The objective response rate was 40.5% and disease control rate was 64.8%, regardless of PD-L1 status. Median overall survival was 12.7 months (range: 0.3-45.7). One-third of patients exhibited early progression. The median PD-L1 expression was 70% (0-100). There was a trend toward higher PD-L1 expression in responsive diseases, with an objective response rate of 58.8% in patients with PD-L1+ and 0% in the one patient with PD-L1- (p = 0.44). The median TMB was 18 (4-39) mutations per megabase, with 87.5% of the cases displaying a high TMB. There was a trend toward higher TMB in responders versus stable or progressive diseases (p = 0.2). CONCLUSIONS Patients with SC exhibited high response rates and prolonged overall survival under ICI treatment. These data support the prospective investigation of ICI in patients with SC who are under first-line treatment.
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Affiliation(s)
- Charlotte Domblides
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital-CHU Bordeaux, Bordeaux, France; ImmunoConcEpt, CNRS UMR 5164, University of Bordeaux, Bordeaux, France
| | - Karen Leroy
- Genetic and Molecular Biology Department, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France
| | | | - Julien Mazières
- Department of Pneumology, Hôpital Larrey, Université Paul Sabatier, Toulouse, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | | | - Simon Baldacci
- Thoracic Oncology Department, Lille University Hospital, Lille, France
| | | | | | | | - Ludovic Doucet
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | | | - Florian Guisier
- Department of Pneumology, Hôpital Charles Nicolle, Rouen, France
| | | | | | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Eric Pichon
- Department of Pneumology, CHRU Bretonneau, Tours, France
| | | | | | - Anne-Marie Ruppert
- Sorbonne Université, GRC n°04, Theranoscan, Paris, France; Department of Pneumology, AP-HP, Groupe Hospitalier HUEP, Hôpital Tenon, Paris, France
| | - Nathalie Rabbe
- Department of Thoracic Oncology, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France; Centre de Recherche des Cordeliers, Université Paris Descartes, Complement, Inflammation and Cancer, Paris, France
| | - Martine Antoine
- Pathology Department, AP-HP, Groupe Hospitalier HUEP, Hôpital Tenon, Paris, France
| | - Marie Wislez
- Department of Thoracic Oncology, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France; Centre de Recherche des Cordeliers, Université Paris Descartes, Complement, Inflammation and Cancer, Paris, France.
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Lachkar S, Guisier F, Roger M, Bota S, Lerouge D, Piton N, Thiberville L, Salaün M. A simple endoscopic method with radial endobronchial ultrasonography for low-migration rate coil-tailed fiducial marker placement. J Thorac Dis 2020; 12:1467-1474. [PMID: 32395284 PMCID: PMC7212149 DOI: 10.21037/jtd.2020.02.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/06/2022]
Abstract
Background Fiducial markers (FMs) are useful for tracking small peripheral lung nodules (PLN) before stereotactic radiotherapy, but migration over the course of treatment may result in inaccurate dosing to the tumor. To minimize FM migration, coil-tailed FMs have been designed. Our objective was to assess both the feasibility of radial endobronchial ultrasonography (r-EBUS) placement and the migration rate of coil-tailed FMs. Methods In this retrospective study, we included patients who received r-EBUS guided placement of coil-tailed FMs for PLN <25 mm from June 2015 to May 2018. We introduced the FM into the nodule with the use of bronchial brush, without fluoroscopy. Results Thirty patients had r-EBUS guided placement of a coil-tailed FM before stereotactic radiation therapy. Nodule’s median long- and short-axis diameters were 15 mm (8–25 mm) and 8 mm (5–20 mm), respectively; short diameter of 27 nodules (90%) was less than 15 mm. All nodules were reached and visualized with r-EBUS, with an ultrasound (US) signal showing a centered or tangential probe in 26 and 4 cases, respectively. No immediate complication was reported. Twenty-three patients had stereotactic radiation therapy within a median time of 29 days (14–126 days). No FM migration occurred between r-EBUS placement and radiotherapy. Pre-treatment planning and 3-month follow-up CT scans showed that all FMs stayed in direct contact with the lesions. Conclusions r-EBUS is a safe procedure for the placement of nitinol coil FMs, which have a low migration rate.
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Affiliation(s)
- Samy Lachkar
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Florian Guisier
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France.,QuantIF-LITIS EA 4108, IRIB, Rouen University, Rouen, France
| | - Maxime Roger
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Suzanna Bota
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Delphine Lerouge
- Department of Oncology radiotherapy, CRLCC F. Baclesse, Caen, France
| | - Nicolas Piton
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Luc Thiberville
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France.,QuantIF-LITIS EA 4108, IRIB, Rouen University, Rouen, France
| | - Mathieu Salaün
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, Rouen, France.,QuantIF-LITIS EA 4108, IRIB, Rouen University, Rouen, France
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49
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Guisier F, Dubos-Arvis C, Viñas F, Doubre H, Ricordel C, Ropert S, Janicot H, Bernardi M, Fournel P, Lamy R, Pérol M, Dauba J, Gonzales G, Falchero L, Decroisette C, Assouline P, Chouaid C, Bylicki O. Efficacy and Safety of Anti–PD-1 Immunotherapy in Patients With Advanced NSCLC With BRAF, HER2, or MET Mutations or RET Translocation: GFPC 01-2018. J Thorac Oncol 2020; 15:628-636. [DOI: 10.1016/j.jtho.2019.12.129] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/04/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022]
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50
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Guisier F, Piton N, Bellefleur M, Delberghe N, Avenel G, Angot E, Vittecoq O, Ould-Slimane M, Morisse-Pradier H, Salaun M, Thiberville L. Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report. BMC Cancer 2020; 20:14. [PMID: 31906956 PMCID: PMC6945627 DOI: 10.1186/s12885-019-6486-3] [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: 03/08/2019] [Accepted: 12/20/2019] [Indexed: 01/18/2023] Open
Abstract
Background Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib. Case presentation A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset. Conclusions This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.
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Affiliation(s)
- F Guisier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France. .,LITIS QuantIF EA4108, Normadie Univ, Rouen, France. .,INSERM CIC 1404, CHU Charles Nicolle, Rouen, France.
| | - N Piton
- Service d'anatomie et cytologie pathologiques, CHU Charles Nicolle, Rouen, France
| | - M Bellefleur
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France
| | - N Delberghe
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France
| | - G Avenel
- Service de rhumatologie, CHU Charles Nicolle, Rouen, France
| | - E Angot
- Service d'anatomie et cytologie pathologiques, CHU Charles Nicolle, Rouen, France
| | - O Vittecoq
- Service de rhumatologie, CHU Charles Nicolle, Rouen, France
| | - M Ould-Slimane
- Service d'orthopédie et traumatologie, CHU Charles Nicolle, Rouen, France
| | - H Morisse-Pradier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France
| | - M Salaun
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France.,LITIS QuantIF EA4108, Normadie Univ, Rouen, France.,INSERM CIC 1404, CHU Charles Nicolle, Rouen, France
| | - L Thiberville
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France.,LITIS QuantIF EA4108, Normadie Univ, Rouen, France.,INSERM CIC 1404, CHU Charles Nicolle, Rouen, France
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