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Schubert L, Mbekwe-Yepnang AM, Wassermann J, Braik-Djellas Y, Jaffrelot L, Pani F, Deniziaut G, Lussey-Lepoutre C, Chereau N, Leenhardt L, Bernier MO, Buffet C. Clinico-pathological factors associated with radioiodine refractory differentiated thyroid carcinoma status. J Endocrinol Invest 2024:10.1007/s40618-024-02352-z. [PMID: 38578580 DOI: 10.1007/s40618-024-02352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Risk factors for developing radioiodine refractory thyroid cancer (RAIR-TC) have rarely been analyzed. The purpose of the present study was to find clinical and pathological features associated with the occurrence of RAIR-disease in differentiated thyroid cancers (DTC) and to establish an effective predictive risk score. METHODS All cases of RAIR-DTC treated in our center from 1990 to 2020 were retrospectively reviewed. Each case was matched randomly with at least four RAI-avid DTC control patients based on histological and clinical criteria. Conditional logistic regression was used to examine the association between RAIR-disease and variables with univariate and multivariate analyses. A risk score was then developed from the multivariate conditional logistic regression model to predict the risk of refractory disease occurrence. The optimal cut-off value for predicting the occurrence of RAIR-TC was assessed by receiver operating characteristic (ROC) curves and Youden's statistic. RESULTS We analyzed 159 RAIR-TC cases for a total of 759 controls and found 7 independent risk factors for predicting RAIR-TC occurrence: age at diagnosis ≥ 55, vascular invasion, synchronous cervical, pulmonary and bone metastases at initial work-up, cervical and pulmonary recurrence during follow-up. The predictive score of RAIR-disease showed a high discrimination power with a cut-off value of 8.9 out of 10 providing 86% sensitivity and 92% specificity with an area under the curve (AUC) of 0.95. CONCLUSION Predicting the occurrence of RAIR-disease in DTC patients may allow clinicians to focus on systemic redifferentiating strategies and/or local treatments for metastatic lesions rather than pursuing with ineffective RAI-therapies.
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Affiliation(s)
- L Schubert
- Service des pathologies thyroïdiennes et tumorales endocrines, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 45-83 boulevard de l'Hôpital, 75013, Paris, France
| | - A M Mbekwe-Yepnang
- Laboratory of Epidemiology, Institut de Radioprotection et de Sureté Nucléaire, BP 17, 92262, Fontenay aux Roses, France
| | - J Wassermann
- Medical Oncology Department and Thyroid and Endocrine Tumors Department, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Y Braik-Djellas
- Service des pathologies thyroïdiennes et tumorales endocrines, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 45-83 boulevard de l'Hôpital, 75013, Paris, France
| | - L Jaffrelot
- Medical Oncology Department and Thyroid and Endocrine Tumors Department, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - F Pani
- Service des pathologies thyroïdiennes et tumorales endocrines, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 45-83 boulevard de l'Hôpital, 75013, Paris, France
| | - G Deniziaut
- Pathology Department, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - C Lussey-Lepoutre
- Nuclear Medicine Department, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
- PARCC-Inserm U970, 56 rue leblanc, 75015, Paris, France
| | - N Chereau
- Department of Endocrine Surgery, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - L Leenhardt
- Service des pathologies thyroïdiennes et tumorales endocrines, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 45-83 boulevard de l'Hôpital, 75013, Paris, France
| | - M- O Bernier
- Laboratory of Epidemiology, Institut de Radioprotection et de Sureté Nucléaire, BP 17, 92262, Fontenay aux Roses, France
| | - C Buffet
- Service des pathologies thyroïdiennes et tumorales endocrines, Sorbonne Université, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 45-83 boulevard de l'Hôpital, 75013, Paris, France.
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS UMR 7371, INSERM U1146, Paris, France.
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Theodon H, Guillerm E, Wassermann J, Deniziaut G, Jaffrelot L, Denis JA, Chereau N, Bigorgne C, Potonnier W, Coulet F, Leenhardt L, Buffet C. Next-Generation-Sequencing on fine needle aspirates in neck recurrence of thyroid cancers. Eur Thyroid J 2024; 13:ETJ-23-0164. [PMID: 38236745 PMCID: PMC10895307 DOI: 10.1530/etj-23-0164] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES Tumor molecular genotyping plays a key role in improving the management of advanced thyroid cancers. Molecular tests are classically performed on Formalin-Fixed Paraffin-Embedded (FFPE) carcinoma tissue. However alternative molecular testing strategies are needed when FFPE tumoral tissue is unavailable. The objective of our study was to retrospectively assess the performance of targeted DNA and RNA-based Next Generation Sequencing (NGS) on the fine needle aspirate from thyroid cancer cervical recurrences to determine if this strategy is efficient in clinical practice. DESIGN/METHODS A retrospective study of 33 patients who had had DNA and/or RNA-based NGS on ultrasound (US)-guided fine needle aspirates of cervical thyroid cancer recurrences in our Department from July 2019 to September 2022. RESULTS In total, 34 DNA and 32 RNA-based NGS analyses were performed. Out of the 34 DNA-based NGS performed, 27 (79%) were conclusive allowing the identification of an oncogenic driver for 18 patients (53%). The most common mutation (n = 13) was BRAF c.1799T>A. Out of the 32 RNA-based NGS performed, 26 were interpretable (81%) and no gene fusion was found. The identification of a BRAFV600E mutation was decisive for one patient in our series, who was prescribed dabrafenib and trametinib. CONCLUSIONS NGS performed on fine needle aspirates of neck lymph node metastases enabled the identification of an oncogenic driver alteration in 53% of the cases in our series of advanced thyroid cancer patients and could significantly alter patient management.
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Affiliation(s)
- Helene Theodon
- H Theodon, Thyroïde et tumeurs endocrines, University Hospital Pitié Salpêtrière, Paris, 75013, France
| | | | - Johanna Wassermann
- J Wassermann, Oncolgy, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | | | - Loic Jaffrelot
- L Jaffrelot, Oncology, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | | | - Nathalie Chereau
- N Chereau, Surgery, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Claude Bigorgne
- C Bigorgne, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Wiame Potonnier
- W Potonnier, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Florence Coulet
- F Coulet, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Laurence Leenhardt
- L Leenhardt, Hopital Universitaire Pitie Salpetriere Bibliotheque de La Pitié, Paris, 75651, France
| | - Camille Buffet
- C Buffet, Thyroid and Endocrine Tumors Department, AP-HP, Paris, 75184, France
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3
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Guével E, Priou S, Lamé G, Wassermann J, Bey R, Uzan C, Chatellier G, Belkacemi Y, Tannier X, Guillerm S, Flicoteaux R, Gligorov J, Cohen A, Benderra M, Teixeira L, Daniel C, Hersant B, Tournigand C, Kempf E. Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med 2023; 12:20918-20929. [PMID: 37909210 PMCID: PMC10709737 DOI: 10.1002/cam4.6637] [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] [Received: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic. METHODS We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020. RESULTS In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups. CONCLUSIONS Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
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Affiliation(s)
- Etienne Guével
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Sonia Priou
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Guillaume Lamé
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Johanna Wassermann
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
| | - Romain Bey
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Catherine Uzan
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre‐Université de Paris (APHP‐CUP)Université Paris CItéParisFrance
| | - Yazid Belkacemi
- Assistance Publique–Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Xavier Tannier
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Sophie Guillerm
- Assistance Publique–Hôpitaux de Paris, Department of radiation therapy, Saint Louis University HospitalUniversité Paris CitéCréteilFrance
| | - Rémi Flicoteaux
- Assistance Publique–Hôpitaux de ParisDepartment of medical informationParisFrance
| | - Joseph Gligorov
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Ariel Cohen
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Marc‐Antoine Benderra
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Luis Teixeira
- Assistance Publique–Hôpitaux de Paris, Department of senology, Saint Louis Teaching HospitalUniversité Paris CitéParisFrance
| | - Christel Daniel
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Barbara Hersant
- Assistance Publique – Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Christophe Tournigand
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Emmanuelle Kempf
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
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Jannin A, Giudici F, de la Fouchardière C, Al Ghuzlan A, Wassermann J, Chougnet CN, Drui D, Godbert Y, Ilouz F, Bardet S, Zanetta S, Roudaut N, Batisse Lignier M, Groussin L, Klein M, Zerdoud S, Lamartina L, Baudin E, Decaussin-Petrucci M, Leteurtre E, Borson Chazot F, Do Cao C, Borget I, Hadoux J. Factors Associated with Survival in Anaplastic Thyroid Carcinoma: A Multicenter Study from the ENDOCAN-TUTHYREF Network. Thyroid 2023; 33:1190-1200. [PMID: 37855745 DOI: 10.1089/thy.2023.0164] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Background: Anaplastic thyroid carcinoma (ATC) is a rare and frequently fatal type of thyroid cancer. The degree of heterogeneity in survival rates for ATC is incompletely studied. This study evaluated the factors associated with overall survival (OS) of patients with ATC using multicenter real-world data from a national tertiary care center network in France. Methods: In this multicenter, retrospective cohort study, all patients with ATC diagnosed between 2010 and 2020 were identified from the national database of the French ENDOCAN-TUTHYREF network. Factors associated with OS were examined in multivariable analyses using Cox proportional hazards models. Results: The study included 360 patients. Of these, 220 (61%) were female and the median age was 72 years (interquartile range: 62-80). The percentages of patients with pure and mixed (synchronously-transformed) ATC (p-ATC and st-ATC) were 62.5% and 26.7%, respectively. The median OS was 6.8 months [confidence interval, CI: 5.5-8.1]: not reached for stage IVa, 11.4 months [8.2-17.8] for IVb, and 4.6 months [3.5-5.7] for IVc. Surgery, radiation therapy to the neck, chemotherapy, and best supportive care were administered to 69 (19.2%), 214 (59.4%), 254 (70.6%), and 66 (18.3%) patients, respectively. In a multivariable analysis, including stage IVb-IVc patients, significantly higher OS was observed in patients with Eastern Cooperative Oncology Group performance-status of 0-1 (hazard ratio [HR], 0.6; [CI, 0.4-0.9], p < 0.02), stage IVb [HR, 0.5; CI, 0.4-0.8, p < 0.001], and multimodal treatment (surgery and chemoradiotherapy) [HR, 0.07; CI, 0.04-0.1, p < 0.001]. Variables associated with significantly worse OS included: p-ATC (vs. st-ATC) [HR, 1.83; CI, 1.33-2.51, p = 0.001] and a neutrophil-to-lymphocyte ratio (NLR) >5.05 [HR, 2.05, CI, 1.39-3.05, p < 0.001]. Conclusions: Factors independently associated with improved OS in ATC included: European Cooperative Oncology Group performance status, disease stage, multimodality treatment, synchronously transformed ATC, and lower NLR. Long-term OS was observed in selected patients with ATC who underwent multimodal treatment.
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Affiliation(s)
- Arnaud Jannin
- CHU Lille, Department of Endocrinology, Diabetology, and Metabolism, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer-Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Fabiola Giudici
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France
- Oncostat, U1018, CESP, Inserm, Paris-Saclay University, "Ligue Contre le Cancer" labeled team, Villejuif, France
| | | | - Abir Al Ghuzlan
- Department of Biology and Pathology, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, France
| | - Johanna Wassermann
- Medical Oncology Department and Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière University Hospital, AP-HP, IUC, Sorbonne University, Paris, France
| | - Cecile N Chougnet
- Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris, Paris, France
| | - Delphine Drui
- Nantes Université, CHU Nantes, Service d'Endocrinologie-Diabétologie et Nutrition, l'institut du thorax, Nantes, France
| | - Yann Godbert
- Nuclear Medicine and Endocrine Oncology Department, Institute of Bergonié, Bordeaux, France
| | | | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Center François Baclesse, Caen, France
| | - Sylvie Zanetta
- Nuclear Medicine Department, Center Georges François Leclerc, Dijon, France
| | - Nathalie Roudaut
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | | | - Lionel Groussin
- Endocrine Department, AP-HP, Hôpital Cochin, Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Marc Klein
- Department of Endocrinology, CHU de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Slimane Zerdoud
- Department of Nuclear Medicine, Institute Claudius Regaud, Oncology University Institute, IUCT Oncopole, Toulouse, France
| | - Livia Lamartina
- Département d'imagerie, Service d'Oncologie Endocrinienne, Gustave Roussy, Villejuif, France
| | - Eric Baudin
- Département d'imagerie, Service d'Oncologie Endocrinienne, Gustave Roussy, Villejuif, France
| | - Myriam Decaussin-Petrucci
- Research on Healthcare Performance (RESHAPE), INSERM U1290, EA 3738 CICLY, Université Lyon 1, Claude Bernard, Lyon, France
- Service d'Anatomopathologie, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Emmanuelle Leteurtre
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer-Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Francoise Borson Chazot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, EA 3738 CICLY, Université Lyon 1, Claude Bernard, Lyon, France
- Endocrinology Department, Hospice Civils de Lyon, Hospital Louis-Pradel, Bron, France
| | - Christine Do Cao
- CHU Lille, Department of Endocrinology, Diabetology, and Metabolism, Lille, France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France
- Oncostat, U1018, CESP, Inserm, Paris-Saclay University, "Ligue Contre le Cancer" labeled team, Villejuif, France
| | - Julien Hadoux
- Département d'imagerie, Service d'Oncologie Endocrinienne, Gustave Roussy, Villejuif, France
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5
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Roussel-Simonin C, Gougis P, Lassoued D, Vozy A, Veyri M, Morardet L, Wassermann J, Foka Tichoue H, Jaffrelot L, Hassani L, Perrier A, Bergeret S, Taillade L, Spano JP, Campedel L, Abbar B. FOLFIRI in advanced platinum-resistant/refractory small-cell lung cancer: a retrospective study. Acta Oncol 2023:1-8. [PMID: 37276270 DOI: 10.1080/0284186x.2023.2216339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Small-cell lung cancer (SCLC) accounts for approximately 15% of lung cancer and is associated with poor prognosis. In platinum-refractory or -resistant SCLC patients, few treatment options are available. Topotecan is one of the standards of care for these patients, however, due to its high toxicity, several different approaches are employed. FOLFIRI (folinate, 5-fluorouracil and irinotecan) is a chemotherapy regimen used in digestive neuroendocrine carcinoma, which shares pathological similarities with SCLC. In this retrospective study, we evaluated the efficacy and safety of FOLFIRI in patients with platinum-resistant/refractory SCLC. METHODS Medical records from all consecutive SCLC patients treated with FOLFIRI in a French University Hospital from 2013 to 2021 were analyzed retrospectively. The primary endpoint was the objective response rate according to RECIST v1.1 or EORTC criteria (ORR); secondary endpoints included duration of response, disease control rate, progression-free survival (PFS), overall survival (OS) and safety profile. RESULTS Thirty-four patients with metastatic platinum-resistant (n = 14) or -refractory (n = 20) SCLC were included. Twenty-eight were evaluable for response, with a partial response observed in 5 patients for an overall ORR in the evaluable population of 17.9% (5/28) and 14.7% (5/34) in the overall population. The disease control rate was 50% (14/28) in the evaluable population. The median PFS and OS were 2.8 months (95%CI, 2.0-5.2 months) and 5.3 months (95%CI, 3.5-8.9 months), respectively. All patients were included in the safety analysis. Grade 3 or 4 adverse events occurred in 13 (38.2%) patients. The most common grade 3 or 4 adverse events were asthenia, neutropenia, thrombopenia and diarrhea. There was no adverse event leading to discontinuation or death. CONCLUSION FOLFIRI showed some activity for platinum-resistant/refractory SCLC in terms of overall response and had an acceptable safety profile. However, caution is needed in interpreting this result. FOLFIRI could represent a potential new treatment for platinum-resistant/refractory SCLC patients. Further prospective studies are needed to assess the benefits of this chemotherapy regimen.HIGHLIGHTSFOLFIRI showed some activity for platinum-resistant/refractory SCLC in terms of overall response.FOLFIRI was well-tolerated in platinum resistant/refractory SLCL patients.FOLFIRI could represent a potential new treatment for SCLC, prospective studies are needed.
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Affiliation(s)
- Cyril Roussel-Simonin
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Paul Gougis
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France
| | - Donia Lassoued
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Aurore Vozy
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
- Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, Inserm U1135, Paris, France
| | - Marianne Veyri
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut Universitaire de Cancérologie, CLIP2 Galilée, Paris, France
| | - Laetitia Morardet
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Johanna Wassermann
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Hervé Foka Tichoue
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Loïc Jaffrelot
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Lamia Hassani
- Department of Pharmacy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Alexandre Perrier
- Sorbonne Université, Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sebastien Bergeret
- Sorbonne Université, Département de Médecine Nucléaire, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laurent Taillade
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut Universitaire de Cancérologie, CLIP2 Galilée, Paris, France
| | - Luca Campedel
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
| | - Baptiste Abbar
- Department of Medical Oncology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Paris, France
- Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, Inserm U1135, Paris, France
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6
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Rosenberg SM, Zheng Y, Gelber S, Ruddy KJ, Poorvu P, Sella T, Tamimi RM, Wassermann J, Schapira L, Borges VF, Come S, Peppercorn J, Sepucha KR, Partridge AH. Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer. Breast Cancer Res Treat 2023; 197:547-558. [PMID: 36436128 PMCID: PMC10233447 DOI: 10.1007/s10549-022-06810-1] [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] [Received: 07/11/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Characterizing oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer can inform strategies to improve overall adherence in this population. METHODS We identified 693 women with hormone receptor-positive, stage I-III breast cancer enrolled in a cohort of women diagnosed with breast cancer at age ≤ 40 years. Women were classified as non-initiators if they did not report taking ET in the 18 months after diagnosis. Women who initiated but did not report taking ET subsequently (through 5-year post-diagnosis) were categorized as non-persistent. We assessed ET decision-making and used logistic regression to identify factors associated with non-initiation/non-persistence and to evaluate the association between non-persistence and recurrence. RESULTS By 18 months, 9% had not initiated ET. Black women had higher odds and women with a college degree had lower odds of non-initiation. Among 607 women who initiated, 20% were non-persistent. Younger age, being married/partnered, and reporting more weight problems were associated with higher odds of non-persistence; receipt of chemotherapy and greater hot flash and vaginal symptom burden were associated with lower odds of non-persistence. Adjusting for age and clinical characteristics, non-persistence was associated with lower odds of recurrence. Women who initiated were more likely to report shared decision-making than non-initiators (57% vs. 38%, p = 0.049), while women who were non-persistent were less likely to indicate high confidence with the decision than women who were persistent (40% vs. 63%, p < 0.001). CONCLUSION Interventions to improve ET decision-making may facilitate initiation and address barriers to adherence in young breast cancer survivors. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT01468246.
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Affiliation(s)
- Shoshana M Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67St LA-0005, New York, NY, 10065, USA.
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shari Gelber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | | | - Philip Poorvu
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tal Sella
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67St LA-0005, New York, NY, 10065, USA
| | - Johanna Wassermann
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medical Oncology, Sorbonne Université, IUC, Pitié-Salpêtrière University Hospital, Paris, AP-HP, France
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, CA, USA
| | - Virginia F Borges
- Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Come
- Harvard Medical School, Boston, MA, USA
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey Peppercorn
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen R Sepucha
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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7
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Chan A, Ruiz-Borrego M, Marx G, Chien AJ, Rugo HS, Brufsky A, Thirlwell M, Trudeau M, Bose R, García-Sáenz JA, Egle D, Pistilli B, Wassermann J, Cheong KA, Schnappauf B, Semsek D, Singer CF, Foruzan N, DiPrimeo D, McCulloch L, Hurvitz SA, Barcenas CH. Final findings from the CONTROL trial: Strategies to reduce the incidence and severity of neratinib-associated diarrhea in patients with HER2-positive early-stage breast cancer. Breast 2022; 67:94-101. [PMID: 36702070 PMCID: PMC9982309 DOI: 10.1016/j.breast.2022.12.003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for HER2-positive early-stage and metastatic breast cancer. Diarrhea is the most frequent side effect and the most common reason for early discontinuation. The phase II CONTROL trial investigated antidiarrheal prophylaxis or neratinib dose escalation (DE) for prevention of diarrhea. We present complete study results including final data for two DE strategies. METHODS Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year. Early cohorts investigated mandatory prophylaxis with loperamide, then additional budesonide or colestipol. Final cohorts assessed neratinib DE over the first 2 (DE1) or 4 weeks (DE2). The primary endpoint was incidence of grade ≥3 diarrhea. Health-related quality of life (HRQoL) was assessed using FACT-B and EQ-5D-5L. RESULTS 563 patients were enrolled into six cohorts. All strategies reduced grade ≥3 diarrhea with the lowest incidence in DE1 (DE1 13%; colestipol + loperamide [CL] 21%, DE2 27%; budesonide + loperamide [BL] 28%; loperamide [L] 31%; colestipol + loperamide as needed [CL-PRN] 33%). Diarrhea-related discontinuations occurred early and were lowest in DE1 (DE1 3%; CL 4%; DE2 6%; CL-PRN 8%; BL 11%; L 20%). More patients stayed on neratinib for the prescribed period versus historical controls. Prior pertuzumab use did not affect rates of grade ≥3 diarrhea, diarrhea-related discontinuations, or treatment duration. Early transient reductions in HRQoL scores were observed. CONCLUSIONS These complete results from CONTROL show improved neratinib tolerability with proactive management at the start of therapy. Two-week neratinib DE with loperamide as needed was particularly effective. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02400476.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia.
| | | | - Gavin Marx
- Sydney Adventist Hospital and Australian National University, Sydney, Australia
| | - A. Jo Chien
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Adam Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO, USA
| | - José A. García-Sáenz
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Daniel Egle
- Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Dieter Semsek
- Praxis am Diakonie Krankenhaus Onkologische Schwerpunktpraxis, Freiberg, Germany
| | - Christian F. Singer
- Medical University of Vienna and Comprehensive Cancer Center, Vienna, Austria
| | | | | | | | - Sara A. Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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8
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Wassermann J, Bagnis CI, Leenhardt L, Ederhy S, Buffet C. Pre-therapeutic evaluation and practical management of cardiovascular and renal toxicities in patients with metastatic radioiodine-refractory thyroid cancer treated with lenvatinib. Expert Opin Drug Saf 2022; 21:1401-1410. [DOI: 10.1080/14740338.2022.2153115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Johanna Wassermann
- Medical Oncology Department and Thyroïd and Endocrine Tumors Department, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, APHP Sorbonne University, Pitié-Salpêtrière Hospital, Paris
| | - Corinne Isnard Bagnis
- Nephrology Department, APHP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurence Leenhardt
- Thyroïd and Endocrine Tumors Department, Sorbonne Université, Groupe de Recherche Clinique n°16GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Stéphane Ederhy
- UNICO-GRECO Cardio-oncology Program, Sorbonne University, Cardiology Department, , Hôpital Saint Antoine 184 rue du FaubourgSaint Antoine, 75012 Paris, France
| | - Camille Buffet
- Thyroïd and Endocrine Tumors Department, Sorbonne Université, Groupe de Recherche Clinique n°16GRC Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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9
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Scherman N, Wassermann J, Tlemsani C, Guillerm E, Deniziaut G, Cochand-Priollet B, Shan L, Chereau N, Gaujoux S, Simon JM, Leenhardt L, Groussin L, Buffet C. Possible Primary Thyroid Nuclear Protein in Testis Carcinomas with NSD3::NUTM1 Translocation Revealed by RNA Sequencing: A Report of Two Cases. Thyroid 2022; 32:1271-1276. [PMID: 35880417 DOI: 10.1089/thy.2022.0136] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Nuclear protein in testis (NUT) carcinomas (NC) are a rare, highly aggressive, subset of squamous cell carcinomas, characterized by a translocation involving the NUTM1 gene. Thyroid location of NUT carcinomas has rarely been described. Methods: We report here two cases of thyroid NC with NSD3::NUTM1 translocation. Results: The first case presented as a very aggressive undifferentiated thyroid carcinoma in a 38-year-old man who died 21 months after the diagnosis. The second case was diagnosed after multiple lymphadenopathy recurrences mainly in the neck in a 37-year-old woman 7 years after total thyroidectomy for papillary thyroid carcinoma with a classic and a solid/trabecular component. Conclusions: Our case reports highlight the challenges in diagnosing these exceptional carcinomas. The therapeutic impact of the administration of pharmacological compounds with epigenetic action, in line with the physiopathology of these carcinomas, is also discussed.
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Affiliation(s)
- Noémie Scherman
- Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Johanna Wassermann
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Camille Tlemsani
- Medical Oncology Department, Cochin Hospital, Paris Cancer Institute CARPEM, Université de Paris, Paris, France
| | - Erell Guillerm
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Oncogenetic Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Gabrielle Deniziaut
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Pathology Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | | | - Larrys Shan
- Endocrine Department, Centre Hospitalier de Polynésie Française, Papeete, French Polynesia
| | - Nathalie Chereau
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Department of Endocrine Surgery, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Sébastien Gaujoux
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Department of Endocrine Surgery, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Jean-Marc Simon
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Radiotherapy Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Laurence Leenhardt
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Department; Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Lionel Groussin
- Endocrine Department; Cochin Hospital, Université de Paris, Paris, France
| | - Camille Buffet
- GRC No. 16, GRC Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Department; Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
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10
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Ruiz De Azua G, Vaz-Luis I, Bovagnet T, Di Meglio A, Havas J, Caumette E, Martin E, Pistilli B, Coutant C, Cottu P, Rouanet P, Arnaud A, Arsene O, Ibrahim M, Wassermann J, Rouzier R, Martin AL, Everhard S, Dumas A, Menvielle G. Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort. J Epidemiol Community Health 2022. [DOI: 10.1136/jech-2021-218331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWe assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.MethodsWe used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models.ResultsOverall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.ConclusionsOne in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.Trial registration numberNCT01993498.
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11
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Dufresne A, Huillard O, Dalban C, Geier M, Wassermann J, Zanetta S, Cabourg M, Catargi B, El Kouri C, Hrab I, Laramas M, Moreira A, Saada E, Tournigand C, Valentin T, Vauleon E, Mayet R, Perol D, Blay JY. 465P Larotracking: Real-life study of locally advanced/metastatic solid tumor treated with larotrectinib in French expanded access program. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.594] [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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12
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de la Fouchardiere C, Jannin A, Giudici F, Wassermann J, Chougnet C, Drui D, Godbert Y, Illouz F, Bardet S, Roudaut N, Batisse Lignier M, Groussin L, Klein M, Zerdoud S, Lamartina L, Baudin E, Borson-Chazot F, Do Cao C, Borget I, Hadoux J. 1647MO BRAF mutated anaplastic thyroid carcinoma: Clinical characteristics and outcome under BRAF inhibitors and chemotherapy in real-life practice, a multicentric retrospective study of the French ENDOCAN TUTHYREF network. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1727] [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: 11/26/2022] Open
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13
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Chan A, Ruiz-Borrego M, Marx G, Brufsky A, Chien J, Thirlwell M, Trudeau M, Bose R, García-Sáenz JA, Egle D, Pistilli B, Wassermann J, Cheong KA, Singer CF, Hunt D, Foruzan N, McCulloch L, Barcenas CH. Abstract P5-18-02: Final findings from the CONTROL trial of diarrheal prophylaxis or neratinib dose escalation on neratinib-associated diarrhea and tolerability in patients with HER2+ early-stage breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-18-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neratinib (NERLYNX®), an irreversible pan-HER tyrosine kinase inhibitor, is approved for the extended adjuvant treatment of early-stage HER2+ breast cancer following adjuvant trastuzumab-based therapy and in combination with capecitabine for HER2+ metastatic breast cancer. Diarrhea is the most frequently reported on-target side effect associated with neratinib; in the ExteNET adjuvant trial, where no mandatory anti-diarrheal prophylaxis was used, 39.8% of patients reported grade 3 diarrhea and 16.8% of patients discontinued neratinib due to diarrhea. The CONTROL trial (Clinicaltrials.gov: NCT02400476) was designed to investigate pre-emptive antidiarrheal prophylaxis (loperamide alone or in combination with budesonide or colestipol) or neratinib dose escalation (DE) for the prevention of neratinib-associated diarrhea. Data for the loperamide, budesonide and colestipol cohorts have been reported previously [Barcenas et al. Ann Oncol 2020]. The final findings for the two DE regimen cohorts are reported here. Methods: CONTROL is an international, multi-cohort, open-label, phase 2 study. Patients ≥18 years of age with stage I-IIIc HER2+ breast cancer received oral neratinib (240 mg/day for 1 year) after trastuzumab-based adjuvant therapy. Patients were enrolled sequentially into separate cohorts investigating: 1) mandatory loperamide prophylaxis; 2) budesonide + loperamide; 3) colestipol + loperamide; 4) colestipol + loperamide PRN; 5) neratinib DE + loperamide PRN (two cohorts). DE1 schedule: neratinib 120 mg/day for week 1, 160 mg/day for week 2, then 240 mg/day from week 3 onwards to complete 12 months of treatment. DE2 schedule: neratinib 160 mg/day for weeks 1&2, 200 mg/day for weeks 3&4, then 240 mg/day from week 5 onwards up to 12 months. Both DE cohorts included loperamide PRN. Adverse events were graded according to NCI-CTCAE v4.0. Primary endpoint: incidence of grade ≥3 diarrhea. Results: A total of 563 patients were enrolled in CONTROL. All preventive strategies reduced the incidence of grade 3 diarrhea compared with that seen in ExteNET (historical control: 39.8%). Median cumulative duration of grade 3 diarrhea ranged from 2-3.5 days across the CONTROL study cohorts for the entire 12-month treatment period (compared with 5.0 days for ExteNET). The proportion of patients discontinuing neratinib because of diarrhea was decreased in all cohorts compared with ExteNET (16.8%), except for loperamide alone. Adoption of neratinib DE, particularly the 2-week DE schedule (DE1), most markedly reduced the incidence, severity, and duration of neratinib-associated diarrhea in CONTROL compared with ExteNET (see Table).
Conclusions: Neratinib DE + loperamide PRN during the first 2 weeks of treatment (DE1 cohort) was associated with the lowest rates of grade 3 diarrhea (13.3%) and diarrhea-related discontinuations (3.3%) compared with all other anti-diarrheal strategies investigated in CONTROL. These final findings from the study show improved tolerability of neratinib with all diarrhea prophylaxis strategies and suggest that neratinib DE1 with loperamide PRN allows patients to stay on treatment longer and receive the full benefit of neratinib therapy.
Table. Patient disposition and diarrhea characteristics: ExteNET vs CONTROL DE cohortsExteNET(n=1408)CONTROL DE1 (n=60)CONTROL DE2 (n=62)Patients completing 1 year of neratinib treatment, %617874Median duration of treatment, months (range)11.6 (2.5–11.9)12.0 (0.2–12.4)11.9 (0.3–14.5)Diarrhea, %Grade 339.813.327.4Grade 4<100Median cumulative duration of grade 3 diarrhea,a days52.52Discontinuations due to diarrhea, %16.83.36.5Dose reductions due to diarrhea, %26311Dose holds due to diarrhea, %341213aNo grade 4 diarrhea was reported in CONTROL.
Citation Format: Arlene Chan, Manuel Ruiz-Borrego, Gavin Marx, Adam Brufsky, Jo Chien, Michael Thirlwell, Maureen Trudeau, Ron Bose, José A García-Sáenz, Daniel Egle, Barbara Pistilli, Johanna Wassermann, Kerry A Cheong, Christian F Singer, Daniel Hunt, Navid Foruzan, Leanne McCulloch, Carlos H Barcenas. Final findings from the CONTROL trial of diarrheal prophylaxis or neratinib dose escalation on neratinib-associated diarrhea and tolerability in patients with HER2+ early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-02.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia
| | | | | | | | - Jo Chien
- University of California San Francisco, San Francisco, CA
| | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
| | | | - Daniel Egle
- University Frauenklinik Innsbruck, Innsbruck, Austria
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de la Fouchardière C, Wassermann J, Calcagno F, Bardet S, Al Ghuzlan A, Borget I, Borson Chazot F, Do Cao C, Buffet C, Zerdoud S, Decaussin-Petrucci M, Godbert Y, Leboulleux S. [Molecular genotyping in refractory thyroid cancers in 2021: When, how and why? A review from the TUTHYREF network]. Bull Cancer 2021; 108:1044-1056. [PMID: 34593218 DOI: 10.1016/j.bulcan.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
Refractory thyroid cancers include radio-iodine-refractory cancers, metastatic or locally advanced unresectable medullary and anaplastic thyroid cancers. Their management has been based for several years on the use of multi-target kinase inhibitors, with anti-angiogenic action, with the exception of anaplastic cancers usually treated with chemo- and radiotherapy. The situation has recently evolved due to the availability of molecular genotyping techniques allowing the discovery of rare but targetable molecular abnormalities. New treatment options have become available, more effective and less toxic than the previously available multi-target kinase inhibitors. The management of refractory thyroid cancers is therefore becoming more complex both at a diagnosis level with the need to know when, how and why to look for these molecular abnormalities but also at a therapeutic level, innovative treatments being hardly accessible. The cost of molecular analyzes and the access to treatments need also to be homogenized because disparities could lead to inequality of care at a national or international level. Finally, the strategy of identifying molecular alterations and treating these rare tumors reinforces the importance of a discussion in a multidisciplinary consultation meeting.
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Affiliation(s)
| | - Johanna Wassermann
- Hôpital Pitié-Salpêtrière, service d'oncologie médicale, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Fabien Calcagno
- Centre Hospitalier Universitaire de Besançon, département d'oncologie médicale, boulevard Fleming, 25030 Besançon, France
| | - Stéphane Bardet
- Centre François-Baclesse, service de médecine nucléaire et UCP thyroïde, 3, avenue du Général Harris, 14000 Caen, France
| | - Abir Al Ghuzlan
- Gustave-Roussy, service de pathologie morphologique (biopathologie), 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France
| | - Isabelle Borget
- Université Paris-Saclay, Gustave-Roussy, service de biostatistique et d'épidémiologie, Villejuif, France; Université Paris-Saclay, Équipe labellisée Ligue contre le cancer, GRADES, Oncostat U1018, Inserm, Chatenay-Malabry, France
| | - Françoise Borson Chazot
- Hôpital Louis-radel, Hospices Civils de Lyon, Fédération d'endocrinologie, 28, avenue doyen Lépine, 69500 Bron, France
| | - Christine Do Cao
- CHU de Lille, hôpital Claude-Huriez, service d'endocrinologie diabétologie métabolisme nutrition, rue Michel-Polonovski, 59037 Lille cedex, France
| | - Camille Buffet
- AP-HP, Sorbonne université, hôpital Pitié-Salpêtrière, Institut E3M, DMU Archimède, Institut universitaire du Cancer (IUC), unité thyroïde-tumeurs endocrines du Pr Leenhardt, France
| | - Slimane Zerdoud
- Institut universitaire du cancer Toulouse - Oncopole, département de médecine nucléaire, 1, avenue Irène Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Myriam Decaussin-Petrucci
- Hôpital Lyon Sud, service d'anatomie et cytologie pathologiques, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Lyon 1, Cancer Research Center of Lyon, Inserm 1052 CNRS 5286, France
| | - Yann Godbert
- Institut Bergonié Bordeaux, département de cancérolgie endocrinienne et médecine nucleaire, 229, cours de l'argonne, 33000 Bordeaux, France
| | - Sophie Leboulleux
- Gustave-Roussy and Paris-Saclay University, Nuclear Medicine and Endocrine Oncology department, 114, rue Edouard-Vaillant, Villejuif, France
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Di Meglio A, Menvielle G, Dumas A, Gbenou A, Pinto S, Bovagnet T, Martin E, Ferreira AR, Vanlemmens L, Arsene O, Ibrahim M, Wassermann J, Martin AL, Lemonnier J, Del Mastro L, Jones LW, Partridge AH, Ligibel JA, Andre F, Michiels S, Vaz Luis I. Body weight and return to work among survivors of early-stage breast cancer. ESMO Open 2021; 5:e000908. [PMID: 33172957 PMCID: PMC7656950 DOI: 10.1136/esmoopen-2020-000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/08/2020] [Accepted: 09/23/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Many breast cancer (BC) survivors are employed at diagnosis and are expected to return to work after treatment. Among them, around 50% are overweight or obese. There are limited data about the impact of body weight on their ability to return to work. METHODS We used data from CANcer TOxicity (NCT01993498), a prospective, multicentre cohort of women with stage I-III BC. Professionally active women who were ≥5 years younger than retirement age were identified. Multivariable logistic regression models examined associations of body mass index (BMI) at diagnosis and subsequent weight changes with non-return to work 2 years after diagnosis, adjusting for psychosocial, treatment and behavioural characteristics. RESULTS Among 1869 women, 689 were overweight or obese. Overall, 398 patients (21.3%) had not returned to work 2 years after diagnosis. Non-return to work was more likely for overweight or obese than underweight or normal weight patients (adjusted OR (aOR) 1.32; 95% CI, 1.01 to 1.75; p=0.045). Weight loss (≥5%) was observed in 15.7% overweight or obese and 8.7% underweight or normal weight patients and was associated with significant increases in physical activity only among overweight or obese patients (mean change, +4.7 metabolic-equivalent-of-task-hour/week; 95% CI +1.9 to +7.5). Overweight or obese patients who lost weight were more likely to return to work compared with those who did not lose weight (aOR of non-return-to-work, 0.48; 95% CI 0.24 to 0.97, p=0.0418), whereas weight loss was associated with increased odds of non-return to work among underweight or normal weight women (aOR 2.07; 95% CI 1.20 to 3.56, p=0.0086) (pinteractionBMI×weight changes=0.0002). The continuous trend of weight gain on non-return to work was significant for overweight or obese patients (aOR for one-percent-unit difference, 1.03; 95% CI 1.01 to 1.06, p=0.030). CONCLUSIONS Excess weight may be a barrier to return to work. Among overweight or obese BC survivors, weight loss was associated with higher rates of return to work, whereas further weight gain was associated with lower likelihood of return to work. Employment outcomes should be evaluated in randomised studies of weight management.
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Affiliation(s)
- Antonio Di Meglio
- Prédicteurs moléculaires et nouvelles cibles en oncologie, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Agnes Dumas
- INSERM Unit 1018, Villejuif, France; UMR Unit 1123, Paris, France; Université Paris Diderot UFR de Médecine, Paris, France
| | - Arnauld Gbenou
- Prédicteurs moléculaires et nouvelles cibles en oncologie, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Sandrine Pinto
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Thomas Bovagnet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Elise Martin
- Prédicteurs moléculaires et nouvelles cibles en oncologie, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisboa, Portugal
| | | | | | - Mahmoud Ibrahim
- Regional Hospital Centre Orleans Porte Madeleine Hospital, Orleans, France
| | | | | | | | - Lucia Del Mastro
- Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
| | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Fabrice Andre
- Prédicteurs moléculaires et nouvelles cibles en oncologie, INSERM Unit 981, Gustave Roussy, Villejuif, France; University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- University Paris-Saclay, Villejuif, France; Department of biostatistics and epidemiology, Gustave Roussy Cancer Campus, Villejuif, France; Oncostat Inserm U1018, Villejuif, France
| | - Ines Vaz Luis
- Prédicteurs moléculaires et nouvelles cibles en oncologie, INSERM Unit 981, Gustave Roussy, Villejuif, France; Medical Oncology, Gustave Roussy, Villejuif, France.
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16
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Marx GM, Chien AJ, García-Sáenz JA, Chan A, Ruiz-Borrego M, Barcenas CH, Thirlwell MP, Trudeau ME, Bose R, Egle D, Pistilli B, Wassermann J, Cheong KA, Semsek D, Singer CF, Hunt D, Khambholja U, Xu F, Shah N, Brufsky A. Dose escalation for mitigating diarrhea: Ranked tolerability assessment of anti-diarrheal regimens in patients receiving neratinib for early-stage breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
536 Background: The primary tolerability concern with neratinib (NERLYNX®; N), an irreversible pan-HER tyrosine kinase inhibitor, is diarrhea. Data from the multi-cohort, open-label, phase 2 CONTROL trial [Barcenas et al. Ann Oncol 2020] demonstrated significant improvement in grade 3 diarrhea and diarrhea-related discontinuations vs the ExteNET trial, which did not mandate anti-diarrheal prophylaxis. We report a systematic analysis of tolerability in CONTROL and ExteNET. Methods: Patients (pts) ≥18y with stage I–IIIc HER2+ breast cancer received N (240 mg/d po for 1y) after trastuzumab-based adjuvant therapy and were enrolled sequentially into cohorts assessing different modalities to mitigate diarrhea. Cohorts with complete data were included: loperamide (L); L+budesonide (BL); L+colestipol (CL); CL as needed (CL-PRN); and N dose escalation (DE; 120 mg/d on d1–7, 160 mg/d on d8–14, and 240 mg/d thereafter). Integrated ranking (IR) analysis was performed on 13 endpoints in 4 domains (exposure, diarrhea, adverse events [AEs], quality of life [QoL]) identified with input from clinicians; cohorts were ranked from 1 (best) to 5 (worst). Index scores (IS) based on individual pt data from CONTROL were calculated as supportive analysis to confirm selection of the regimen with best overall tolerability, which was then compared with ExteNET. Results: Of the 5 CONTROL cohorts evaluated, DE ranked best for most endpoints. Average ranks per IR method: L 3.4; BL 3.2; CL 3.0; CL-PRN 3.3; DE 2.0. The IS analysis supported DE as the cohort with best overall tolerability. Comparison of CONTROL DE vs ExteNET showed improvement in tolerability in all domains (table). Conclusions: These analyses suggest superiority of weekly DE vs other anti-diarrheal strategies. A lower rate of grade 3 diarrhea was observed with CONTROL DE vs ExteNET (13.3 vs 39.9%, respectively), as well as a comparable or improved AE profile. The data also reveal greater compliance with N (fewer early discontinuations, longer treatment duration, higher cumulative dose) and reduced impact on QoL with DE, suggesting improved tolerability. Clinical trial information: NCT02400476. [Table: see text]
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Affiliation(s)
| | - Amy Jo Chien
- University of California, San Francisco, San Francisco, CA
| | | | - Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia
| | | | | | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
| | - Daniel Egle
- University Frauenklinik Innsbruck, Innsbruck, Austria
| | | | | | | | - Dieter Semsek
- Praxis am Diakonie Krankenhaus Onkologische Schwerpunktpraxis, Freiburg, Germany
| | | | | | | | - Feng Xu
- Puma Biotechnology Inc., Los Angeles, CA
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17
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Saïe C, Wassermann J, Mathy E, Chereau N, Leenhardt L, Tezenas du Montcel S, Buffet C. Impact of age on survival in radioiodine refractory differentiated thyroid cancer patients. Eur J Endocrinol 2021; 184:667-676. [PMID: 33667193 DOI: 10.1530/eje-20-1073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objectives of our study were to analyze the influence of age on the survival of patients with RAIR-DTC and to determine their prognostic factors according to age. METHODS This single-center, retrospective study enrolled 155 patients diagnosed with RAIR-DTC. The primary end point was overall survival (OS) according to different cutoff (45, 55, 65, 75 years). Secondary endpoints were progression free survival (PFS) and prognostic factors in patients under and over 65 years. RESULTS Median OS after RAIR diagnosis was 8.2 years (95% IC: 5.3-9.6). There was no difference according to age with a 65 (P = 0.47) and 55 years old cutoff (P = 0.28). Median OS improved significantly before 45 years old (P = 0.0043). After 75 years old, median OS significantly decreased (P = 0.0008). Median PFS was 2.1 years (95% CI: 0.8-3) in patients < 65 years old, and 1 year in patients ≥ 65 years old (95% CI: 0.8-1.55) with no statistical difference (P = 0.22). There was no impact of age on PFS with any cutoff. In both groups, progressive disease despite 131I treatment reduced OS. In patients < 65 years old, an interval of less than 3 years between the initial diagnosis and the diagnosis of RAIR metastatic disease was predictive of poor survival. In patients > 65 years old, the presence of a mediastinum metastasis was a significant factor for mortality (HR: 4.55, 95% CI: 2.27-9.09). CONCLUSION In RAIR-DTC patients, a cut-off age of 65 years old was not a significant predictive factor of survival. Forty-five and 75-years-old cutoff were predictive for OS but not PFS.
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Affiliation(s)
- C Saïe
- Thyroid and Endocrine Tumors Unit, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
| | - J Wassermann
- Oncology Department, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
- GRC n°16, GRC Tumeurs Thyroïdiennes, Sorbonne Universite, Paris, Ile de France, France
| | - E Mathy
- Thyroid and Endocrine Tumors Unit, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
| | - N Chereau
- GRC n°16, GRC Tumeurs Thyroïdiennes, Sorbonne Universite, Paris, Ile de France, France
- Department of Surgery, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
| | - L Leenhardt
- Thyroid and Endocrine Tumors Unit, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
- GRC n°16, GRC Tumeurs Thyroïdiennes, Sorbonne Universite, Paris, Ile de France, France
| | - S Tezenas du Montcel
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, Ile de France, France
| | - C Buffet
- Thyroid and Endocrine Tumors Unit, Sorbonne Universite, Pitié-Salpêtrière Hospital APHP, Paris, Ile de France, France
- GRC n°16, GRC Tumeurs Thyroïdiennes, Sorbonne Universite, Paris, Ile de France, France
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Ruiz-de-Azua Unzurrunzaga G, Luis I, Bovagnet T, Di Meglio A, Havas J, Caumette E, Martin E, Pistilli B, Coutant C, Cottu P, Rouanet P, Arnaud A, Arsene O, Ibrahim M, Wassermann J, Rouzier R, Martin AL, Everhard S, Dumas A, Menvielle G. 235P Breast cancer and perceived discrimination in the workplace: A longitudinal cohort study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.356] [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: 10/23/2022] Open
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19
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De La Fouchardiere C, Godbert Y, Dalban C, Do Cao C, Illouz F, Zerdoud S, Wassermann J, Bardet S, Rodien P, Chougnet CN, Benisvy D, Niccoli P, Ravaud A, Lebosse W, Bourne-Branchu V, Gautier J, Leboulleux S. Final results of the multicenter, open-label, randomized phase II trial PAZOTHYR evaluating continuous versus intermittent administration of pazopanib in radio-iodine-refractory thyroid cancers (NCT01813136). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6540] [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
6540 Background: Multikinase inhibitors (MKI) targeting angiogenesis, including pazopanib (P), have shown efficacy in progressive radioiodine refractory thyroid cancers (RAIR-TC) but are accompanied by adverse effects, leading to dose adjustments/interruptions. We aimed to investigate the efficacy and tolerance of a discontinuous scheme of pazopanib administration in this situation. Methods: This randomized phase II study enrolled RAIR-TC patients (pts) in first or second-line of MKI with documented disease progression within 12 months (m). After a 6-m pazopanib continuous induction phase, pts with stable disease (SD) or tumor response were randomly assigned in a 1:1 ratio to receive continuous pazopanib (CP) or intermittent pazopanib (IP) until progression and restart. They were stratified by best tumor response [stable disease vs. objective response] and prior MKI treatment [yes vs. no]). Primary endpoint was time to treatment failure (TTF) defined as time between randomization and permanent discontinuation of pazopanib (either for disease progression or intolerance); secondary endpoints included overall response rate (ORR), progression-free survival (PFS) and safety. Results: 168 pts (66.5 years median age; 51.8% female) were included and 100 pts randomized (CP: 50, IP: 50). The median number of metastatic sites was 2.0 (1-7) and 50 pts (29.8%) were pretreated with MKI. With a median follow-up of 31.3 m, we did not show any statistically significant difference in the TTF, 80% (66.0-88.7%)] of the pts being under P at 6 m after randomization in the IP arm versus 78% (63.8-87.2%) in the CP arm. Median TTF was 14.7 m 95% CI [9.3; 17.4] and 11.9 m 95% CI [7.5; 15.6] respectively (HR 0.79 [0.49-1.27]). The best response with P was 35.6% (95% CI [28.2; 43.6]) and the disease control rate was 89.4% 95% CI [83.5; 93.7]. Median time to progression under P was not statistically different between 2 arms (5.7m 95% CI [4.8;7.8] in the IP arm vs. 9.2m 95% CI [7.3;11.1] in the CP arm (HR 1.36 [0.88; 2.12]). 36/100 pts (36%) experienced pazopanib-related grade 3/4 AEs (CP:17; IP: 19) mainly represented by gastrointestinal disorders, hypertension, cardiac disorders and asthenia. Five pazopanib-related deaths were reported (CP:1;IP: 4). Conclusions: The intermittent administration of pazopanib study did not significantly demonstrate superiority in efficacy or tolerance over continuous treatment. Continuous administration of MKI remains the standard in RAIR-TC. Clinical trial information: NCT01813136 .
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Affiliation(s)
| | - Yann Godbert
- Bergonié Institute Cancer center, Bordeaux, France
| | | | | | | | - Slimane Zerdoud
- Institut Universitaire du cancer Toulouse Oncopole, Toulouse, France
| | - Johanna Wassermann
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | | | | | | | | | | | - Alain Ravaud
- CHU Hopitaux de Bordeaux-Hôpital Saint-André, Bordeaux, France
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20
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Barber M, Nguyen LS, Wassermann J, Spano JP, Funck-Brentano C, Salem JE. Cardiac arrhythmia considerations of hormone cancer therapies. Cardiovasc Res 2020; 115:878-894. [PMID: 30698686 DOI: 10.1093/cvr/cvz020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 12/28/2022] Open
Abstract
Breast and prostate cancers are among the most prevalent cancers worldwide. Oestradiol and progesterone are major drivers for breast cancer proliferation, and androgens for prostate cancer. Endocrine therapies are drugs that interfere with hormone-activated pathways to slow cancer progression. Multiple new breakthrough drugs improving overall survival have recently been developed within this class. As the use of these latter drugs grows, incidence of cardiac arrhythmias has emerged as an unappreciated complication. These changes are not surprising given that sex hormones alter ventricular repolarization. Testosterone shortens action potential duration and QT interval duration, while oestradiol has an opposite effect. In patients with breast cancer, selective oestrogen receptor modulators are associated with more reports for long QT and torsade de pointes (TdP) than aromatase inhibitors, likely through an oestradiol-like effect on the heart. Cyclin-dependent kinase 4/6 inhibitors, a new class of anticancer drugs used in combination with endocrine therapies in hormone receptor positive breast cancer, are also variably associated with drug-induced long QT, particularly with ribociclib. In prostate cancer, androgen deprivation therapy is associated with long QT and TdP, and possibly atrial fibrillation for abiraterone. In this review, we have summarized the clinical and preclinical data focusing on cardiac arrhythmia considerations of hormone cancer therapies.
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Affiliation(s)
- Mary Barber
- Department of Medicine and Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA
| | - Lee S Nguyen
- Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Johanna Wassermann
- Department of Oncology, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Jean-Philippe Spano
- Department of Oncology, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Christian Funck-Brentano
- Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Joe-Elie Salem
- Department of Medicine and Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA.,Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
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21
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Buffet C, Wassermann J, Hecht F, Leenhardt L, Dupuy C, Groussin L, Lussey-Lepoutre C. Redifferentiation of radioiodine-refractory thyroid cancers. Endocr Relat Cancer 2020; 27:R113-R132. [PMID: 32191916 DOI: 10.1530/erc-19-0491] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/19/2020] [Indexed: 11/08/2022]
Abstract
The management of radioiodine refractory thyroid cancers (RAIR TC) is challenging for the clinician. Tyrosine kinase inhibitors classically prescribed in this setting can fail due to primary or acquired resistance or the necessity of drug withdrawal because of serious or moderate but chronic and deleterious adverse effects. Thus, the concept of redifferentiation strategy, which involves treating patients with one or more drugs capable of restoring radioiodine sensitivity for RAIR TC, has emerged. The area of redifferentiation strategy leads to the creation of new definitions of RAIR TC including persistent non radioiodine-avid patients and 'true' RAIR TC patients. The latter group presents a restored or increased radioiodine uptake in metastatic lesions but with no radiological response on conventional imaging, that is, progression of a metastatic disease, thus proving that they are 'truly' resistant to the radiation delivered by radioiodine. Unlike these patients, metastatic TC patients with restored radioiodine uptake offer the hope of prolonged remission or even cure of the disease as for radioiodine-avid metastatic TC. Here, we review the different redifferentiation strategies based on the underlying molecular mechanism leading to the sodium iodide symporter (NIS) and radioiodine uptake reinduction, that is, by modulating signaling pathways, NIS transcription, NIS trafficking to the plasma membrane, NIS post-transcriptional regulation, by gene therapy and other potential strategies. We discuss clinical trials and promising preclinical data of potential future targets.
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Affiliation(s)
- Camille Buffet
- Sorbonne Université, Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Johanna Wassermann
- Sorbonne Université, Service d'Oncologie, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fabio Hecht
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Laurence Leenhardt
- Sorbonne Université, Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Corinne Dupuy
- UMR 8200 CNRS, Villejuif, France
- Université Paris-Saclay et Gustave Roussy, Villejuif, France
| | - Lionel Groussin
- INSERM Unité 1016, CNRS, UMR 8104, Institut Cochin, Paris, France
- Université de Paris, Paris, France
- Department of Endocrinology, APHP, Cochin Hospital, Paris, France
| | - Charlotte Lussey-Lepoutre
- Sorbonne Université Service de Médecine Nucléaire, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
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22
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Kaboré EG, Guenancia C, Vaz-Luis I, Di Meglio A, Pistilli B, Coutant C, Cottu P, Lesur A, Petit T, Dalenc F, Rouanet P, Arnaud A, Arsene O, Ibrahim M, Wassermann J, Boileau-Jolimoy G, Martin AL, Lemonnier J, André F, Arveux P. Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study. PLoS Med 2019; 16:e1002989. [PMID: 31869400 PMCID: PMC6927582 DOI: 10.1371/journal.pmed.1002989] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast cancer (BC) was recently suggested. However, due to meta-analysis design, it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline (antineoplastic antibiotic) and trastuzumab (monoclonal antibody) cardiotoxicity. METHODS AND FINDINGS Using prospective data collected from 2012-2014 in the French national multicenter prospective CANTO (CANcer TOxicities) study of 26 French cancer centers, we aimed to examine the association of body mass index (BMI) and cardiotoxicity (defined as a reduction in left ventricular ejection fraction [LVEF] > 10 percentage points from baseline to LVEF < 50%). In total, 929 patients with stage I-III BC (mean age 52 ± 11 years, mean BMI 25.6 ± 5.1 kg/m2, 42% with 1 or more cardiovascular risk factors) treated with anthracycline (86% epirubicin, 7% doxorubicin) and/or trastuzumab (36%), with LVEF measurement at baseline and at least 1 assessment post-chemotherapy were eligible in this interim analysis. We analyzed associations between BMI and cardiotoxicity using multivariate logistic regression. At baseline, nearly 50% of the study population was overweight or obese. During a mean follow-up of 22 ± 2 months following treatment completion, cardiotoxicity occurred in 29 patients (3.2%). The obese group was more prone to cardiotoxicity than the normal-weight group (9/171 versus 8/466; p = 0.01). In multivariate analysis, obesity (odds ratio [OR] 3.02; 95% CI 1.10-8.25; p = 0.03) and administration of trastuzumab (OR 12.12; 95% CI 3.6-40.4; p < 0.001) were independently associated with cardiotoxicity. Selection bias and relatively short follow-up are potential limitations of this national multicenter observational cohort. CONCLUSIONS In BC patients, obesity appears to be associated with an important increase in risk-related cardiotoxicity (CANTO, ClinicalTrials.gov registry ID: NCT01993498). TRIAL REGISTRATION ClinicalTrials.gov NCT01993498.
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Affiliation(s)
- Elisé G Kaboré
- "Health across Generations" Team, Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
| | - Charles Guenancia
- Cardiology Department, University Hospital Dijon Bourgogne, Dijon, France
| | | | | | | | | | | | - Anne Lesur
- Centre Alexis Vautrin, Vandoeuvre les Nancy, France
| | | | | | | | | | | | | | | | | | | | | | | | - Patrick Arveux
- "Health across Generations" Team, Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France.,Centre Georges-François Leclerc, Dijon, France
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Wassermann J, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Schapira L, Borges VF, Come SE, Meyer ME, Partridge AH. Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer. Cancer 2019; 125:3266-3274. [PMID: 31120571 DOI: 10.1002/cncr.32192] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC. METHODS As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model. RESULTS Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04). CONCLUSIONS Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population.
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Affiliation(s)
- Johanna Wassermann
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, French National Institute of Health and Medical Research, Paris, France
| | - Shari I Gelber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shoshana M Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Rulla M Tamimi
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lidia Schapira
- Department of Medicine, Stanford Cancer Institute, Palo Alto, California
| | - Virginia F Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Steven E Come
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Meghan E Meyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Wassermann J, Mathy E, Lescaille G, Slim M, Buffet C, Saie C, Braik-Djellas Y, Simon JM, Ménégaux F, Tresallet C, Chami L, Lussey-Lepoutre C, Hervé G, Bernier MO, Spano JP, Leenhardt L. Safety of denosumab in patients with refractory differentiated thyroid cancer and advanced medullary thyroid cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
e17578 Background: Few data exist regarding the use of denosumab in patients with bone metastases from radioactive iodine (RAI) refractory differentiated thyroid cancer (DTC) and advanced medullary thyroid cancer (MTC). We aimed to describe adverse events of specific interest - osteonecrosis of the jaw (ONJ) and severe hypocalcemia - in this rare setting. Methods: We retrospectively reviewed the charts of all the patients treated with denosumab for bone metastases from RAI-refractory DTC and advanced MTC in our institution. All patients had a calcium measurement and a clinical and radiological dental screening before denosumab initiation. All patients without hypercalcemia received a calcium supplementation. We assessed associations between ONJ or severe hypocalcemia ( < 1.75mmol/L) and suspected risk factors by Fisher exact tests. Results: Between 2014 and 2018, 23 patients were treated with denosumab. Two-thirds of patients were male (n = 16), median age was 69 years (range 43-87). Histology was DTC and MTC in 19 (83%) and 4 (17%) patients, respectively. DTC patients had received a median cumulated dose (CD) of 300 mCi of RAI (range 100-700). Ten patients (43%) had at least one cervical surgery for recurrence or persistence, and 6 (26%) had cervical radiotherapy. Four patients had hypoparathyroidism before denosumab initiation. Two-thirds of patients ( n =15) received a tyrosine kinase inhibitor (TKI) in association with denosumab. The median duration of denosumab was 20 months (range 1-47). ONJ occurred in 6 patients (26%) and severe hypocalcemia in 3 patients (13%). Conclusions: Patients with RAI-refractory DTC and advanced MTC are at high risk of ONJ and severe hypocalcemia under denosumab treatment. Benefit/risk ratio should be highly weighted particularly when treatment is prolonged. Patients should be closely monitored for the risk of ONJ and hypocalcemia. [Table: see text]
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Affiliation(s)
- Johanna Wassermann
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Elise Mathy
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Geraldine Lescaille
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Marine Slim
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Camille Buffet
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Clotilde Saie
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Yasmin Braik-Djellas
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Jean-Marc Simon
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Fabrice Ménégaux
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Christophe Tresallet
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Linda Chami
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | | | - Geneviève Hervé
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Marie-Odile Bernier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-Aux-Roses, France
| | - Jean-Philippe Spano
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | - Laurence Leenhardt
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
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Di Meglio A, Menvielle G, Dumas A, Gbenou AS, Bovagnet T, Martin E, Ferreira AR, Vanlemmens L, Arsene O, Ibrahim M, Wassermann J, Martin AL, Lemonnier J, Del Mastro L, Jones L, Partridge AH, Ligibel JA, Andre F, Michiels S, Luis IMVD. Impact of overweight, obesity, and post-treatment weight changes on occupational reintegration of breast cancer (BC) survivors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11562] [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
11562 Background: Overweight and obesity are strongly linked to poorer BC-specific outcomes, quality of life and financial burden in cancer care. Weight loss interventions have the potential to improve such outcomes. Fewer data exist on whether excess weight and post-diagnosis weight changes impact the ability of BC survivors to return to work (RTW). Methods: CANTO (NCT01993498) is a multicenter prospective longitudinal study of 12000 patients (pts) with stage I-III BC that characterizes long-term toxicities of BC treatment. Of 5801 pts enrolled from 2012-2014 (last data lock), we identified 1874 pts who were professionally active at BC diagnosis, ≥5 years (yrs) younger than minimum legal retirement age (62 yrs) and with updated work status 2 yrs after diagnosis. Logistic regression models evaluated the impact of body mass index (BMI) at diagnosis and of weight changes over 2 yrs after diagnosis on odds of non-RTW, adjusting for age, education, income, BC treatment and recreational physical activity (PA). Results: 37% pts were overweight or obese at diagnosis (BMI ≥25 kg/m2): 34% of them gained ≥5% and 16% lost ≥5% weight after diagnosis. Rates of non-RTW at 2 yrs were significantly higher in overweight or obese vs under or normal weight pts (27% vs 18%, p≤.001; adjusted odds ratio 1.37, 95% Confidence Interval [CI] 1.04-1.80, p = .017). Overweight and obese pts who did not RTW experienced higher increments in weight (mean [95% CI]: +3.6% [+2.3, +4.9] vs +1.5% [+0.8, +2.2]) and reported more modest changes in PA (mean [95% CI]: +1.0 [-1.4, +3.5] vs +2.1 [+0.8, +3.3] MET-h/week) vs those who did RTW. Weight changes independently impacted odds of non-RTW in overweight and obese pts (p for interaction weight change*BMI ≤.001): a 5% weight gain was associated with 17% increase in adjusted odds of non-RTW (95% CI 2-35%, p = .024), whereas a loss ≥5% with 60% reduced odds of non-RTW vs weight gain (95% CI 18-82%, p = .013). Conclusions: Excess weight and weight changes are significantly associated with occupational reintegration after BC in overweight and obese pts. Randomized studies testing dedicated weight control interventions should also measure outcomes of social rehabilitation in this large subset of survivors. Clinical trial information: NCT01993498.
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Affiliation(s)
| | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | | | | | - Thomas Bovagnet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | | | | | | | | | | | - Johanna Wassermann
- Pitié-Salpêtrière Hospital, Sorbonne University, Cancer University Institute, Paris, France
| | | | | | - Lucia Del Mastro
- Department of Medical Oncology, IRCCS AOU San Martino–IST, National Cancer Institute, Genova, Italy
| | - Lee Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
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Borson-Chazot F, Dantony E, Illouz F, Lopez J, Niccoli P, Wassermann J, Do Cao C, Leboulleux S, Klein M, Tabarin A, Eberle MC, Benisvy D, de la Fouchardière C, Bournaud C, Lasolle H, Delahaye A, Rabilloud M, Lapras V, Decaussin-Petrucci M, Schlumberger M. Effect of Buparlisib, a Pan-Class I PI3K Inhibitor, in Refractory Follicular and Poorly Differentiated Thyroid Cancer. Thyroid 2018; 28:1174-1179. [PMID: 30105951 DOI: 10.1089/thy.2017.0663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dysregulation of the phosphatidylinositol 3-kinase (PI3K) pathway is frequent in advanced follicular (FTC) and poorly differentiated thyroid (PDTC) carcinomas and has been implicated in oncogenesis and tumor progression. This study investigated the efficacy and safety of buparlisib, a pan-PI3K inhibitor in radioiodine refractory FTC and PDTC. METHODS The primary endpoint of this open-label, multicenter, phase 2 pilot study was progression-free survival (PFS) at 6 months. The sample size was determined considering that a PFS ≤50% at 6 months would denote an absence of benefits (null hypothesis). Secondary endpoints were objective response rate, PFS at 12 months, overall survival at 6 and 12 months, and safety based on the frequency and severity of adverse events (AEs). RESULTS Forty-three patients (19M/24 F; median age: 67 years) with metastatic, radioiodine refractory, progressive disease received buparlisib, 100 mg, daily. Histology was PDTC in 25 (58%), FTC in 17 (40%), and Hürthle cell carcinoma in 1 (2%). RAS mutation was found in 44% (12/27) and activation of the PI3K pathway in 35% (8/23) of tested tumors. The probability of PFS was 41.7% [95% confidence interval (CI) 7.7-55.5] at 6 months and 20.9% [CI 0-35.7] at 12 months, lower than the 50% expected PFS. At 6 months, 25.6% patients had stable disease, 48.8% were progressive and 25.6% had stopped treatment due to AE. The response to therapy was not influenced by age, sex, histology, or genetic alterations. The overall survivals at 6 and 12 months were 85.9% [CI 76-97] and 78.7 % [CI 67-92], respectively. The mean tumor growth rate decreased from 3.78 mm/month [CI 2.61-4.95] before treatment to 0.8 mm/month [CI -0.2-1.88] during treatment (p < 0.02). Severe grade 3-4 AEs occurred in 27 patients (63%), including hepatitis (25%), hyperglycemia (21%), mood disorders (12%), and skin toxicity (12%), with favorable outcome after temporary or permanent treatment discontinuation or dose reduction. CONCLUSIONS Buparlisib did not result in significant efficacy in advanced FTC and PDTC. However, the decrease in tumor growth rate may suggest incomplete inhibition of oncogenic pathways and/or escape mechanisms. This should lead to evaluate combined therapy associating inhibitors of both the PI3K and mitogen-activated protein kinase pathways.
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Affiliation(s)
- Francoise Borson-Chazot
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Emmanuelle Dantony
- 2 Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Université Lyon 1 , Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Frederic Illouz
- 3 Service d'Endocrinologie, Centre de Référence de la Thyroïde et des Récepteurs Hormonaux , Centre Hospitalier Universitaire d'Angers, France
| | - Jonathan Lopez
- 4 Service de Biochimie et Biologie moléculaire, Centre Hospitalier Lyon-Sud , Hospices Civils de Lyon, Université Lyon 1, France
| | - Patricia Niccoli
- 5 Departement d'Oncologie Médicale, Institut Paoli Calmette , Marseille, France
| | - Johanna Wassermann
- 6 Département d'oncologie Médicale, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Sorbonne , Paris, France
| | - Christine Do Cao
- 7 Service d'Endocrinologie, Centre Hospitalier Regional et Universitaire Lille , France
| | - Sophie Leboulleux
- 8 Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave Roussy , Villejuif et Université Paris Saclay, France
| | - Marc Klein
- 9 Service d'Endocrinologie, Centre Hospitalier Universitaire et Université de Nancy , France
| | - Antoine Tabarin
- 10 Service d'Endocrinologie, Centre Hospitalier Universitaire et Université de Bordeaux , France
| | - Marie-Claude Eberle
- 11 Service de Médecine Nucléaire, Institut du Cancer de Montpellier , France
| | - Danielle Benisvy
- 12 Service de Médecine Nucléaire, Centre Antoine Lacassagne , Nice, France
| | | | - Claire Bournaud
- 14 Centre de Médecine Nucléaire, Groupement Hospitalier Est , Hospices Civils de Lyon, France
| | - Helene Lasolle
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Armelle Delahaye
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Muriel Rabilloud
- 2 Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Université Lyon 1 , Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- 15 Service de Radiologie, Centre Hospitalier Lyon-Sud , Hospices Civils de Lyon, France
| | - Myriam Decaussin-Petrucci
- 16 Service d'Anatomie et Cytologie Pathologiques, Groupement Hospitalier Lyon Sud , Hospices Civils de Lyon, et Université Lyon 1, France
| | - Martin Schlumberger
- 8 Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave Roussy , Villejuif et Université Paris Saclay, France
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Wassermann J, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Schapira L, Borges VF, Come SE, Partridge AH. Non-adherence behaviors among young women on adjuvant endocrine therapy for breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
526 Background: Young age at diagnosis (dx) is a predictor of worse prognosis in patients (pts) with luminal breast cancer (BC). Poorer adherence to endocrine therapy (ET) among younger women may contribute to this disparity. Aim: To assess non-adherent behaviors and associated factors among young women with stage 1-3 hormone receptor (HR)+ BC taking ET. Methods: This study is a part of a multi-center, prospective cohort of pts with dx of BC at or under age 40. On a survey 30 months after dx, among pts reporting taking ET, adherence was measured using a 3-item Likert-type scale (Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor?). Pts reporting any non-adherent behavior during the last 3 months were classified as non-adherers. Variables with a p-value <0.20 were included in a multivariate logistic model. Results: Among361 pts eligible for this analysis, 174 (48%) reported some non-adherent behaviors in the last 3 months; 56 (16%) moderate or greater non-adherent behaviors. None of the studied variables was associated with non-adherent behaviors (table). Conclusions: Non-adherent behaviors to ET are present in almost half of the young women with HR+ BC. Further analyses of explanatory factors and impact of non-adherence are required to understand and potentially improve this problem. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann H. Partridge
- Dana-Farber Cancer Institute, Adult Survivorship Program, Boston, MA
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Wassermann J, Bernier MO, Spano JP, Lepoutre-Lussey C, Buffet C, Simon JM, Ménégaux F, Tissier F, Leban M, Leenhardt L. Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas. Oncologist 2015; 21:50-8. [PMID: 26675742 DOI: 10.1634/theoncologist.2015-0107] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Outcomes vary among patients with radioiodine refractory (RR) differentiated thyroid cancer (DTC). The prognostic factors for survival are not well-known, resulting in difficulty in selecting patients for new targeted therapies. We assessed overall survival (OS) and cancer-specific survival (CSS) from RR-DTC to identify prognostic factors associated with survival. PATIENTS AND METHODS The data on all cases of metastatic RR-DTC treated in our center from 1990 to 2011 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method; associated prognostic factors were assessed using Cox's model. RESULTS Of 153 cases of metastatic DTC, 59% (n = 91) met a criterion for RR: that is, 60% (n = 55) had at least 1 metastasis without (131)I uptake; 21% (n = 19) had progressive disease (PD) despite (131)I; 19% (n = 17) had persistent disease despite a cumulative activity of (131)I of ≥600 mCi. After the diagnosis of RR, median OS was 8.9 years (95% confidence interval [CI]: 5.4-NR); median CSS was 9.6 years (95% CI: 6.01-NR). In multivariate analyses, PD despite (131)I as a criterion for RR disease and the time from initial diagnosis of DTC to diagnosis of RR <3 years were the only independent prognostic factors for poor OS and CSS. Thyroglobulin doubling time (Tg-DT) was assessed in 31 of 91 cases. Among the 11 patients with Tg-DT for <1 year or undetectable Tg, 6 deaths occurred, whereas only 3 died of 20 patients with Tg-DT >1 year or negative Tg-DT. CONCLUSION The identification of prognostic factors for decreased survival in RR-DTC may improve the selection of patients for targeted agents. IMPLICATIONS FOR PRACTICE This study shows a great heterogeneity in terms of prognosis in radioiodine refractory differentiated thyroid carcinoma. Poorer prognosis is observed in patients with tumor progression or with a diagnosis of radioiodine resistance within 3 years after the initial diagnosis of thyroid cancer. Those findings could lead to improvements in the selection of patients for targeted therapies.
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Affiliation(s)
- Johanna Wassermann
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Marie-Odile Bernier
- Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France Department of Epidemiology, Institute of Nuclear safety and radioprotection, Fontenay aux Roses, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Charlotte Lepoutre-Lussey
- Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Jean-Marc Simon
- Department of Radiotherapy, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Fabrice Ménégaux
- Department of Endocrine Surgery, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Frédérique Tissier
- Department of Pathology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Monique Leban
- Department of Biochemistry, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France
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Drake A, Wassermann J, Quaas J. 166 Prompted Post-Resuscitation Formal Feedback Improves Clinician Satisfaction Without Distracting from Other Duties. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.198] [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: 10/23/2022]
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30
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Bouattour M, Payancé A, Wassermann J. Evaluation of antiangiogenic efficacy in advanced hepatocellular carcinoma: Biomarkers and functional imaging. World J Hepatol 2015; 7:2245-2263. [PMID: 26380650 PMCID: PMC4568486 DOI: 10.4254/wjh.v7.i20.2245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/15/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Many years after therapeutic wilderness, sorafenib finally showed a clinical benefit in patients with advanced hepatocellular carcinoma. After the primary general enthusiasm worldwide, some disappointments emerged particularly since no new treatment could exceed or at least match sorafenib in this setting. Without these new drugs, research focused on optimizing care of patients treated with sorafenib. One challenging research approach deals with identifying prognostic and predictive biomarkers of sorafenib in this population. The task still seems difficult; however appropriate investigations could resolve this dilemma, as observed for some malignancies where other drugs were used.
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Wassermann J, Toledano A, Gligorov J, Conforti R, Grapin J, Benothman S, Spano J, Khayat D. 1968 Routine practice use of Oncotype Dx assay in French breast cancer patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30916-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bouattour M, Rousseau B, Wassermann J, Payancé A, Huillard O. Negative Trials for Foreseeable Safety Reasons in Advanced Hepatocellular Carcinoma: How Long Are We Going to Take Lightly Pharmacokinetics of Tyrosine Kinase Inhibitors? J Clin Oncol 2015; 33:2484-5. [DOI: 10.1200/jco.2014.60.6954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mohamed Bouattour
- Beaujon University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Diderot, Clichy, France
| | - Benoît Rousseau
- Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Paris Est Créteil Université, INSERM U 955 Team 18, Paris, France
| | - Johanna Wassermann
- Pitié-Salpêtrière University Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie Paris VI, Paris, France
| | - Audrey Payancé
- Beaujon University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Diderot, Clichy, France
| | - Olivier Huillard
- Angiogenesis Inhibitors Multidisciplinary Study Group, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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Boissier E, Wassermann J, Kempf E, Spano JP, Tournigand C, Rousseau B. Relationship between response and progression free survival in 8965 patients with advanced renal cell carcinoma treated with first-line antiangiogenic therapy in 39 trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Emilie Boissier
- APHP, Henri-Mondor Hospital, Oncology department, Créteil, France
| | | | - Emmanuelle Kempf
- AP-HP, Henri-Mondor Hospital, Oncology Department, Creteil, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière University Hospital - INSERM UMR_S 1136, Paris, France
| | | | - Benoit Rousseau
- Medical Oncology, Hopital Henri Mondor, INSERM U955, Creteil, France
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Colle E, Wassermann J, de Guillebon E, Tartour E. Brèves de l’AERIO. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2457-4] [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: 10/24/2022]
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Huillard O, Blanchet B, Boudou-Rouquette P, Thomas-Schoemann A, Wassermann J, Goldwasser F. Sorafenib in thyroid cancer patients: learning from toxicity. Oncologist 2014; 19:e3. [PMID: 25052452 DOI: 10.1634/theoncologist.2014-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Olivier Huillard
- Medical Oncology Department, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA), Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Benoit Blanchet
- Pharmacokinetics and Pharmacochemistry Unit, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA), Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Pascaline Boudou-Rouquette
- Medical Oncology Department, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA), Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Audrey Thomas-Schoemann
- Pharmacokinetics and Pharmacochemistry Unit, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA), Cochin Hospital, AP-HP and UMR 8638 CNRS, Faculty of Pharmacy, Paris Pharmaceutical Research Center, Paris Descartes University, Paris, France
| | - Johanna Wassermann
- Medical Oncology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre et Marie Curie University, Paris, France
| | - François Goldwasser
- Medical Oncology Department, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA), Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
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Wassermann J, Huillard O, Rousseau B, Peron J, Rodrigues MJ, Spano JP, Bouattour M. Sorafenib discontinuation due to toxicity: A literature-based meta-analysis and meta-regression analysis of 18 randomized controlled trials in solid and hematologic malignancies. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Johanna Wassermann
- Department of Medical Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Cochin University Hospital, Paris, France
| | - Benoit Rousseau
- Department of Medical Oncology, Henri Mondor University Hospital, Creteil, France
| | - Julien Peron
- Department of Medical Oncology, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Mohamed Bouattour
- Department of Hepatology, Beaujon University Hospital, Clichy, France
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Ronot M, Bouattour M, Wassermann J, Bruno O, Dreyer C, Larroque B, Castera L, Vilgrain V, Belghiti J, Raymond E, Faivre S. Alternative Response Criteria (Choi, European association for the study of the liver, and modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in patients with advanced hepatocellular carcinoma treated with sorafenib. Oncologist 2014; 19:394-402. [PMID: 24652387 DOI: 10.1634/theoncologist.2013-0114] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), may underestimate activity and does not predict survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib. This study assessed the value of alternative radiological criteria to evaluate response in HCC patients treated with sorafenib. PATIENTS AND METHODS A retrospective blinded central analysis was performed of computed tomography (CT) scans from baseline and the first tumor evaluation in consecutive patients treated with sorafenib over a 2-year period in a single institution. Four different evaluation criteria were used: Choi, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), and RECIST 1.1. RESULTS Among 82 HCC patients, 64 with Barcelona Clinic Liver Cancer stage B-C were evaluable with a median follow-up of 22 months. Median duration of sorafenib treatment was 5.7 months, and median overall survival was 12.8 months. At the time of the first CT scan, performed after a median of 2.1 months, Choi, EASL, mRECIST, and RECIST 1.1 identified 51%, 28%, 28%, and 3% objective responses, respectively. Responders by all criteria showed consistent overall survival >20 months. Among patients with stable disease according to RECIST 1.1, those identified as responders by Choi had significantly better overall survival than Choi nonresponders (22.4 vs. 10.6 months; hazard ratio: 0.43, 95% confidence interval: 0.15-0.86, p = .0097). CONCLUSION Choi, EASL, and mRECIST criteria appear more appropriate than RECIST 1.1 to identify responders with long survival among advanced HCC patients benefiting from sorafenib.
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Affiliation(s)
- Maxime Ronot
- Departments of Radiology, Hepatology, Medical Oncology, Biostatistics, and Hepatobiliary and Pancreatic Surgery, Beaujon University Hospital, Assistance Publique Hopitaux de Paris, Clichy, France
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Wassermann J, Groheux D, Coussy F, Cuvier C, Huon De Kermadec E, Banayan S, Albiter M, De Bazelaire C, Lalloum M, De Roquancourt A, Bourstyn E, Cahen-Doidy L, Hindié E, Espié M, Giacchetti S. Abstract P6-12-13: Synchronous metastases are highly prevalent in HER2 positive inflammatory breast carcinomas evaluated by 18F-FDG PET/CT. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-12-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Inflammatory breast carcinomas have poor prognosis even in the absence of evident synchronous metastases. 18F-FDG PET/CT is not recommended in initial staging but could improve the sensibility of synchronous metastases detection and the management of the patients.
Objective: To assess factors associated with synchronous metastases in inflammatory breast carcinomas when evaluated by 18F-FDG PET/CT.
Methods: Since 2006, initial staging of locally advanced breast carcinomas in our center consisted of 18F-FDG PET/CT in addition to standard laboratory and radiological tests. We reviewed data of patients with inflammatory breast carcinomas treated from 2006 to 2013 who had an initial evaluable18F-FDG PET/CT. Fisher's exact test and logistic model were used to assess factors associated with synchronous metastases. Overall survival was estimated with the method of Kaplan-Meier.
Results: Among 353 locally advanced breast carcinomas seen at the breast disease unit, hospital Saint Louis from 04/2006 to 04/2013, we identified 40 inflammatory breast carcinomas. Initial 18F-FDG PET/CT was available for review in 32 inflammatory breast carcinomas. Median age was 57 years (range 38-78), 39% had pre-menopausal status (n = 12), clinical node involvement was found in 87.5% (n = 28). Histological features on biopsy were: ductal invasive carcinoma 91% (n = 29), SBR grade III 72% (n = 23), negative hormonal receptor 75% (n = 24), positive HER2 37.5% (n = 12), triple negative 44% (n = 14). Synchronous metastases were found in 41% of inflammatory breast carcinomas (n = 13), bone (n = 7), liver (n = 6) and mediastinum (n = 4). Synchronous metastases seemed more common in HER2 positive than in HER2 negative inflammatory breast carcinomas (58% vs 30%, p = 0.15). In multivariate analysis, no factor was associated with synchronous metastases. All patients with inflammatory breast carcinomas received neoadjuvant chemotherapy with sequential anthracycline and taxane (16 patients), dose-dense anthracycline and alkylating agent (8 patients), taxane with or without bevacizumab (7 patients) and anthracycline in 1 patient. Trastuzumab was given in all HER2 positive inflammatory breast carcinomas. Clinical response to neoadjuvant chemotherapy was complete in 16.5% (n = 5), partial in 67% (n = 20), stable or progressive in 16.5% (n = 5) and missing for 1 patient. One patient died before response assessment. Thirty patients (94%) underwent radical mastectomy with axillary node dissection. Pathologic complete response in breast and nodes was found in 27.5% (n = 8). Axillary node invasion was found in 45% (n = 13). All positive hormonal receptors patients received endocrine therapy after surgery. With a median follow-up of 33 months, 10 patients died. Median overall survival was 38.8 months (95%CI: 30.3-NA) with no difference between HER2 positive and HER2 negative patients.
Conclusion: Synchronous metastases are common in inflammatory breast carcinomas especially in case of HER2 positive tumors. Complete initial staging with 18F-FDG PET/CT could be useful to detect synchronous metastases mainly in bone and liver and thus allowed to adapt further treatment.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-12-13.
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Affiliation(s)
| | - D Groheux
- Saint-Louis University Hospital, Paris, France
| | - F Coussy
- Saint-Louis University Hospital, Paris, France
| | - C Cuvier
- Saint-Louis University Hospital, Paris, France
| | | | - S Banayan
- Saint-Louis University Hospital, Paris, France
| | - M Albiter
- Saint-Louis University Hospital, Paris, France
| | | | - M Lalloum
- Saint-Louis University Hospital, Paris, France
| | | | - E Bourstyn
- Saint-Louis University Hospital, Paris, France
| | | | - E Hindié
- Saint-Louis University Hospital, Paris, France
| | - M Espié
- Saint-Louis University Hospital, Paris, France
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Wassermann J, Bellesoeur A. [Young oncologists to the service tomorrow's cancerology]. Bull Cancer 2013; 100:1233-1234. [PMID: 24516898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Espié M, Wassermann J, de Kermadec E, Lalloum M, Coussy F. Vitamine D et cancers. Presse Med 2013; 42:1405-11. [DOI: 10.1016/j.lpm.2013.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022] Open
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Wassermann J, Bernier MO, Spano JP, Lepoutre-Lussey C, Simon JM, Ménégaux F, Hoang C, Aurengo A, Leenhardt L. Survival and prognostic factors of radioiodine refractory pulmonary metastatic differentiated thyroid carcinoma (DTC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6093] [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
6093 Background: The challenging key point of management of radioiodine refractory DTC patients is to define those who could benefit from experimental drugs in clinical trials. Methods: We reviewed clinical and pathological data of patients with refractory pulmonary metastatic DTC treated in our center from 1990 to 2011. Survival was estimated with the method of Kaplan-Meier. Associated prognostic factors were studied in Cox model based analyses. Results: Among 167 pulmonary metastatic DTC, 46% (n=76) met a criterion of radioiodine refractory disease: at least one metastases without I131 uptake: 61% (n=46); progressive disease despite I131: 22% (n=17) and absence of complete response despite a cumulated dose >600mCi: 17% (n=13). There were 63% of female (n=48) and the median age was 64 years (range 18-87). The initial treatment was total thyroidectomy in 92% (n=70), lymph node dissection in 71%, (n=54) and radioiodine therapy in 100% of patients. Pathological features were papillary histology in 61% (n=46), follicular histology in 29% (n=22) and poor differentiated histology in 10% (n=8). pT stage was 1ab, 2, 3, and 4 in 11%, 13%, 63% and 13% respectively, pN stage after lymph node dissection was 0, 1a and 1b in 33%, 7% and 60% respectively. Metastasis were present at diagnosis in 45% (n=34) of cases. The refractory feature was established at the time of diagnosis and in the follow-up in 18% and 82% of cases respectively. When the disease was considered as refractory, the median overall survival was 5.5 years. The refractory feature at the initial diagnosis was the only independent prognostic factor correlated with poor survival (p<0.001). Conclusions: Patients who are considered as radioiodine refractory at the initial diagnosis of DTC have poor prognosis and should be considered for clinical trials in case of progression.
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Affiliation(s)
- Johanna Wassermann
- Department of Nuclear Medicine, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marie-Odile Bernier
- Department of Nuclear Medicine, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Jean-Marc Simon
- Department of Radiotherapy, Pitié-Salpêtrière University Hospital, Paris, France
| | - Fabrice Ménégaux
- Department of Endocrine Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Catherine Hoang
- Department of Pathology, Pitié-Salpêtrière University Hospital, Paris, France
| | - André Aurengo
- Department of Nuclear Medicine, Pitié-Salpêtrière University Hospital, Paris, France
| | - Laurence Leenhardt
- Department of Nuclear Medicine, Pitié-Salpêtrière University Hospital, Paris, France
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Rodrigues M, Peron J, Frénel JS, Vano YA, Wassermann J, Debled M, Picaud F, Albiges L, Vincent-Salomon A, Cottu P. Benefit of adjuvant trastuzumab-based chemotherapy in T1ab node-negative HER2-overexpressing breast carcinomas: a multicenter retrospective series. Ann Oncol 2013; 24:916-24. [DOI: 10.1093/annonc/mds536] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Frenel JS, Rodrigues MJ, Peron J, Yann-Alexandre V, Wassermann J, Debled M, Picaud F, Albiges L, Vincent-Salomon A, Cottu PH. Impact of adjuvant trastuzumab-based chemotherapy in T1ab node-negative HER2 overexpressing breast carcinomas. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
601 Background: HER2 overexpression has been recognized as a pejorative prognostic factor in node negative T1ab (T1abN0) breast tumors. Randomized clinical trials have shown benefit of adjuvant trastuzumab-based chemotherapy (ATBC) for node-positive and/or greater than 1 cm (T1c or more) HER2+ breast carcinomas. There are no prospective efficacy data of ATBC in T1abN0 HER2+ tumors. Methods: We retrospectively evaluated 276 cases of T1ab node-negative HER2+ breast tumors in 8 French Comprehensive Cancer Centers. We assessed clinical, therapeutic features and outcome. We estimated the probability of disease-free survival (DFS), analyzed associations of ATBC, patient and tumor characteristics with DFS and prognosis factors using the log-rank test, multivariate analysis with logistic regression and Cox’s proportional hazards model. Results: Out of the 276 T1abN0 cases, 129 (47%) received ATBC (ATBC+) and 123 (45%) were not treated by either trastuzumab or chemotherapy (ATBC-). Of these 252 ATBC+ or ATBC- patients, decision of ATBC was associated with date of diagnosis (before or after ASCO 2005 Annual Meeting when interim results from three trastuzumab adjuvant trials were reported) and with poor prognosis features: negative hormone receptors (HR-) status, Elston-Ellis high grade, tumor size > 5 mm and age. With a median follow-up of 44 months 16 recurrences were observed (13 in the ATBC- group, 2 in the ATBC+ and 1 with adjuvant chemotherapy alone). Nine recurrences were distant metastases. A survival benefit in ATBC+ was observed with a 99% 40-months DFS versus 93% for ATBC- (logrank p-test = 0.018). In an exploratory analysis, two factors were significantly associated with worst prognosis for ATBC- that were not observed for ATBC+ : HR- status (98% 40-months DFS for ATBC+ patients versus 84% for ATBC- patients; logrank p-test = 0.0003) and presence of lymphovascular invasion (100% 40-months DFS for ATBC+ versus 73% in ATBC- cases; logrank p-test = 0.003). Conclusions: In our seriesATBC is associated with a significant reduction of risk of recurrence of T1abN0 HER2+ tumors. A clear DFS benefit of ATBC was observed in HR- tumors and/or in presence of lymphovascular invasion.
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Affiliation(s)
| | | | | | | | | | - Marc Debled
- Institut Bergonié, South-West Comprehensive Cancer Center, Bordeaux, France
| | | | - Laurence Albiges
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
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Bouattour M, Wassermann J, Guedj N, Paradis V, Dreyer C, Castera L, Vilgrain V, Faivre SJ, Raymond E. Value of preoperative biopsy and radiological assessment for the diagnosis of mixed hepatocellular cholangiocarcinoma (HCC-CC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
176 Background: Mixed tumors with hepatocellular and cholangiocarcinoma component (HCC-CC) are rare variants of primary liver tumors. In this study, we aimed to describe clinical, radiological and histopathological features of patients with resected HCC-CC. Methods: From 2000 to 2010, patients (pts) with diagnosis of mixed HCC-CC based on surgical specimen were identified from our database. Demographic, clinical, radiological and pathological data were analyzed retrospectively, along with outcome after resection. Results: Among 18 pts, 6 men (33%) and 12 women (67%) were identified. The median age was 64 years (range 38- 75). Nine pts (50%) had at least one risk factor for chronic liver disease including alcohol consumption (6), NASH (3) and HBV infection (2). Twelve (67%) and 6 pts (33%) underwent major and minor hepatic resections respectively. The positive predictive value of radiological and pathological diagnosis was reviewed. Imaging by CT scan and/or MRI suggested characteristics of HCC and CC in 5 and 6 pts respectively. In 3 pts imaging showed combined features of HCC and CC while it was atypical in 4 cases. Preoperative biopsy was performed in 10 pts and analyzed using only morphological features. Biopsy sample was non contributive in 2 cases and concluded to CC, HCC and mixed HCC-CC in 5, 2 and 1 cases respectively. This contrasted with examination of resection specimen showing evidence of HCC combined with CC phenotype. Immunostaining on resection specimens showed the presence of differentiation markers for both hepatocytes and biliairy cancer cells (CK7 +, CK19 +, anti-hepatocyte +, and glypican +). Non tumor liver analysis showed normal underlying liver, non extensive fibrosis ≤ F2, extensive fibrosis > F2 without cirrhosis and cirrhosis in 2, 3, 7 and 6 specimens respectively. With more than 6 months follow-up (range 6 -59 months) the recurrence rate was higher than 50%. Conclusions: Mixed HCC-CC are not accurately identified by preoperative biopsy using only morphological features and CT scan/MRI assessment. Following resection, mixed HCC-CC behave more like CC than HCC.
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Affiliation(s)
- Mohamed Bouattour
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Johanna Wassermann
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Nathalie Guedj
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Valerie Paradis
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Chantal Dreyer
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Laurent Castera
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Valérie Vilgrain
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Sandrine J. Faivre
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Eric Raymond
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France
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Bouattour M, Wassermann J, Bruno O, Dreyer C, Larroque B, Castera L, Vilgrain V, Belghiti J, Raymond E, Faivre SJ. Blinded independent central response assessment using RECIST, mRECIST, and CHOI criteria in patients treated with sorafenib for advanced hepatocellular carcinoma (HCC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
172 Background: Despite survival benefit in patients with advanced HCC, sorafenib has been infrequently associated with changes in tumors dimensions, challenging standard RECIST criteria. Experts have suggested new response criteria based on changes in tumor vascularization and density (mRECIST and Choi). Aim is to evaluate response in patients treated with sorafenib using three different methods and their correlation with overall survival (OS) Methods: Radiological evaluations were performed from consecutive patients treated with sorafenib from January 2007 to February 2009. Patients were considered evaluable if CT scans were performed within 6 weeks before sorafenib and in the three months following treatment initiation at the first evaluation. A radiologist blinded for clinical data performed tumor evaluations according to RECIST, mRECIST, and Choi criteria. Best response was correlated with OS Results: Among 82 patients, 60 were evaluable (median age 63, male/female 52/8). The majority of patients were Child A (80%). Tumor staging showed BCLC stage B and C in 33% and 67%, respectively. The median duration of treatment with sorafenib was 6.6 months (range 1.2-16.5). Tumor evaluations by CT scan were performed in a median of 2.1 months (range 1.5-3.2). For the entire cohort, median OS was 9.9 months, and survival rates at 6, 12, and 24 months were 69%, 39% and 22%, respectively. The table summarizes the best responses measured using RECIST, mRECIST, and Choi criteria. Conclusions: Better OS was observed in patients with complete/partial response than in patients with stable disease and progression, regardless the type of radiological criteria. However, mRECIST and Choi criteria identified more adequately than RECIST subgroups of patients with complete/partial response who also experienced longer survival [Table: see text]
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Affiliation(s)
- Mohamed Bouattour
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Johanna Wassermann
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Onorina Bruno
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Chantal Dreyer
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Beatrice Larroque
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Laurent Castera
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Valérie Vilgrain
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Jacques Belghiti
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Eric Raymond
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
| | - Sandrine J. Faivre
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Epidemiology, Beaujon University Hospital, Clichy, France; Beaujon University Hospital, Clichy, France; Department of Surgery, Beaujon University Hospital, Clichy, France
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Bouattour M, Wassermann J, Dreyer C, Vilgrain V, Paradis V, Raymond E, Faivre SJ. Rapamycin in patients with advanced hepatocellular carcinoma progressing on prior antiangiogenic therapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.356] [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
356 Background: PI3K/Akt/mTOR is a critical survival pathway in hepatocellular carcinoma (HCC) often correlated with poor prognosis. Rapamycin (sirolimus) and its analogue everolimus, are specific mTOR inhibitors that showed promising antitumor activity in preclinical models and clinical cases of HCC Aims: To evaluate the safety and efficacy of rapamycin in patients (pts) with advanced HCC after failure or intolerance to prior antiangiogenic therapy Methods: In this retrospective cohort, we analyzed consecutive patients with progressive HCC after 1 to 3 lines of treatment including at least sorafenib. All pts received oral rapamycin at 20 to 30 mg once a week. Adverse events (AEs) were assessed using NCI-CTCAE v3.0, and tumor response was evaluated according to RECIST criteria. Results: Nine patients (F/M: 1/8) with compensated liver cirrhosis (Child A, n = 6; Child B7, n = 2) or no cirrhosis (n=1) and histologically proven HCC were included in this study. Overall, therapy with rapamycin was well tolerated. Most common toxicities were asthenia (grade 1-2: 5 pts) anaemia (all grade: 5 pts; grade 3: 2 pts ) and thrombocytopenia (grade 1-2: 2 pts). Liver function deterioration was observed in 2 pts with advanced cirrhosis (Child B7). Radiological evaluation was available in 6 pts. No objective tumor response was observed however stable disease ≥ 3 months was observed in 4 cases. Moreover, 2 pts showed stable disease at 6 months. Prolonged stabilization under rapamycin was observed in pts who were previously controlled at least for 6 months with sorafenib. Rapamycin was discontinued due to disease progression in 7/8 pts, toxicity in 1/8 pts. One pt shows ongoing long-lasting disease stabilization (8 + months). Conclusions: Rapamycin displayed an acceptable safety profile and may achieved disease stabilization in patients with heavily pretreated advanced HCC.
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Affiliation(s)
- Mohamed Bouattour
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Johanna Wassermann
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Chantal Dreyer
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Valérie Vilgrain
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Valerie Paradis
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Eric Raymond
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
| | - Sandrine J. Faivre
- Department of Oncology, Beaujon University Hospital, Clichy, France; Department of Radiology, Beaujon University Hospital, Clichy, France; Department of Pathology, Beaujon University Hospital, Clichy, France
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Peron J, Vano Y, Frenel JS, Wassermann J, Albiges L, Rodrigues MJ, Cottu PH. P2-18-03: Systemic Adjuvant Treatment of T1a and T1b N0M0 HER2+ Breast Carcinomas; an AERIO/UNICANCER Study. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-18-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Trials have shown benefit of adjuvant trastuzumab (TZM) for node-positive (N+) or T1c+ HER2−positive breast carcinomas.
Methods: Retrospective series in 6 french cancer centers from 2000 to 2010 of T1abN0M0 HER2 positive breast carcinomas. Multifocal tumors were excluded.
Results: Two hundred five N- cases were retrieved. Median size was 8 mm (range, 2 to 10 mm), 51 were T1a (25%), 152 tumors were T1b; 120 tumors (59 %) exhibited significant hormonal receptors (HR) expression. All patients had surgery, 65 % (n= 133) had a local irradiation. Ninety percent of HR+ patients (108/120) received hormonotherapy: 77 received aromatase inhibitors (AI) upfront or sequential; 23 received tamoxifen (TAM) alone 13 received LHRH agonists alone or in combination with TAM or AI. Forty-nine percent (n= 101) had chemotherapy (CT) (Anthracycline alone for 41 cases, taxane alone for 31 cases, sequential A/T for 28 cases and concurrent for 1 case), associated with TZM in 90 cases. TZM was administered without chemotherapy in 3 cases. Decision of adjuvant CT and/or TZM was associated with (all p<0.05) HR-negative status, Elston-Ellis grade 2/3 and high mitotic index (MI) while patients with HR+/ low MI tumors were rarely treated (p<0.01). With a 41 months median follow-up, there was a statistically significant difference in invasive recurrences between TZM treated patients and others (log-rank test p=0.04). Twelve of the 112 patients treated without TZM (11%) had a recurrent invasive disease including 6 metastatic cases and 3 fatal events. There was one invasive recurrence in TZM group. There were as much recurrences in T1a as in T1b tumors. Three of the 12 recurrences (25%) in the group without TZM occurred in T1a cases.
Conclusion: T1abN0M0 HER2 positive tumors have a significant risk of recurrence which could be avoided by adjuvant chemotherapy associated with TZM. Interestingly, there were no differences in the risk of recurrence between T1a and T1b. Adjuvant chemotherapy associated with TZM should not only be discussed in T1bN0 HER2−positive tumors but also in T1aN0 HER2−positive cases.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-18-03.
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Affiliation(s)
- J Peron
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - Y Vano
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - J-S Frenel
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - J Wassermann
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - L Albiges
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - MJ Rodrigues
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
| | - PH Cottu
- 1Centre Léon Bérard, Lyon, France; Centre Antoine Lacassagne, Nice; Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes; Institut Curie, Centre René Huguenin, Saint-Cloud; Institut Gustave Roussy, Villejuif; Institut Curie, Paris
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Rodrigues MJ, Albiges-Sauvin L, Wassermann J, Cottu PH. Evaluating the risk-benefit ratio of adjuvant trastuzumab-based therapy for T1a,bN0M0 HER2-positive breast carcinomas. Ann Oncol 2011; 22:2530. [PMID: 21700734 DOI: 10.1093/annonc/mdr308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M J Rodrigues
- Department of Medical Oncology, Institut Curie, Paris; Association pour l'Enseignement et la Recherche des Internes en Oncologie (AERIO), Paris
| | - L Albiges-Sauvin
- Association pour l'Enseignement et la Recherche des Internes en Oncologie (AERIO), Paris; Department of Medical Oncology, Institut Gustave Roussy, Villejuif
| | - J Wassermann
- Association pour l'Enseignement et la Recherche des Internes en Oncologie (AERIO), Paris; Department of Medical Oncology, Institut Curie/Hôpital René Huguenin, Saint-Cloud, France
| | - P H Cottu
- Department of Medical Oncology, Institut Curie, Paris.
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Wassermann J, Albiges L, Rodrigues MJ, Brain E, Delaloge S, Guinebretiere J, Mathieu MC, Guillot E, Vincent-Salomon A, Cottu PH. Treatment of small node-negative HER2+ invasive breast carcinomas: Forty-month update of the joint Aerio/Remagus study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.557] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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50
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Rodrigues M, Haberer S, Dionysopoulos D, Barrière J, Wassermann J, Tazi Y, Rajpar S, Giroux J, Bidard FC, Loriot Y. Internet to boost patient accrual in oncology trials? A multiinstitutional AERIO study. Ann Oncol 2011; 22:490-1. [DOI: 10.1093/annonc/mdq746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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