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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Gantzer J, Toulmonde M, Severac F, Chamseddine AN, Charon-Barra C, Vinson C, Hervieu A, Bourgmayer A, Bertucci F, Ryckewaert T, Valentin T, Firmin N, Chaigneau L, Bompas E, Follana P, Rioux-Leclercq N, Soibinet-Oudot P, Bozec L, Le Loarer F, Weingertner N, Chevreau C, Duffaud F, Blay JY, Kurtz JE, Schöffski P, Brahmi M, Malouf GG. PEC-PRO: A new prognostic score from a series of 87 patients with localized perivascular epithelioid cell neoplasms (PEComas) treated with curative intent. Cancer 2024. [PMID: 38470379 DOI: 10.1002/cncr.35277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Perivascular epithelioid cell neoplasms (PEComas) encompass a heterogeneous family of mesenchymal tumors. Previously described clinicopathologic features aimed at distinguishing benign from malignant variants but lacked prognostic value. METHODS This retrospective analysis examined clinicopathologic data from patients who had localized PEComa across French Sarcoma Network centers. The authors analyzed 12 clinicopathologic features in a Cox proportional hazard framework to derive a multivariate prognostic risk model for event-free survival (EFS). They built the PEComa prognostic score (PEC-PRO), in which scores ranged from 0 to 5, based on the coefficients of the multivariate model. Three groups were identified: low risk (score = 0), intermediate risk (score = 1), and high risk (score ≥ 2). RESULTS Analyzing 87 patients who had a median 46-month follow-up (interquartile range, 20-74 months), the median EFS was 96.5 months (95% confidence interval [CI], 47.1 months to not applicable), with 2-year and 5-year EFS rates of 64.7% and 58%, respectively. The median overall survival was unreached, with 2-year and 5-year overall survival rates of 82.3% and 69.3%, respectively. The simplified Folpe classification did not correlate with EFS. Multivariate analysis identified three factors affecting EFS: positive surgical margins (hazard ratio [HR], 5.17; 95% CI, 1.65-16.24; p = .008), necrosis (HR, 3.94; 95% CI, 1.16-13.43; p = .030), and male sex (HR, 3.13; 95% CI, 1.19-8.27; p = 0.023). Four variables were retained in the prognostic model. Patients with low-risk PEC-PRO scores had a 2-year EFS rate of 93.7% (95% CI, 83.8%-100.0%), those with intermediate-risk PEC-PRO scores had a 2-year EFS rate of 67.4% (95% CI, 53.9%-80.9%), and those with high-risk PEC-PRO scores had a 2-year EFS rate of 2.3% (95% CI, 0.0%-18.3%). CONCLUSIONS The PEC-PRO score reliably predicts the risk of postoperative recurrence in patients with localized PEComa. It has the potential to improve follow-up strategies but requires validation in a prospective trial.
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Affiliation(s)
- Justine Gantzer
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - François Severac
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ali N Chamseddine
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Charles Vinson
- Department of Pathology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Agathe Bourgmayer
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseilles, France
| | | | - Thibaud Valentin
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Institut Regional du Cancer en Franche-Comté, Besançon, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Philippe Follana
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | | | - Noëlle Weingertner
- Department of Pathology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Florence Duffaud
- Department of Medical Oncology, Centre Hospitalier Universitaire de Marseilles, Marseilles, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - Patrick Schöffski
- Department of Medical Oncology, University Hospitals, Leuven, Belgium
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Gabriel G Malouf
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
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3
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Llacer-Moscardo C, Moureau-Zabotto L, Ollivier L, Helfré S, Ducassou A, Bonvalot S, Sunyach MP, Sargos P, Gillon P, Firmin N, Le Péchoux C, Thariat J. Management of oligometastatic/metastatic sarcomas and place of local treatments with focus on modern radiotherapy approaches. Cancer Radiother 2024; 28:93-102. [PMID: 38212215 DOI: 10.1016/j.canrad.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/09/2023] [Accepted: 06/29/2023] [Indexed: 01/13/2024]
Abstract
Soft tissue sarcomas are a rare and heterogeneous disease. For localized disease, treatment is based on surgery and radiotherapy with or without chemotherapy depending on risk factors. Upfront metastases are present in 7 to 20% of cases, and are localized to the lungs in most of cases. Disseminated disease is generally considered incurable but in selected cases, aggressive local treatment of metastases allowed long survival. Treatment of primary tumour is often debated. Our purpose is to evaluate the literature concerning the role of radiotherapy in the management of primary metastatic soft tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - L Moureau-Zabotto
- Department of radiotherapy, centre de radiothérapie du Pays d'Aix, avenue Henri-Pontier, 13100 Aix-en-Provence, France
| | - L Ollivier
- Department of radiotherapy, institut de cancérologie de l'Ouest (ICO), centre René-Gauducheau, Saint-Herblain, France
| | - S Helfré
- Department of radiotherapy, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Ducassou
- Department of radiotherapy, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - S Bonvalot
- Department of oncological surgery, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M-P Sunyach
- Department of radiotherapy, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - P Sargos
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - P Gillon
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - N Firmin
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - C Le Péchoux
- Department of radiotherapy, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - J Thariat
- Department of radiotherapy, centre François-Baclesse, 12, rue Jean-Baptiste-Colbert, 14000 Caen, France
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Bay JO, Auberger B, Bouleuc C, Cohen R, Delom F, Firmin N, Gandemer V, L'Allemain G, Magne N, De Nonneville A, Orbach D, Pellier I, Rodrigues M, Wislez M. [A 2023 inventory in oncology news]. Bull Cancer 2024; 111:18-32. [PMID: 38184423 DOI: 10.1016/j.bulcan.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
In 2023, the improvement of our therapeutic management has largely taken shape. The aim of our article is to highlight the major advances that will change our practices. These are not only in the field of treatment, but also in the improvement of supportive care. Here, we present these new developments organ by organ, cancer by cancer. You can read everything or concentrate on the cancers that are your areas of expertise. But this exhaustiveness should be representative of our current state of progress.
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Affiliation(s)
- Jacques-Olivier Bay
- Service de thérapie cellulaire et d'hématologie clinique adulte, UE7453 CHELTER, Inserm CIC-501, site Estaing, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Benjamin Auberger
- Service d'oncologie médicale, ICH Morvan, CHU de Brest, 29200 Brest, France
| | - Carole Bouleuc
- Département de soins de support, Sorbonne université et institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Romain Cohen
- Service d'oncologie médicale, hôpital Saint-Antoine, AP-HP, Inserm, UMRS 938 et SIRIC CURAMUS, centre de recherche Saint-Antoine, équipe instabilité des microsatellites et cancer, équipe labellisée par la Ligue Nationale contre le Cancer, Sorbonne université, 75012 Paris, France
| | - Frédéric Delom
- ARTiSt Lab, Inserm U1312, université de Bordeaux, 33000 Bordeaux, France
| | - Nelly Firmin
- ICM Montpellier et Inserm U1194, IRCM, université de Montpellier, 208, avenue des apothicaires, 34298 Montpellier, France
| | - Virginie Gandemer
- Service d'hémato-oncologie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - Gilles L'Allemain
- Inserm, institut biologie Valrose, CNRS, université Côte d'Azur, 06108 Nice, France
| | - Nicolas Magne
- Département de radiothérapie, institut Bergonie, Bordeaux, France
| | | | - Daniel Orbach
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, l'adolescent et le jeune adulte (SIREDO), PSL université, 26, rue d'Ulm, 75005 Paris, France
| | - Isabelle Pellier
- Unité d'onco-hématologie pédiatrique, CHU d'Angers, 49000 Angers, France
| | - Manuel Rodrigues
- Département d'oncologie médicale, institut Curie, PSL Research University, 26, rue d'Ulm, 75005 Paris, France
| | - Marie Wislez
- Service de pneumologie, unité d'oncologie thoracique, AP-HP centre, hôpital Cochin, 75000 Paris, France
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5
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Blay JY, Tlemsani C, Toulmonde M, Italiano A, Rios M, Bompas E, Valentin T, Duffaud F, Le Nail LR, Watson S, Firmin N, Dubray-Longeras P, Ropars M, Perrin C, Hervieu A, Lebbe C, Saada-Bouzid E, Soibinet P, Fiorenza F, Bertucci F, Boudou P, Vaz G, Bonvalot S, Honoré C, Marec-Berard P, Minard V, Cleirec M, Biau D, Meeus P, Babinet A, Dumaine V, Carriere S, Fau M, Decanter G, Gouin F, Ngo C, Le Loarer F, Karanian M, Meurgey A, Dufresne A, Brahmi M, Chemin-Airiau C, Ducimetiere F, Penel N, Le Cesne A. Sclerosing Epithelioid Fibrosarcoma (SEF) versus Low Grade Fibromyxoid Sarcoma (LGFMS): Presentation and outcome in the nationwide NETSARC+ series of 330 patients over 13 years. Eur J Cancer 2024; 196:113454. [PMID: 38008029 DOI: 10.1016/j.ejca.2023.113454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
Sclerosing Epithelioid Fibrosarcoma (SEF) and Low Grade Fibromyxoid Sarcoma (LGFMS) are ultrarare sarcomas sharing common translocations whose natural history are not well known. We report on the nationwide exhaustive series of 330 patients with SEF or LGFMS in NETSARC+ since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB). Since 2010, (i) pathological review has been mandatory for sarcoma,and (ii) tumour/patients' characteristics have been collected in the NETSARC+ nationwide database. The characteristics of patients with SEF and LGFMS and their outcome are compared. RESULTS 35/73 (48%) and 125/257(49%) of patients with SEF and LGFMS were female. More visceral, bone and trunk primary sites were observed in SEF (p < 0.001). 30% of SEF vs 4% of LGFMS patients had metastasis at diagnosis (p < 0.0001). Median size of the primary tumor was 51 mm (range 10-90) for LGFMS vs 80 (20-320) for SEF (p < 0.001). Median age for LGFMS patients was 12 years younger than that of SEF patients (43 [range 4-98] vs 55 [range 10-91], p < 0.001). Neoadjuvant treatment was more often given to SEF (16% vs 9%, p = 0.05). More patients with LGFMS were operated first in reference centers (51% vs 26%, p < 0.001). The R0 rate on the operative specimen was 41% in LGFMS vs 16% in SEF (p < 0.001). Median event-free survival (EFS) of patients with SEF and LGFMS were 32 vs 136 months (p < 0.0001). The median overall survival (OS) was not reached. Fifty-months OS was 93% vs 81% for LGFMS vs SEF (p = 0.05). Median OS was 77 months after first relapse, similar for SEF and LGFMS. In multivariate analysis, age, tumor size, metastasis at diagnosis were independent prognostic factors for OS in LGFMS. CONCLUSIONS Although sharing close molecular alterations, SEF and LGFMS have a different natural history, clinical presentation and outcome, with a higher risk of metastatic relapse in SEF. Survival after relapse is longer than with other sarcomas, and similar for SEF and LGFMS.
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Affiliation(s)
- J Y Blay
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | | | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Rios
- Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest Nantes, France
| | - T Valentin
- Institut Claudius Regaud & Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- La Timone University Hospital, Marseille, France
| | | | - S Watson
- Dept of Medical Oncology, Institut Curie & INSERM U830, Institut Curie Research Center, Paris, France
| | - N Firmin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - M Ropars
- Eugene Marquis Comprehensive Cancer Center, France
| | | | - A Hervieu
- Centre George Francois Leclerc, Dijon, France
| | - C Lebbe
- Centre Georges François Leclerc, Dijon, France
| | - E Saada-Bouzid
- Dermato-Oncology Unit, Saint Louis Hospital, Paris, France
| | | | | | - F Bertucci
- Institut Paoli-Calmettes, Marseille, France
| | | | - G Vaz
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - C Honoré
- Gustave Roussy Cancer Campus, Villejuif, France
| | - P Marec-Berard
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - V Minard
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | - D Biau
- Hopital Cochin, Paris, France
| | - P Meeus
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | - S Carriere
- Institut de Cancérologie de Montpellier, Montpellier, France
| | - M Fau
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - G Decanter
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - F Gouin
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Ngo
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - M Karanian
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Meurgey
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Dufresne
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - M Brahmi
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Chemin-Airiau
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - F Ducimetiere
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | - N Penel
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
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Hanslik N, Bourgier C, Thezenas S, Carrère S, Firmin N, Riou O, Azria D, Llacer-Moscardo C. [Predictive factors assessment of pathological response to neoadjuvant radiotherapy of soft tissue sarcomas]. Cancer Radiother 2023; 27:689-697. [PMID: 37813717 DOI: 10.1016/j.canrad.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Conserving surgery combined with radiotherapy in presence of local recurrence risk factors is standard treatment of soft tissue sarcomas, a group of rare and heterogeneous tumours. Radiotherapy is performed before or after surgery. In neoadjuvant setting, late radiation-induced toxicity is reduced and pathological response to radiotherapy could be achieved. A complete pathological response to radiotherapy has recently been shown to predict better survival. Our study aims at identifying predictive factors of pathological response to neoadjuvant radiotherapy (clinical, radiological or histological) of soft tissue sarcomas. PATIENTS AND METHODS Clinical, imaging (MRI: perilesional oedema, necrosis, tumour heterogeneity, vasculonervous relationships) and pathological (pathological subtype, tumour grade, anticipated/obtained resection quality) data were retrospectively collected. Tumour response (imaging and pathological), patient outcome, acute and late radiation-induced toxicity, predictive factors of pathological response to neoadjuvant radiotherapy were studied. The 2-test or exact-Fisher test (qualitative variables) and by Student's t-test or Kruskal-Wallis test (quantitative variables) were used for statistical analysis. RESULTS From April 2017 to April 2021, neoadjuvant radiotherapy (50Gy in 25 fractions) followed by surgical excision was performed to 36 consecutive patients with liposarcomas (n=17/36), or undifferentiated sarcomas (n=8/36). MRI response was complete in 1 patient, partial in 9 patients (n=9/36, 25%), stable in 21 patients (n=21/36, 58%) or in progression in 5 patients (n=5/36, 14%). Pathological response was observed in 22 patients (61%). No grade 3-4 acute radiation-induced toxicity was observed. Regarding late toxicity, 28% of patients had grade 1-2 oedema (n=10/36), 39% had a grade 1 fibrosis (n=14/36), and 30% grade 1 pain (n=11/36). No predictive factors of response to radiotherapy was statistically significant. CONCLUSIONS Neoadjuvant radiotherapy is well-tolerated. No clinical, radiological or pathological predictive factors was identified for radiotherapy tumour response.
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Affiliation(s)
- N Hanslik
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - C Bourgier
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; IRCM, institut de recherche en cancérologie de Montpellier, Inserm U1194, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - S Thezenas
- Unité de biostatistiques, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - S Carrère
- Service de chirurgie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - N Firmin
- Département d'oncologie, ICM, institut régional du Cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - O Riou
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; IRCM, institut de recherche en cancérologie de Montpellier, Inserm U1194, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - C Llacer-Moscardo
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France.
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7
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Blay JY, Piperno-Neumann S, Watson S, Dufresne A, Valentin T, Duffaud F, Toulmonde M, Italiano A, Bertucci F, Tlemsani C, Firmin N, Bompas E, Perrin C, Ropars M, Saada-Bouzid E, Dubray-Longeras P, Hervieu A, Lebbe C, Gantzer J, Chaigneau L, Fiorenza F, Rios M, Isambert N, Soibinet P, Boudou-Roquette P, Verret B, Ferron G, Ryckewaert T, Lebellec L, Brahmi M, Gouin F, Meeus P, Vaz G, Le Loarer F, Karanian M, De Pinieux G, Ducimetiere F, Chemin C, Morelle M, Le Cesne A, Penel N. Epithelioid hemangio-endothelioma (EHE) in NETSARC: The nationwide series of 267 patients over 12 years. Eur J Cancer 2023; 192:113262. [PMID: 37625241 DOI: 10.1016/j.ejca.2023.113262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
EPITHELIOID HEMANGIOENDOTHELIOMA A NATIONWIDE STUDY: Epithelioid hemangioendothelioma (EHE) is an ultrarare sarcoma whose natural history and treatment is not well defined. We report on the presentation and outcome of 267 patients with EHE in the NETSARC+ network since 2010 in France. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centres with specialised multidisciplinary tumour boards (MDTB), funded by the French National Cancer Institute (NCI), Institut National du Cancer (INCA). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients. Patients' characteristics are collected in a nationwide database regularly monitored with stable incidence since 2013. The characteristics of patients with EHE at diagnosis are presented as well as progression-free survival (PFS), overall survival (OS), and outcome under treatment. RESULTS Two hundred and sixty-seven patients with EHE were included in the NETSARC+ database since 2010. Median age in the series was 51 (range 10-90) years, 58% were women. Median tumour size was 37 mm (4-220). Forty-eight percent, 42%, and 10% were visceral, soft parts, or bone primaries. The most frequent sites were liver (28%), lung (13%). 40% were reported to have systemic (i.e. multifocal or metastatic disease) at diagnosis. With a median follow-up of 20 months, OS and PFS rates at 24 months were 82% and 67%, with 10-year projected OS and PFS of 62% and 21% respectively. Male and M+ patients at diagnosis had a significantly worse OS, but not PFS. Local treatment was associated with a favourable survival in localised but not in patients with advanced stage at diagnosis. For 23 patients receiving medical treatment, PFS and OS were 50.2% and 33.2% at 60 months were respectively. CONCLUSIONS EHE is a frequently metastatic sarcoma at diagnosis with a unique natural history. This study shows in a nationwide series over 12 years that most patients progressed but are still alive at 10 years, both in localised and metastatic stages.
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Affiliation(s)
- J Y Blay
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France.
| | - S Piperno-Neumann
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - S Watson
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - A Dufresne
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - T Valentin
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- Department of Medical oncology, La Timone University Hospital, Marseille, France
| | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Bertucci
- Department of Medical oncology, Institut Paoli-Calmettes, Marseille, France
| | - C Tlemsani
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - N Firmin
- Department of Medical oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest, Nantes, France
| | - C Perrin
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - M Ropars
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - E Saada-Bouzid
- Department of Medical oncology, Centre Antoine-Lacassagne, Nice, France
| | - P Dubray-Longeras
- Department of Medical oncology, Centre Georges François Leclerc, Dijon, France
| | - A Hervieu
- Department of Medical oncology, Centre Jean Perrin/ERTICa EA 4677, Clermont-Ferrand, France
| | - C Lebbe
- Department of Medical oncology, Oncology Unit, Saint Louis Hospital, Paris, France
| | - J Gantzer
- Department of Medicine, ICANS, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical oncology, CHU Besancon, Besançon, France
| | - F Fiorenza
- Department of Medical oncology, CHU Limoges, Limoges, France
| | - M Rios
- Department of Medical oncology, Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - N Isambert
- Department of Medical oncology, CHU, Poitiers, France
| | - P Soibinet
- Department of Medical oncology, Institut J Godinot Reims, Reims, France
| | - P Boudou-Roquette
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - B Verret
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Ferron
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - T Ryckewaert
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - L Lebellec
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - M Brahmi
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Gouin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - P Meeus
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G Vaz
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Le Loarer
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Karanian
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G De Pinieux
- Department of Medical oncology, CHU Tours, Tours, France
| | - F Ducimetiere
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - C Chemin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - M Morelle
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - A Le Cesne
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Penel
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
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8
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Le Cesne A, Chevreau C, Perrin C, Italiano A, Hervieu A, Blay JY, Piperno-Neumann S, Saada-Bouzid E, Bertucci F, Firmin N, Kalbacher E, Narciso B, Schiffler C, Yara S, Jimenez M, Bouvier C, Vidal V, Chabaud S, Duffaud F. Regorafenib in patients with relapsed advanced or metastatic chordoma: results of a non-comparative, randomised, double-blind, placebo-controlled, multicentre phase II study. ESMO Open 2023; 8:101569. [PMID: 37285716 DOI: 10.1016/j.esmoop.2023.101569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND REGOBONE multicohort study explored the efficacy and safety of regorafenib for patients with advanced bone sarcomas; this report details the cohort of patients with relapsed advanced or metastatic chordoma. METHODS Patients with relapsed chordoma progressing despite 0-2 prior lines of systemic therapy, were randomised (2 : 1) to receive regorafenib (160 mg/day, 21/28 days) or placebo. Patients on placebo could cross over to receive regorafenib after centrally-confirmed progression. The primary endpoint was the progression-free rate at 6 months (PFR-6) (by RECIST 1.1). With one-sided α of 0.05, and 80% power, at least 10/24 progression-free patients at 6 months (PFR-6) were needed for success. RESULTS From March 2016 to February 2020, 27 patients were enrolled. A total of 23 patients were assessable for efficacy: 7 on placebo, 16 on regorafenib, 16 were men, median age was 66 (32-85) years. At 6 months, in the regorafenib arm, 1 patient was not assessable, 6/14 were non-progressive (PFR-6: 42.9%; one-sided 95% CI = 20.6) 3/14 discontinued regorafenib due to toxicity; and in the placebo arm, 2/5 patients were non-progressive (PFR-6: 40.0%; one-sided 95% CI = 7.6), 2 were non-assessable. Median progression-free survival was 8.2 months (95% CI 4.5-12.9 months) on regorafenib and 10.1 months (95% CI 0.8 months-non evaluable [NE]) on placebo. Median overall survival rates were 28.3 months (95% CI 14.8 months-NE) on regorafenib but not reached in placebo arm. Four placebo patients crossed over to receive regorafenib after centrally-confirmed progression. The most common grade ≥3 regorafenib-related adverse events were hand-foot skin reaction (22%), hypertension (22%), pain (22%), and diarrhoea (17%), with no toxic death. CONCLUSION This study failed to show any signal of benefit for regorafenib in patients with advanced/metastatic recurrent chordoma.
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Affiliation(s)
- A Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif
| | - C Chevreau
- Medical Oncology Department, Institut Universitaire de Cancérologie de Toulouse, Oncopole, Toulouse
| | - C Perrin
- Medical Oncology Unit, Centre Eugène Marquis, Rennes
| | - A Italiano
- Medical Oncology Department, Institut Bergonié, Bordeaux
| | - A Hervieu
- Medical Oncology Department, Centre Georges Francois Leclerc, Dijon
| | - J Y Blay
- Medical Oncology Department, Centre Léon Bérard, Lyons. https://twitter.com/jeanyvesblay
| | | | - E Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice
| | - F Bertucci
- Medical Oncology Department, Institut Paoli Calmettes, Marseille
| | - N Firmin
- Medical Oncologie Department, Centre Valdorelle, Montpellier
| | - E Kalbacher
- Medical Oncology Department, CHU J Minjoz, Besançon
| | - B Narciso
- Medical Oncology Department, CHU Bretonneau, Tours
| | - C Schiffler
- Department of Statistics, Centre Léon Bérard, Lyons
| | | | | | - C Bouvier
- Aix Marseille Univ, APHM Hopital La Timone, Pathology Department, Marseille
| | - V Vidal
- Aix Marseille Univ, APHM Hopital La Timone, Radiology Department, Marseille
| | - S Chabaud
- Department of Statistics, Centre Léon Bérard, Lyons
| | - F Duffaud
- Aix Marseille University (AMU), APHM Hopital La Timone, Medical Oncology Unit, APHM, Marseille, France.
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9
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Lalaoui Rachidi S, Firmin N, Elfadli M, Essadi I, Belbaraka R. A Case Report of SMARCA4-Deficient Thoracic Sarcoma: A Rare and Aggressive Disease With a Grim Prognosis. Cureus 2023; 15:e39571. [PMID: 37378131 PMCID: PMC10292728 DOI: 10.7759/cureus.39571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
SMARCA4-deficient thoracic sarcoma (DTS) is a rare malignancy defined by inactivating SMARCA4 mutations leading to protein loss. It was recently described as an aggressive disease with a dismal prognosis, mostly affecting young men with a history of heavy smoking. Histologically, SMARCA4-DTS is a poorly differentiated tumor with rhabdoid or epithelioid features that can be distinguished from other soft tissue, and thoracic sarcomas by a higher tumor mutation burden (TMB) and the presence of smoking signatures, including KRAS, STK11, and KEAP1 mutations. Currently, there is no approved treatment for SMARCA4-DTS, which is known to be chemo-resistant, but more recent studies have shown some effectiveness with immune checkpoint inhibitors. We report the case of a 42-year-old man with a family history of cancer who was admitted to the hospital with acute respiratory distress and superior vena cava syndrome. He had been experiencing thoracic pain, dry cough, dyspnea, fatigue, and unintentional weight loss for a month. Imaging revealed multiple masses and lymph nodes in the chest, as well as pleural effusion. PET scan showed widespread metastases. A cervical lymph node biopsy confirmed the diagnosis of SMARCA4-deficient thoracic sarcoma. Unfortunately, his general condition did not allow an aggressive treatment. He was started on Pazopanib 800mg per day, but deteriorated rapidly and passed away. This report highlights the aggressive nature and unfavorable prognosis associated with SMARCA4-deficient thoracic sarcoma. Accurate diagnosis of this entity can be challenging due to its unique marker expression and unfamiliar histological features. Currently, there are no established treatment strategies for this condition; however, recent studies have shown promising results with immune checkpoint inhibitors and targeted therapies. Further research is necessary to identify the most effective treatment approaches for SMARCA4-DTS.
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Affiliation(s)
| | - Nelly Firmin
- Medical Oncology, Montpellier Cancer Institute (ICM), Montpellier, FRA
| | - Mohamed Elfadli
- Medical Oncology, Mohammed VI University Hospital, Marrakesh, MAR
| | - Ismail Essadi
- Medical Oncology, Ibn Sina Military Teaching Hospital Marrakesh, Marrakesh, MAR
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10
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Thomas QD, Firmin N, Mbatchi L, Evrard A, Quantin X, Leenhardt F. Combining Three Tyrosine Kinase Inhibitors: Drug Monitoring Is the Key. Int J Mol Sci 2023; 24:ijms24065518. [PMID: 36982592 PMCID: PMC10054357 DOI: 10.3390/ijms24065518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
A combination of tyrosine kinase inhibitors (TKIs) is likely to be a therapeutic option for numerous oncological situations due to high frequency of oncogenic addiction and progress in precision oncology. Non-small cell lung cancer (NSCLC) represents a subtype of tumors for which oncogenic drivers are frequently involved. To the best of our knowledge, we report the first case of a patient treated with three different TKIs. Osimertinib and crizotinib were administered concurrently for an epidermal growth factor receptor (EGFR)-mutated NSCLC developing a MET amplification as a resistance mechanism to osimertinib. Simultaneously, imatinib was administered for a metastatic gastrointestinal stromal tumor. The progression-free survival was 7 months for both tumors with this tritherapy. The use of therapeutic drug monitoring to assess plasma concentrations of each TKI was a powerful tool to manage the toxicity profile of this combination (creatine phosphokinase elevation) while preserving an optimal exposure to each TKI and treatment efficacy. We observed an imatinib over-exposition related to crizotinib introduction, probably explained by drug–drug interaction mediated by crizotinib enzymatic inhibition on cytochrome P-450 3A4. Posology adjustment due to therapeutic drug monitoring was probably involved in the good survival outcome of the patient. This tool should be used more routinely for patients treated by TKIs to prevent co-treatment interactions and, in particular, for patients receiving TKI combinations to obtain optimal therapeutic exposure and efficacy while reducing possible side-effects.
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Affiliation(s)
- Quentin Dominique Thomas
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Correspondence:
| | - Nelly Firmin
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
| | - Litaty Mbatchi
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
| | - Alexandre Evrard
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
| | - Xavier Quantin
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
| | - Fanny Leenhardt
- Montpellier Cancer Institute (ICM), 34090 Montpellier, France
- Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), 34090 Montpellier, France
- Pharmacokinetics Laboratory, Faculty of Pharmacy, University of Montpellier, 34090 Montpellier, France
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11
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Valentin T, Lambert M, Chaltiel L, Allal B, Mseddi M, Yakoubi M, Chevreau C, Toulmonde M, Firmin N, Filleron T, Chatelut E. Population pharmacokinetic analysis reveals no impact of aprepitant on the pharmacokinetics of ifosfamide, 2-dechloroifosfamide, and 3-dechloroifosfamide. Eur J Pharm Sci 2023; 185:106420. [PMID: 36882147 DOI: 10.1016/j.ejps.2023.106420] [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: 12/13/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Several case reports and retrospective series have clearly pointed to the role of aprepitant, an antiemetic drug, in the development of encephalopathy when used with ifosfamide. Described as an inhibitor of several CYP metabolic pathways, aprepitant is suspected of drug-drug-interaction on ifosfamide pharmacokinetics. The pharmacokinetics of ifosfamide and two of its metabolites (2-dechloroifosfamide and 3-dechloroifosfamide) was studied in patients with soft tissue sarcomas to evaluate the impact of aprepitant administration. METHODS A population pharmacokinetic approach was applied to analyze data obtained in 42 patients at cycle 1 (without aprepitant) and cycle 2 (with aprepitant for 34 of them). RESULTS A previously published pharmacokinetic model including a time-dependency process well fit the data. Aprepitant had no impact on ifosfamide or its two metabolite pharmacokinetic parameters. CONCLUSION This study suggests that aprepitant does not lead to a significant modification of ifosfamide metabolization, even though other metabolites such as 4 hydroxyifosfamide and chloroacetaldehyde were not monitored in this study.
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Affiliation(s)
| | - Marie Lambert
- Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France; CRCT, Université de Toulouse, Inserm
| | | | - Ben Allal
- Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France; CRCT, Université de Toulouse, Inserm
| | - Mourad Mseddi
- Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France; CRCT, Université de Toulouse, Inserm
| | - Malika Yakoubi
- Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France; CRCT, Université de Toulouse, Inserm
| | | | | | - Nelly Firmin
- Medical Oncology, Montpellier Cancer Institute, France
| | | | - Etienne Chatelut
- Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France; CRCT, Université de Toulouse, Inserm.
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12
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Jacot W, Chateau MC, Thezenas S, Guiu S, Firmin N, Boissière-Michot F. Abstract P2-11-17: Prognostic value of Trop2 expression levels in non-metastatic triple-negative breast cancer and correlation with other biomarkers. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-11-17] [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: 03/06/2023]
Abstract
Abstract
Background: Since the development of anti Trop2 antibody-drug conjugates (ADC), Trop2 has been validated as a major therapeutic target for antibody-drug conjugates in metastatic triple-negative breast cancer (TNBC). However, very few data have been reported regarding the prognostic implication, or clinicopathological variables, associated with Trop2 expression levels in early TNBC. Our aim was to evaluate Trop2 expression and its prognostic value in a retrospective series of patients with non-metastatic TNBC and a long follow-up, characterized for Basal-like (BL) or molecular apocrine-like (MA) IHC profiles as well as TILs infiltrate, PDL1 expression and PIK3CA/PTEN mutations. Patients and methods: The analysis was performed in a series of 228 patients with non-metastatic TNBC treated in our center between 2002 and 2012 arrayed on 6 TMA. BL and MA profiles were defined as IHC CK5/6 and/or EGFR expression, and Androgen-receptor and FOXA1 IHC expression, respectively. Trop2 expression levels were tested for their association with baseline clinicopathological variables, and for Relapse-Free Survival (RFS) and Overall survival (OS). Trop2 IHC level of expression was evaluated using the ENZ-ABS380 mouse monoclonal antibody and the methodology described by Bardia et al. (Annals of Oncology, 2021) to quantify the membrane signal. First, we established a score grid, according to staining intensity (no labeling: 0; weak labeling: 1; moderate labeling: 2; strong labeling: 3). Then, for each sampled core, the percentage of labeled invasive tumor cells in each intensity was reported. The overall membrane expression was then calculated using the H-Score method (3 x % of cells with labeling intensity 3 + 2 x % of cells with intensity 2 + 1 x % of cells with intensity 1). The scores obtained ranged from 0 to 300. Results: Median age was 58.2 years (range 28.5-89.1). 43.9% of tumors were classified pT1 and 63.5% pN0. 83.8% of patients had ductal carcinomas. Histological grade 1-2 represented 22.7% of all tumors. A BL phenotype was observed in 68.1% of cases, and an MA profile in 39.4% of the cases. Adjuvant chemotherapy (ACT) was delivered in 74% of patients. We observed low Trop2 expression (H-Score < 100) in 12.3% of the cases (28/228 samples), moderate Trop2 expression (H-Score 100-200) in 28.9% of the cases (66/228 samples), and strong Trop2 expression (H-Score >200) in 58.8% of the cases (134/228 samples). We only identified 3 tumors without any Trop2 expression. Regarding baseline clinicopathological correlations, Trop2 levels were only found significantly associated with pT stage, pT1 tumors displaying more frequently high Trop2 scores compared to tumors >= pT2 (p=0.002). No significant correlation was found between Trop2 expression levels and HER2 levels (0 vs. 1+/2+), BL or MA status. With a median follow-up of 9.7 years, Trop2 levels were not associated with RFS nor OS in univariate analysis. In multivariate analysis, poor RFS was associated with classical variables in the early TNBC setting: tumors >=T2 stage (Hazard Ratio (HR) 2.13, p=0.02), N+ status (HR 3.51, p< 0.001), while high (>5%) TILs infiltration levels (HR 0.54, p=0.03) and adjuvant chemotherapy use (HR 0.49, p=0.007) were associated with improved RFS. Conclusions: Trop2 is expressed in nearly all early TNBC cases, and Trop2 levels of expression, while associated with T stage, did not impact survival in this population. These results are consistent with the ones reported in the metastatic setting in the ASCENT trial. Trop2 level of expression appearing homogeneous distributed in all the clinicopathological subtypes of TNBC, advocating for the evaluation of combined treatments with anti-Trop2 ADCs and dedicated targeted therapies in specific TNBC subgroups.
Citation Format: William Jacot, Marie-Christine Chateau, Simon Thezenas, Séverine Guiu, Nelly Firmin, Florence Boissière-Michot. Prognostic value of Trop2 expression levels in non-metastatic triple-negative breast cancer and correlation with other biomarkers [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-17.
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Affiliation(s)
- William Jacot
- 1Institut du Cancer de Montpellier, Université de Montpellier, INSERM U1194, Montpellier, Languedoc-Roussillon, France
| | - Marie-Christine Chateau
- 2Institut du Cancer de Montpellier (ICM) Val d’Aurelle, Montpellier University, INSERM U1194, Montpellier, France
| | - Simon Thezenas
- 3Institut du Cancer de Montpellier (ICM) Val d’Aurelle, Montpellier University, INSERM U1194, Montpellier, France
| | - Séverine Guiu
- 4Institut du Cancer de Montpellier (ICM) Val d’Aurelle, Montpellier University, INSERM U1194, Montpellier, France
| | - Nelly Firmin
- 5Institut du Cancer de Montpellier (ICM) Val d’Aurelle, Montpellier University, INSERM U1194, Montpellier, France
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Bouillin A, Gayte L, Firmin N, Carrere S, Linares L. 108P New biomarkers in liposarcomas: A metabolic approach. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101145] [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: 04/05/2023] Open
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14
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Bay JO, Bouleuc C, Caux C, Delom F, Firmin N, Gandemer V, L'Allemain G, Magné N, Orbach D, Robert J, Rodrigues M, Sabatier R, Thiery-Vuillemin A, Wislez M. [A 2022 inventory in oncology news]. Bull Cancer 2023; 110:19-31. [PMID: 36529541 DOI: 10.1016/j.bulcan.2022.12.002] [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: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
The Cancer Bulletin continues its tradition. At the beginning of 2023, the members of the editorial committee would like to share with you their analyses of the highlights of 2022. The objective remains to highlight what will change our practices and lead to different diagnostic or therapeutic options. Our synthesis will therefore focus on published data. They have been analyzed and placed in the more general context of the management of each type of cancer to deduce the practical consequences for our patients. This synthesis exercise will concern almost all tumor pathologies, most often on the therapeutic level, and will, however, exclude the evolution of techniques, whether they are diagnostic or used for the follow-up of our patients. The final objective is to allow you to have a thoughtful, didactic and practical reading. Our goal is to provide our readers with the rational bases that can lead to a different approach for treatments in 2023.
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Affiliation(s)
- Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, UE7453 CHELTER, Inserm CIC-501, site Estaing, 63000 Clermont-Ferrand, France.
| | - Carole Bouleuc
- Sorbonne université, Paris, France; Institut Curie, département de soins de support, 26, rue d'Ulm, 75005 Paris, France
| | - Christophe Caux
- Université Claude-Bernard Lyon 1, CNRS 5286, centre de recherche en cancérologie de Lyon, Inserm U1052, 69008 Lyon, France
| | - Frédéric Delom
- University Bordeaux, ARTiSt Lab, Inserm U1312, 33000 Bordeaux, France
| | - Nelly Firmin
- Université Montpellier, ICM Montpellier, IRCM, Inserm U1194, 208, avenue des apothicaires, 34298 Montpellier, France
| | - Virginie Gandemer
- CHU de Rennes, service d'hémato-oncologie pédiatrique, 35000 ReDnnes, France
| | - Gilles L'Allemain
- Université Côte d'Azur, CNRS, Inserm, institut biologie Valrose, 06108 Nice, France
| | - Nicolas Magné
- Institut Bergonie, département de radiothérapie, Bordeaux, France
| | - Daniel Orbach
- PSL université, institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Jacques Robert
- Université de Bordeaux, Inserm U1218, 33000 Bordeaux, France
| | - Manuel Rodrigues
- PSL Research University, institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Renaud Sabatier
- Aix-Marseille université, CNRS, institut Paoli-Calmettes, département d'oncologie médicale, Inserm, Marseille, France
| | - Antoine Thiery-Vuillemin
- CHRU Jean-Minjoz, department of medical oncology, 25030 Besançon cedex, France; Université de Franche-Comté, SFR IBCT, Inserm U1098, 25020 Besançon cedex, France
| | - Marie Wislez
- AP-HP Centre, hôpital Cochin, service de pneumologie, unité d'oncologie thoracique, 75000 Paris, France
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Brahmi M, Gaspar N, Gantzer J, Toulmonde M, Boudou‐Rouquette P, Bompas E, Firmin N, Valentin T, Cancel M, Duffaud F, Bertucci F, Perrin C, Dufresne A, Marec‐Bérard P, Jean‐Denis M, Ray‐Coquard I, Le Loarer F, Pierron G, Tirode F, Blay J, Watson S. Patterns of care and outcome of
CIC
‐rearranged sarcoma patients: A nationwide study of the French sarcoma group. Cancer Med 2022; 12:7801-7807. [PMID: 36537582 PMCID: PMC10134374 DOI: 10.1002/cam4.5539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND CIC-rearranged sarcomas (CIC-RS) represent the most frequent subset of "Ewing-like" undifferentiated small round cell sarcomas. These tumors tend to be more aggressive than Ewing sarcomas. Moreover, treatment strategy can differ according to teams. The primary aim of this retrospective study was to describe the characteristics, treatments, and outcome for patients with CIC-RS included in the French NETSARC+ database. METHODS Pediatric and adult patients from 13 French centers with a diagnosis of CIC-RS were registered from October 2008 to March 2021. Patients and tumors characteristics were collected from the national network NETSARC+ database (http://netsarc.sarcomabcb.org). CIC-RS diagnosis was pathologically and molecularly confirmed with a central review by expert pathologists. Two groups of patients were studied: those treated as classical Ewing sarcomas (cohort EwS) and those treated as high-grade soft tissue sarcomas (cohort STS) according to ESMO and/or EpSSG guidelines. Survival was calculated using the Kaplan-Meier method and the log-rank test was used to compare survival. RESULTS Among 79 patients, the male/female sex ratio was 0.7 and the median age at diagnosis was 27 years (range 2-87). With a median follow-up of 37 months, 39 patients died of the disease. Median overall survival from diagnosis was 18 months, with no significant difference between both cohorts (p = 0.9). Nevertheless, when focusing on patients with metastatic disease at diagnosis (N = 21), all patients from cohort STS died of disease while some patients from cohort EwS were still alive and in complete remission. CONCLUSION FSG experience confirms the aggressive clinical course of CDS patients regardless of chemotherapy regimen.
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Penel N, Giraud A, Chemin C, Cantarel C, Ducimetiere F, Honoré C, Le Cesne A, Gouin F, Toulmonde M, Decanter G, Bonvalot S, Chevreau C, Anract P, Firmin N, Duffaud F, Kurtz J, Bompas E, Ropars M, Blay JY, Mathoulin-Pelissier S. 1515P Nationwide management of soft tissue sarcoma (STS) in France, before (2019) versus during COVID-19 pandemic (2020). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1618] [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: 11/25/2022] Open
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17
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Pautier P, Italiano A, Piperno-Neumann S, Chevreau C, Penel N, Firmin N, Boudou-Rouquette P, Bertucci F, Balleyguier C, Lebrun-Ly V, Ray-Coquard I, Kalbacher E, Bardet A, Bompas E, Collard O, Isambert N, Guillemet C, Rios M, Archambaud B, Duffaud F, ITALIANO A, PAUTIER P, LECESNE A, PIPERNO-NEUMANN S, CHEVREAU C, CUPISSOL D, PENEL N, ALEXANDRE J, BERTUCCI F, RAY-COQUARD I, LEBRUN-LY V, KALBACHER E, DUFFAUD F, DELCAMBRE C, BOMPAS E, COLLARD O, ISAMBERT N, GUILLEMET C, SOULIE P, RIOS M, SAADA-BOUZID E. Doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin alone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol 2022; 23:1044-1054. [DOI: 10.1016/s1470-2045(22)00380-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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18
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Chen TWW, Chiang RCJ, Le Cesne A, Hsieh YC, Italiano A, Yang YW, Penel N, Lee WC, Bompas E, Valentin T, Anract P, Firmin N, Duffaud F, Cheng AL, Ducimetiere F, Chan KA, Blay JY. Soft tissue sarcoma incidences and clinical characteristics are significantly different in France and Taiwan. Cancer 2022; 128:3360-3369. [PMID: 35796499 DOI: 10.1002/cncr.34372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of different soft tissue sarcoma (STS) histotypes among ethnic and geographic populations has not been comprehensively investigated. METHODS Data from 2013 to 2016 were obtained from national cancer registry databases in France and Taiwan. Liposarcoma (LPS), leiomyosarcoma (LMS), angiosarcoma (AS), synovial sarcoma (SS), and malignant peripheral nerve sheath tumor (MPNST) were selected as index STSs to estimate the age-standardized incidence rates (ASRs) and other clinical features between patients. RESULTS In total, 9398 patients (7148 from France and 2250 from Taiwan) were included. The ASRs of AS (5.4 vs. 2.8) and MPNST (2.0 vs. 1.0) were significantly higher in Taiwan; France had significantly higher ASRs for LPS (12.0 vs. 10.0), LMS (9.7 vs. 7.6), and SS (1.7 vs. 1.2). Patients in Taiwan with LMS or LPS were younger than their French counterparts. With regard to the distribution according to primary anatomic site, French patients had higher odds for extremity and truncal LMS (odds ratio [OR], 2.84; p < .001), AS (OR, 2.67; p < .001), MPNST (OR, 1.55; p = .027), and LPS (OR, 1.38; p < .001) and for breast AS (OR, 10.58; p < .001). Taiwanese patients had higher odds for liver AS (OR, 10.72; p < .001) and uterine LMS (OR, 3.21; p < .001). SS age and distribution according to primary anatomic site did not differ significantly between the French and Taiwanese populations. CONCLUSIONS Significant differences in the incidence and clinical characteristics of index STS suggested that geographic (environmental) and ethnicity factors likely play a vital role in the pathogenesis of STS.
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Affiliation(s)
- Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruru Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | - Alex Le Cesne
- Medical Oncology, Gustave Roussy Institute-Cancer Campus, Villejuif, France
| | - Yu-Chun Hsieh
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | | | - Ya-Wen Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | - Nicolas Penel
- General Oncology Department, Oscar Lambret Center, Lille, France
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | | | | | - Philippe Anract
- Department of Orthopedics, Assistance publique Hopitaux de Paris, Paris, France
| | - Nelly Firmin
- Montpellier Cancer Institute, Montpellier, France
| | - Florence Duffaud
- Medical Oncology, Greater Paris University Hospitals, Marseilles, France
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - K Arnold Chan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Gantzer J, Toulmonde M, Severac F, Chamseddine AN, Charon-Barra C, Bourgmayer A, Bertucci F, Ryckewaert T, Valentin T, Firmin N, Chaigneau L, Bompas E, Follana P, Rioux-Leclercq N, Bozec Lemoal L, Duffaud F, Schöffski P, Blay JY, Brahmi M, Malouf GG. PEC-PRO: A new prognostic score from a series of 93 patients with localized perivascular epithelioid cell neoplasms (PEComas) treated with curative intent. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11571] [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
11571 Background: Perivascular Epithelioid Cell Neoplasms (PEComas) encompass a heterogeneous family of mesenchymal tumors. The current understanding of their natural history is limited. Previously described clinicopathological factors aimed to define benign or malignant variants, but there is a lack of prognostic factors associated with recurrence of surgically resected tumors, preventing the development of a prognostic score to better optimize patient’s management. Methods: This is a retrospective analysis of clinicopathological features from patients diagnosed with a localized PEComa, within all centers from the French Sarcoma network and one center in Belgium. We analyzed 12 clinicopathological factors in a Cox proportional hazard framework to derive a multivariate prognostic risk model for progression-free survival (PFS). We built the PEComa PROgnostic score (PEC-PRO) ranging from 0 to 5, based on the coefficients of the multivariate model. Three different prognostic groups were identified: low risk (score = 0), intermediate risk (score = 1) and high risk (score ≥2). Results: Ninety-three patients were analyzed with a median follow-up of 46 months (range, 3-253). At diagnosis, the median age was 54 years (range, 13-84), with female predominance (72%). Most common primary locations were uterus (n = 15;16%) and kidney (n = 15;16%). Median tumor size was 6.2 cm (range, 0.8-30). Among patients with reported surgical margins, 64 (73%) and 23 (27%) had R0 and R1-2 margins, respectively. The median PFS was 26 months (IC95, 2.9-124.4), with 1- and 5-year overall survival (OS) rates of 95.7% and 69.9%, respectively, while the median OS was not reached. Using univariate analyses, male gender, primary tumor size > 5 cm, high nuclear grade and cellularity, high mitotic rate > 1/50 HPF, necrosis, vascular invasion, nodal invasion, and R1-2 margins were associated with a shorter PFS. Among those, male gender (HR = 2.88; IC95 1.12-7.411, p = 0.03), vascular invasion (HR = 3.14; IC95 1.10-8.96, p = 0.034), necrosis (HR = 3.93; IC95 1.35-11.47, p = 0.015), and R1-2 margins (HR 4.47; IC95 1.60-12.46, p = 0.007) remained associated with PFS in the multivariate analysis and were included in the multivariate model. Median PFS in patients with high PEC-PRO score was 16 months as compared to 104 months and not reached for patients with intermediate and low PEC-PRO scores, respectively (p < 0.001). We also confirmed the prognostic relevance of the PEC-PRO score in terms of OS. Conclusions: Using a weighted combination of clinicopathological features, the PEC-PRO score reliably predicts the post-operative recurrence risk in patients with localized PEComas. It has the potential to better improve follow-up strategies and personalize adjuvant treatments. The findings of this retrospective analysis require validation in a prospective trial.
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Affiliation(s)
| | - Maud Toulmonde
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
| | | | | | | | | | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | - Loic Chaigneau
- Institut Regional du Cancer en Franche-Comté-University Hospital, Besançon, France
| | | | - Philippe Follana
- GINECO and Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | | | - Patrick Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Gabriel G. Malouf
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France
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Brahmi M, Gautier J, Dufresne A, Marec-Berard P, Cropet C, Vizoso S, Bissuel L, Valentin T, Entz-Werle N, Bompas E, Toulmonde M, Kalbacher E, Duffaud F, Penel N, Mir O, Gantzer J, Boudou-Rouquette P, Firmin N, Ray-Coquard IL, Blay JY. REGOMAIN: A randomized, placebo-controlled, double-blinded, multicenter, comparative phase II study of the efficacy of regorafenib as maintenance treatment in patients (pts) with high-grade bone sarcomas (HGBS) at diagnosis or relapse and without complete remission after standard treatment. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps11585] [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
TPS11585 Background: Primary metastatic osteosarcoma (OS) patients are treated with a curative intent following the same principles of non-metastatic OS, while the treatment of recurrent OS is primarily surgical in the case of isolated lung metastases. When complete removal of all metastases cannot be achieved, the prognosis remains poor, with a median Progression-Free Survival (PFS) between 3 to 8 months, and therefore there is a clinical need to reduce the risk of progression after the initial treatment sequence. The REGOBONE study reported a significant PFS benefit of regorafenib (REG) compared to placebo (in osteosarcomas: median PFS: 16.4 versus 4.1 weeks) and a manageable safety profile in patients with histologically confirmed HGBS (i.e., osteosarcoma or other bone sarcomas with the exception of Ewing sarcomas, chondrosarcoma and chordoma). Methods: This multicenter trial is ongoing to study the efficacy and safety of maintenance REG in pts > = 16 years old with HGBS, without complete remission but with no progressive disease after standard treatment, either at diagnosis or at relapse. Sixty pts will be randomly allocated in a 1:1 ratio to receive either oral REG at a daily dose of 120mg or its matching placebo, continuously for a maximum of 12 months. Randomization is stratified according to the setting of the disease: initial diagnosis versus relapse. The primary objective is to compare the efficacy (PFS) between the 2 arms. The expected 4-month PFS rates are 30% in the control arm and 60% in the REGO arm (HR = 0.42). Fifty-two events will provide 87% power to show significant improvement in PFS, using a 2-sided log-rank test at a 5% level. Secondary endpoints include Overall Response Rate (ORR), Disease Control Rate (DCR), Time to Treatment Failure (TTF), Overall Survival (OS), Quality of Life (QoL), and safety profile. Radiological endpoints will be evaluated using the RECIST 1.1 with tumor assessments every 2 months (first 6 months) and then every 3 months. Translational objectives will identify predictive biomarkers for efficacy of REG as maintenance therapy. Pts of the control arm who experience disease progression may switch to receive open label REG. As of Feb 1st, 2022, 3 patients have been randomized. 14 sites of the French Sarcoma Group will participate. An amendment is being implemented to lower the age limit (12 years old) and to expand tumor types to other HGBS (Ewing sarcomas, chondrosarcomas, Undifferentiated Pleomorphic Sarcomas, Leiomyosarcomas and angiosarcomas). Clinical trial information: NCT04698785.
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Affiliation(s)
| | | | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Claire Cropet
- Unite de Biostatistique et d'Evaluation des Therapeutiques-Direction de la Recherche et d l'Innovation, Centre Leon Berard, Lyon, France
| | | | | | | | | | | | - Maud Toulmonde
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
| | - Elsa Kalbacher
- Groupe d’Investigateurs Nationaux pour l’Etute des Cancers Ovariens and CHRU Jean Minjoz, Besançon, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | - Pascaline Boudou-Rouquette
- AP-HP, Hôpital Cochin Port-Royal, Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Paris, France
| | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
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Sargos P, Sunyach MP, Ducassou A, Llacer C, Bellera CA, Michot A, Valentin T, Firmin N, Blay JY, Dinart D, Italiano A. Preliminary results of a phase IB study of olaparib with concomitant radiotherapy in locally advanced/unresectable soft-tissue sarcoma from the French Sarcoma Group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11522 Background: The poly(ADP-ribose) polymerase (PARP) inhibitor olaparib (O) has radiosensitizing properties in several tumor models including sarcomas. We studied safety and activity of O with external beam radiation therapy (EBRT) in patients with locally advanced soft-tissue sarcomas (STS). Methods: This phase I study first assessed four dose levels (DL1:25 mg, DL2:50 mg, DL3:100 mg, DL4:150 mg BID) of O administered in combination with EBRT (59.4 Gy in 33 fractions of 1.8 Gy) using a TITE-CRM design. Next, we recruited 15 additional patients in an expansion cohort to assess the tumor response or the histological response for patients with resectable disease. Tumor response was assessed by investigators according to RECIST 1.1 criteria. Results: A total of 41 patients (17 men, 24 women) were enrolled in both cohorts, of whom 19 (46.3%) underwent post-treatment surgery. We observed 1 DLT at DL1 (n = 5), 1 at DL2 (n = 7), 0 at DL3 (n = 11) and 1 at DL4 (n = 3) during the dose escalation. The recommended dose (RP2D) was 100 mg BID. Most common adverse events related to O and/or EBRT were acute dermatitis (G1/2 63.4% of patients, G3/4 34.1%), edema limbs (G1/2 36.6%), fatigue (G1/2 36.6%), nausea (G1/2 31.7%) and myositis (G1/2 29.3%). Among the 22 patients assessed for tumor response, 3 unconfirmed partial responses, 12 stable diseases, 5 progressive diseases, and 2 non-evaluable responses were recorded as best overall responses. The 6-month non-progression rate in that population was 9.1% [95%CI 1.1%-29.2%]. Six (31.6%) good histological responses and 9 (47.4%) poor responses were observed on the 19 patients who underwent surgery (4 responses non-available). Conclusions: This study shows that the combination of O with EBRT is well tolerated and lead to encouraging downstaging. A little less than half of the population was able to benefit from surgery with positive results in more than 30% of the cases and the rest of the population showed a promising stability of the disease at 6 months. We are currently awaiting a minimum of one year follow-up for the expansion cohort to assess survival. Clinical trial information: NCT02787642.
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Affiliation(s)
| | | | | | - Carmen Llacer
- Institut du Cancer de Montpellier, Montpellier, France
| | - Carine A. Bellera
- Institut Bergonié, Clinical and Epidemiological Research Unit, Bordeaux, France
| | - Audrey Michot
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
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22
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Moreau-Bachelard C, Campion L, Toulmonde M, Le Cesne A, Brahmi M, Italiano A, Mir O, Piperno-Neumann S, Laurence V, Firmin N, Penel N, Duffaud F, Chevreau C, Bertucci F, Narciso B, Dubray-Longeras P, Delcambre C, Saada-Bouzid E, Boudou-Rouquette P, Soulie P, Perrin C, Blay JY, Bompas E. Patterns of care and outcomes of 417 patients with METAstatic SYNovial sarcoma (METASYN): real-life data from the French Sarcoma Group (FSG). ESMO Open 2022; 7:100402. [PMID: 35202953 PMCID: PMC9058906 DOI: 10.1016/j.esmoop.2022.100402] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
Background Synovial sarcoma (SS) occurs in both adult and pediatric patients. The primary aim of this study is to describe the outcomes, prognostic factors, and treatment of patients with metastatic SS within a nationwide cohort. Patients and methods All pediatric and adult patients with metastatic SS are registered in the French Sarcoma Group database. Data were collected from the national database https://conticabase.sarcomabcb.org/ up to March 2020. Descriptive and comparative analyses were conducted using SAS 9.4 and Stata Special Edition 16.1 software. Results Between January 1981 and December 2019, 417 patients with metastatic SS from 17 French sarcoma centers were included, including 64 (15.3%) under the age of 26 years. Median age was 42.5 years (range 9-87 years). The metastases were synchronous (cohort 1) or metachronous (cohort 2) in 18.9% (N = 79) and 81.1% (N = 338) patients, respectively. Median overall survival (OS) from the date of metastasis was 22.3 months (95% confidence interval 19.7-24.1 months). First-line chemotherapy without ifosfamide and/or doxorubicin was unfavorable for progression-free survival and OS (P < 0.001). Concerning cohort 1, young age, surgery of the primary tumor, and single metastatic site were independent favorable prognostic factors for OS. In cohort 2, surgery within an expert French Sarcoma Group center, absence of chemotherapy in the perioperative setting, the lungs as a single metastatic site, time to first metastasis >12 months, local therapy, and ifosfamide in the first metastatic line were independent favorable prognostic factors. Conclusions The outcome of patients with metastatic SS is influenced by local treatment, management in reference centers, and cytotoxic treatments given in the perioperative and metastatic setting. METASYN is the largest retrospective study on metastatic adult and pediatric SS. This study confirms that surgery remains the mainstay for improving OS in reference centers. METASYN emphasizes the importance of focal treatment of metastases for OS. This study offers real-life results in a metastatic setting and is a useful support for developing new strategies.
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Affiliation(s)
| | - L Campion
- ICO Centre René Gauducheau, Oncology, Nantes, France; CNRS, Inserm, CRCINA, Nantes, France
| | - M Toulmonde
- Institut Bergonié, Medical Oncology, Bordeaux, France
| | - A Le Cesne
- Department of Ambulatory Cancer Care & Sarcoma Group, Gustave Roussy, Villejuif, France
| | - M Brahmi
- Centre Leon Berard, Medical Oncology, Lyon, France
| | - A Italiano
- Institut Bergonié, Medical Oncology, Bordeaux, France
| | - O Mir
- Department of Ambulatory Cancer Care & Sarcoma Group, Gustave Roussy, Villejuif, France
| | | | - V Laurence
- Institut Curie, Medical Oncology, Paris, France
| | - N Firmin
- Department of Medical Oncology, ICM, INSERM U1194, IRCM, Université Montpellier, Montpellier, France
| | - N Penel
- Centre Oscar Lambret, Medical Oncology, Lille, France
| | - F Duffaud
- Hôpital De La Timone, Medical Oncology, Marseille, Aix Marseille Université, Marseille, France
| | - C Chevreau
- IUCT Oncopole, Oncology, Medical Toulouse, Toulouse, France
| | - F Bertucci
- Institut Paoli-Calmettes (IPC), Medical Oncology, Marseille, France
| | - B Narciso
- CHRU Bretonneau, Medical Oncology, Tours, France
| | | | - C Delcambre
- Centre François Baclesse, Medical Oncology, Caen, France
| | - E Saada-Bouzid
- Centre Antoine Lacassagne, Medical Oncology, Nice, France
| | | | - P Soulie
- ICO Centre Paul Pain, Medical Oncology, Angers, France
| | - C Perrin
- Centre Eugène Marquis, Medical Oncology, Rennes, France
| | - J Y Blay
- Centre Leon Berard, Medical Oncology, Lyon, France
| | - E Bompas
- ICO Centre René Gauducheau, Oncology, Nantes, France.
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23
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Leenhardt F, Fiteni F, Gauthier L, Alexandre M, Guiu S, Firmin N, Pouderoux S, Gautier C, Lossaint G, Payen A, Gongora C, Mbatchi L, Evrard A, Jacot W. Abstract P5-13-23: Pharmacokinetic determinants of palbociclib hematological toxicity. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-13-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction CDK4/6 inhibitors, such as palbociclib, are prescribed in association with hormonal therapy in metastatic breast cancer patients. In Phase II/III studies, high neutropenia occurred in more than one in two patients leading to significant dose reductions, palbociclib interruptions and additional hematological samplings. Like most oral targeted drug, therapeutic drug monitoring (TDM) may be of interest for monitoring plasma exposition and optimize their dosage. We evaluated the correlation of this toxicity with palbociclib pharmacokinetics (PK), and classical sources of PK variabilities. Materials and method This is an open-label biomarker study conducted in subjects with first-line ER+/HER2- metastatic breast cancer treated with a palbociclib-aromatase inhibitor association (NCT04025541). Primary endpoint was the correlation between palbociclib trough concentration (Ctrough) at day 15 of first cycle of treatment (D15C1) and incidence of grade 3/4 neutropenia, within the first two months of treatment. Secondary endpoints included the analysis of variables associated with grade 3/4 neutropenia, with D15C1 palbociclib Ctrough values, and correlations with genetic polymorphisms in selected genes involved in palbociclib PK. Co-medications were collected to assess drug-drug interactions (DDI) risk and the potential impact on palbociclib PK. Results 58 patients, with mean age of 62.9 years, were included and followed up for 1 year. Clinicopathological variables were classical for the setting. One third of the population was taking concurrently a CYP3A4 and/or Pgp inhibitor, and one fourth an anti-acid medication, drugs that may interact with palbociclib. High-grade neutropenia occurred in 67.2% of patients (70.7% all grade neutropenia). One third of patients required a dose reduction, mainly for hematological toxicity. The geometric median of palbociclib plasma Ctrough was 74.1 ng/ml (interquartile range 61.3 - 101.5). Other covariates influencing the PK of palbociclib were significant in the univariate analysis. Indeed, while age > 65.5 years old (median) and reduced renal function (< 88.5 ml/min, median) were correlated with increased palbociclib concentration (p=0.003 and p=0.017, respectively) in univariate analysis. In multivariate analysis, higher neutrophil counts at inclusion (HR=0.54 for each 109/L increase in neutrophils count, range 0.33 - 0.87, p=0.002) while higher (>74.1 ng/mL, HR 5.51, range 1.10 - 27.6, p=0.024) plasma concentration of palbociclib were the only 2 variables correlated with the incidence of neutropenia. PK of palbociclib is closely related to co-medications, with majored exposition in CYP3A4 inhibitor cohort (106 vs 71.3 ng/ml, p=0.031, HR 0.22) or reduced exposition in anti-acid cohort (72.2 vs 80 ng/ml, p= 0.016, HR -0.27). Lastly, the homozygote G/G allele of the NRI2 (PXR) variant (Rs10934498) was associated with reduced palbociclib concentration (p=0.031) in univariate analysis. Conclusion We have characterized PK/toxicity correlation of palbociclib, regarding high-grade neutropenia. D15C1 higher palbociclib Ctrough is associated with the occurrence of high-grade neutropenia. As drug-drug interaction appears to be the most relevant source of palbociclib Ctrough variability in our cohort, a special attention must be paid to comedications in this population of patients. This is the first prospective study which characterizes biomarkers of toxicity associated with palbociclib treatment. Therapeutic drug monitoring can be a tool to limit high grade toxicities under palbociclib.
Citation Format: Fanny Leenhardt, Frédéric Fiteni, Ludovic Gauthier, Marie Alexandre, Séverine Guiu, Nelly Firmin, Stéphane Pouderoux, Chloé Gautier, Gerald Lossaint, Alexandre Payen, Celine Gongora, Litaty Mbatchi, Alexandre Evrard, William Jacot. Pharmacokinetic determinants of palbociclib hematological toxicity [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 P5-13-23.
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Affiliation(s)
| | | | | | | | - Séverine Guiu
- Institut du Cancer de Montpellier, Montpellier, France
| | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | - Chloé Gautier
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Celine Gongora
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Montpellier, France
| | | | | | - William Jacot
- Institut du Cancer de Montpellier, Montpellier, France
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Carey LA, Zelnak A, Rugo HS, Dalenc F, Nanda R, Danso M, Saghatchian M, Kalinsky K, Firmin N, Ruiz-Borrego M, Favret A, Sun J, Schwartzberg L, Hilton C, Omene C, Young R, Hurvitz SA, Harting E, Phan S, Bardia A. Abstract P5-16-07: Assessment of sacituzumab govitecan (SG) in Black patients (pts) from the phase 3 ASCENT study in metastatic triple-negative breast cancer (mTNBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-16-07] [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: Black women have higher incidence rates of TNBC and may experience worse clinical outcomes compared with White women with TNBC, due to disparities, comorbidities, or differences in TNBC biology (Dietze EG, et al. Nat Rev Cancer. 2015;15:248-254). As a result, Black pts with TNBC may benefit from novel therapies to improve outcomes. SG is an antibody-drug conjugate composed of an anti-Trop-2 antibody coupled to the cytotoxic SN-38 payload via a proprietary, hydrolyzable linker. SG received FDA approval for pts with mTNBC who received ≥2 prior chemotherapies (at least 1 in the metastatic setting). The confirmatory phase 3 ASCENT study (NCT02574455) in pts treated in second line or greater (2L+) mTNBC setting demonstrated a significant survival benefit of SG over single-agent chemotherapy treatment of physician’s choice (TPC; median progression-free survival, [PFS]: 4.8 vs 1.7 mo, HR 0.43, P<0.001; median overall survival [OS]: 11.8 vs 6.9 mo, HR 0.51) in the full trial population, with a manageable safety profile. To better understand the clinical outcomes of Black pts in the ASCENT study, a subgroup analysis was performed. Methods: In ASCENT, pts with mTNBC refractory to or relapsing after ≥2 prior chemotherapies (at least 1 in the metastatic setting) were randomized 1:1 to receive SG (10 mg/kg IV on days 1 and 8, every 21 days) or TPC (capecitabine, eribulin, vinorelbine, or gemcitabine). Primary endpoint was PFS per RECIST 1.1 by independent review in brain metastases-negative pts. Secondary endpoints included OS, objective response rate (ORR), clinical benefit rate (CBR), and safety. Race was self-reported and a prespecified subgroup for efficacy analyses. In this subgroup analysis, efficacy outcomes were assessed in the full trial population (including pts with and without known brain metastases) of pts reporting Black race; safety was analyzed in pts who received ≥1 dose of study drug in this subgroup. Results: Of the 529 pts in the full trial population, 62 (12%) pts who received SG (n=28) or TPC (n=34) were Black pts (median age, 54 y [range, 32-75] with a median of 4 prior anticancer regimens [range, 2-10]; 2 pts (3%) were positive for BRCA1/2 mutations). Characteristics were generally balanced across treatment arms. Median duration of treatment was 5.3 vs 1.6 mo in the SG vs TPC arms, respectively. In this subgroup, median PFS was improved with SG vs TPC (5.4 vs 2.2 mo; HR, 0.44; 95% CI, 0.24-0.80; P=0.008) as were ORR (32% vs 6%; odds ratio, 7.6; 95% CI, 1.5-38.8; P=0.008) and CBR (43% vs 15%; odds ratio, 4.4; 95% CI, 1.3-14.6; P=0.014). Median OS was numerically longer with SG vs TPC (13.8 vs 8.5 mo; HR, 0.64; 95% CI, 0.34-1.19; P=0.159). The safety profile of SG in Black pts was similar to that of the full trial population. Key treatment-related adverse events (TRAEs) of grade ≥3 in this subgroup (SG vs TPC) were neutropenia (48% vs 42%), anemia (12% vs 6%), leukopenia (8% vs 16%), and febrile neutropenia (8% vs 3%). No pts in the SG arm discontinued due to TRAEs; 1 pt in the TPC (3%) arm discontinued due to TRAEs. There were no treatment-related deaths. Conclusions: While only 12% of pts in the ASCENT trial self-identified as Black, Black pts with pretreated mTNBC derived a similar clinical benefit from SG over TPC as seen in the full trial population, with a manageable safety profile. SG should be considered as a treatment option for pts with mTNBC in the 2L+ setting.
Citation Format: Lisa A. Carey, Amelia Zelnak, Hope S. Rugo, Florence Dalenc, Rita Nanda, Michael Danso, Mahasti Saghatchian, Kevin Kalinsky, Nelly Firmin, Manuel Ruiz-Borrego, Anne Favret, Jun Sun, Lee Schwartzberg, Christie Hilton, Coral Omene, Robyn Young, Sara A. Hurvitz, Eliza Harting, See Phan, Aditya Bardia. Assessment of sacituzumab govitecan (SG) in Black patients (pts) from the phase 3 ASCENT study in metastatic triple-negative breast cancer (mTNBC) [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 P5-16-07.
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Affiliation(s)
- Lisa A. Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | | | - Rita Nanda
- The University of Chicago Medical Center, Chicago, IL
| | | | | | | | - Nelly Firmin
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - Anne Favret
- Virginia Cancer Specialists, PC, Fairfax, VA
| | - Jun Sun
- Maryland Oncology Hematology – Clinton Office, Clinton, MD
| | | | | | - Coral Omene
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robyn Young
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | - Sara A. Hurvitz
- University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | - See Phan
- Gilead Sciences Inc., Foster City, CA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Bay JO, Bouleuc C, Firmin N, Gandemer V, Magne N, Orbach D, Penel N, Rodrigues M, Thiery-Vuillemin A, Wislez M, L'Allemain G, Sabatier R, Robert J. [A 2021 inventory in oncology news]. Bull Cancer 2021; 109:8-19. [PMID: 34980367 DOI: 10.1016/j.bulcan.2021.12.003] [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: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
Once again this year, the Editorial Board presents here a summary of the most important advances in treatment and patient care in oncology over the past year. Some of the most important results in breast and gynecological cancers (endometrium and cervix), lung, brain, urologic and digestive cancers. Are also presented progresses in hematological malignancies, pediatric oncology, and of course supportive care essential for our patients.
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Affiliation(s)
- Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique, adulte, UE7453 CHELTER, Inserm CIC-501, site Estaing, 63000 Clermont-Ferrand, France.
| | - Carole Bouleuc
- Sorbonne université, Paris, France; Institut Curie, département de soins de support, 26, rue d'Ulm, 75005 Paris, France
| | - Nelly Firmin
- ICM Montpellier, 208, avenue des apothicaires, 34298 Montpellier, France
| | - Virginie Gandemer
- CHU de Rennes, service d'hémato-oncologie pédiatrique, 35000 Rennes, France
| | - Nicolas Magne
- Department of Radiation, Lucien-Neuwirth Cancer Institute, Saint-Étienne, France; Department of Research and Teaching, Lucien-Neuwirth Cancer Centre, Saint-Étienne, France
| | - Daniel Orbach
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Nicolas Penel
- Université de Lille, centre Oscar-Lambret, Lille, France
| | - Manuel Rodrigues
- Institut Curie, PSL Research University, département d'oncologie médicale, INSERM U830, 26 rue d'Ulm, 75005 Paris, France
| | - Antoine Thiery-Vuillemin
- CHRU Jean-Minjoz, department of medical oncology, 25030 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France
| | - Marie Wislez
- Université de Paris, faculté de médecine, 75000 Paris, France; Centre de recherche des Cordeliers, Team « Inflammation, Complement and Cancer », Inserm, 75000 Paris, France; AP-HP Centre, hôpital Cochin, service de pneumologie, unité d'oncologie thoracique, 75000 Paris, France
| | - Gilles L'Allemain
- Institut biologie Valrose, université Côte d'Azur, Inserm U1091, CNRS 7277, 06108 Nice, France
| | - Renaud Sabatier
- Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille-Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Department of Medical Oncology, Aix-Marseille University, Inserm, Centre National de la Recherche Scientifique, Marseille, France
| | - Jacques Robert
- Université de Bordeaux, Inserm U1218, 33000 Bordeaux, France
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Boudou-Rouquette P, Martin E, Kempf E, Penel N, Toulmonde M, Bompas E, Duffaud F, Firmin N, Bertucci F, Kurtz JE, Chaigneau L, Isambert N, Saada-Bouzid E, Dubray-Longeras P, Larousserie F, Anract P, Chevreau C, Blay JY, Piperno-Neumann S. Rare bone sarcomas: A retrospective analysis of 145 adult patients from the French Sarcoma Group. Int J Cancer 2021; 150:825-836. [PMID: 34611903 DOI: 10.1002/ijc.33837] [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: 03/01/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022]
Abstract
The benefit of chemotherapy (CT) in rare bone sarcomas is not documented in prospective studies. Our retrospective study from the French sarcoma network for bone tumors ResOs was performed in adult patients (pts) from 1976 to 2014, with histologically verified diagnosis of leiomyosarcomas (LMS), undifferentiated pleomorphic sarcoma (UPS) or radiation-associated sarcomas of bone. The median follow-up was 4.7 years (95% CI: 3.7-6.5). Clinical features, treatment modalities and outcomes were recorded and analyzed from 145 pts (median age 53 years [range 20-87]). Site of disease was extremities (66%) or axial skeleton (34%), 111 (77%) presented with localized and potentially resectable disease. The most common histological subtypes were UPS (58%) and LMS (33%); 58% were high-grade tumors. Surgery was performed in 127 pts. In the 111 localized pts, 28 pts (25%) underwent upfront surgery or exclusive radiotherapy (RT; >50 Gy) without CT, whereas 83 pts (75%) received either neoadjuvant (n = 26) or adjuvant CT (n = 13) or both (n = 44). Neoadjuvant and adjuvant CT was mostly doxorubicin-based (95%/86%) and cisplatin-based (67%/63%). R0 resection was achieved in 59 pts, and a good histological response in 15 patients (25%). Adjuvant RT was performed in 24 (22%) pts. For the whole cohort (n = 145), the 5-year overall survival (OS) rate was 53% [42; 62]. In univariate analysis, age ≤ 60 was associated with a longer disease-free survival (DFS) (P = .0436). Neoadjuvant and adjuvant CT tended to be associated with better DFS (P = .056) with no significant impact on OS in this retrospective series.
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris, France.,AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, Toulouse, France.,Department of Biostatistics, IUCT Oncopole, Toulouse, France
| | - Emmanuelle Kempf
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - Nicolas Penel
- Clinical Research and Innovation Department, Head of the General Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - Florence Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille, France.,Department of Medical Oncology, Aix-Marseille Université (AMU), Marseille, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Strasbourg, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Institut Regional du Cancer en Franche-Comté-University Hospital, Besançon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Pascale Dubray-Longeras
- Department of Medical Oncology, Cellular Therapy and Clinic Hematology Unit for Adults, Clermont-Ferrand, France
| | - Frédérique Larousserie
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Pathology, Cochin Hospital, Paris, France.,Department of Pathology, Paris University, Paris, France
| | - Philippe Anract
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Orthopedic Surgery, Cochin Hospital, Paris, France.,Department of Orthopedic Surgery, Paris University, Paris, France
| | - Christine Chevreau
- Department of Medical Oncology, UCT-Oncopôle Institut Claudius Regaud, Toulouse, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, LYRICAN, Universite de Lyon, Lyon, France
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Lavit E, Aldea M, Piperno-Neumann S, Firmin N, Italiano A, Isambert N, Kurtz JE, Delcambre C, Lebrun V, Soibinet-Oudot P, Chevreau C, Bompas E, Le Maignan C, Boudou-Rouquette P, Le Cesne A, Mancini J, Blay JY, Duffaud F. Treatment of 120 adult osteosarcoma patients with metachronous and synchronous metastases: A retrospective series of the French Sarcoma Group. Int J Cancer 2021; 150:645-653. [PMID: 34562271 DOI: 10.1002/ijc.33823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Treatment options for metastatic osteosarcomas are scarce. Following failure of standard first line therapy, patients who relapse present a challenging treatment dilemma, and have a poor prognosis. Surgical removal of all metastases is essential. A retrospective analysis of patients with metastatic osteosarcomas was conducted in 15 French Sarcoma Group centers. From January 2009 to December 2018, we identified 120 adult patients; 36 with synchronous and 84 with metachronous metastases with 74 males and 46 females. Mean age was 30 years (18-53). Metastatic sites were lung, bone and other in 91, 11 and 24 patients, respectively. Mean time to first metachronous metastases was 22 months (4-97). All patients except 13 (10.8%) with metachronous metastases received a first line systemic treatment for relapse, and 39 patients (32.5%) were included in a clinical trial. Eighty-one patients (67.5%) had local treatment of distant metastases. Median progression free survival (PFS) and overall survival (OS) were 5.5 (95% CI 4.6-6.4) and 20.5 months (95% CI 13.2-27.7) respectively for the overall group. In multivariate analysis, more than five metastases, time to first metastases <24 months, were statistically significant negative prognostic factors for OS and PFS (P = .002, ≤.001 and P = .006, ≤.001, respectively). Surgery of metastases was associated with better prognosis on OS and PFS (P = .001 and .037, respectively). The presence of bone metastases was a negative prognostic factor on OS but not on PFS (P = .021). In reference sarcoma centers, relapsed osteosarcoma patients with more than one metastasis commonly receive more than one line of systemic therapy, and are included in clinical trial if available.
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Affiliation(s)
- Elise Lavit
- Department of Oncology, Hôpital La Timone, Marseille, France
| | | | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Jean-Emmanuel Kurtz
- Department of Onco-Hematology, University Hospital Strasbourg, Strasbourg, France
| | | | - Valérie Lebrun
- Department of Oncology, University Hospital Dupuytren, Limoges, France
| | | | | | | | | | | | | | - Julien Mancini
- Department of Oncology, Hôpital La Timone, Marseille, France.,Aix Marseille University, Inserm, IRD, SESSTIM, Marseille, France
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28
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Chen TW, Chang RJ, Le Cesne A, Hsieh YC, Italiano A, Yang YW, Penel N, Lee WC, Bompas E, Valentin T, Anract P, Firmin N, Duffaud F, Chan K, Blay JY. 1544P Soft tissue sarcoma (STS) incidences and clinical characteristics are significantly different between different geographic and ethnic populations. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.874] [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: 11/24/2022] Open
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29
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Viala M, Firmin N, Touraine C, Pouderoux S, Metge M, Rifai L, Romieu G, de Forges H, Roca L, Guiu S, D'Hondt V, Jacot W. Changes in vitamin D and calcium metabolism markers in patients undergoing adjuvant chemotherapy for breast cancer. BMC Cancer 2021; 21:815. [PMID: 34266398 PMCID: PMC8283899 DOI: 10.1186/s12885-021-08563-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/18/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Changes in calcium metabolism and calcium urinary excretion during chemotherapy have not been thoroughly assessed in patients with early breast cancer (EBC), a population who frequently present vitamin D insufficiency. As hypercalciuria is a classical contra-indication to vitamin D (VD) supplementation, this study evaluated changes in VD and calcium metabolism parameters in patients with EBC undergoing adjuvant chemotherapy (CT). METHODS In patients with EBC who received six cycles of adjuvant CT, VD and calcium parameters were monitored at inclusion, and then every 3 weeks, at each CT cycle initiation. The primary endpoint was the percentage of patients showing hypercalciuria during adjuvant CT (between Day 1, Cycle 1 [D1C1] and Day 1, Cycle 6 [D1C6]). RESULTS The primary endpoint could be evaluated in 82 patients. Most patients (n = 66, 80.5%) had VD insufficiency (< 30 ng/mL) at baseline. Hypercalciuria was detected in 29 patients (35.4%; 95% CI: 25.6-46.5) between D1C1 and D1C6, but was not clinically significant in any of the affected patients. The percentage of hypercalciuria events was not different between patients with sufficient and insufficient baseline VD levels (34.8% vs. 37.5%), and between patients who received or not VD supplementation (37.5% vs. 34.5%,). CONCLUSIONS This comprehensive study on VD and calcium parameter changes in patients with EBC during adjuvant chemotherapy shows that hypercalciuria is a frequent abnormality in this setting, although asymptomatic. Therefore, it should not be considered as a limitation for high dose VD supplementation in this population. TRIAL REGISTRATION EudraCT:2014-A01454-43 . Registered 29 august 2016.
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Affiliation(s)
- Marie Viala
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France.
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
- INSERM U1194 - IRCM, Montpellier, France
| | - Célia Touraine
- Biometrics Unit, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France
| | - Stéphane Pouderoux
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
| | - Manon Metge
- Clinical Research Center, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France
| | - Lobna Rifai
- Department of Clinical Research and Innovation, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France
| | - Gilles Romieu
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
| | - Hélène de Forges
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Lise Roca
- Biometrics Unit, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
- INSERM U1194 - IRCM, Montpellier, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
- INSERM U1194 - IRCM, Montpellier, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 avenue des Apothicaires, 34090, Montpellier, France
- INSERM U1194 - IRCM, Montpellier, France
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30
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Cissé MY, Pyrdziak S, Firmin N, Gayte L, Heuillet M, Bellvert F, Fuentes M, Delpech H, Riscal R, Arena G, Chibon F, Le Gellec S, Maran-Gonzalez A, Chateau MC, Theillet C, Carrere S, Portais JC, Le Cam L, Linares LK. Targeting MDM2-dependent serine metabolism as a therapeutic strategy for liposarcoma. Sci Transl Med 2021; 12:12/547/eaay2163. [PMID: 32522803 DOI: 10.1126/scitranslmed.aay2163] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
Well-differentiated and dedifferentiated liposarcomas (LPSs) are characterized by a systematic amplification of the MDM2 oncogene, which encodes a key negative regulator of the p53 pathway. The molecular mechanisms underlying MDM2 overexpression while sparing wild-type p53 in LPS remain poorly understood. Here, we show that the p53-independent metabolic functions of chromatin-bound MDM2 are exacerbated in LPS and mediate an addiction to serine metabolism that sustains nucleotide synthesis and tumor growth. Treatment of LPS cells with Nutlin-3A, a pharmacological inhibitor of the MDM2-p53 interaction, stabilized p53 but unexpectedly enhanced MDM2-mediated control of serine metabolism by increasing its recruitment to chromatin, likely explaining the poor clinical efficacy of this class of MDM2 inhibitors. In contrast, genetic or pharmacological inhibition of chromatin-bound MDM2 by SP141, a distinct MDM2 inhibitor triggering its degradation, or interfering with de novo serine synthesis, impaired LPS growth both in vitro and in clinically relevant patient-derived xenograft models. Our data indicate that targeting MDM2 functions in serine metabolism represents a potential therapeutic strategy for LPS.
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Affiliation(s)
- Madi Y Cissé
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Samuel Pyrdziak
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Nelly Firmin
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France.,Institut régional du Cancer Montpellier, Montpellier F-34298, France
| | - Laurie Gayte
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Maud Heuillet
- TBI, Université de Toulouse, CNRS, INRA, INSA, Toulouse F-31400, France.,MetaToul-MetaboHUB, National Infrastructure of Metabolomics and Fluxomics, Toulouse F-31077, France
| | - Floriant Bellvert
- TBI, Université de Toulouse, CNRS, INRA, INSA, Toulouse F-31400, France.,MetaToul-MetaboHUB, National Infrastructure of Metabolomics and Fluxomics, Toulouse F-31077, France
| | - Maryse Fuentes
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Hélène Delpech
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Romain Riscal
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Giuseppe Arena
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Frédéric Chibon
- INSERM UMR 1037, Centre de Recherche en Cancérologie de Toulouse, Université Paul Sabatier Toulouse-III, Toulouse F-31100, France
| | - Sophie Le Gellec
- INSERM UMR 1037, Centre de Recherche en Cancérologie de Toulouse, Université Paul Sabatier Toulouse-III, Toulouse F-31100, France.,Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse F-31100, France
| | | | | | - Charles Theillet
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Sébastien Carrere
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France.,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France.,Institut régional du Cancer Montpellier, Montpellier F-34298, France
| | - Jean-Charles Portais
- TBI, Université de Toulouse, CNRS, INRA, INSA, Toulouse F-31400, France.,MetaToul-MetaboHUB, National Infrastructure of Metabolomics and Fluxomics, Toulouse F-31077, France.,Université Paul Sabatier, Université de Toulouse, Toulouse F-31062, France
| | - Laurent Le Cam
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France. .,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
| | - Laetitia K Linares
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier F-34298, France. .,Equipe Labélisée par la Ligue contre le Cancer, Paris F-75013, France
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Leenhardt F, Gracia M, Perrin C, Muracciole-Bich C, Marion B, Roques C, Alexandre M, Firmin N, Pouderoux S, Mbatchi L, Gongora C, Jacot W, Evrard A. Abstract PS5-16: Impact of drug-drug interaction on palbociclib serum levels: Interest of therapeutic drug monitoring. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-16] [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: The CDK4/6 inhibitors palbociclib is prescribed in association with hormonal therapy for the management of metastatic breast cancer patients. Like most oral targeted drug, therapeutic drug monitoring may be used for personalize their dosage. Using a recently published dosing technique (LC-MS/MS), we aimed at evaluating the correlation between first-cycle palbociclib plasma exposition and co-medications in order to evaluate drug-drug interaction (DDI) impact under palbociclib treatment.Methods: This is an open-label phase 4 study conducted in female subjects with first-line metastatic breast cancer (NCT04025541) treated with a palbociclib-aromatase inhibitor association. Plasma concentration of palbociclib was assessed at 24 hours postdose (plasma trough concentration Ctrough) at day 15 of first cycle of treatment. A dedicated pharmacist consultation allowed the determination of clinical covariates of interest, such as weight, body surface area, ethnicity, food intake, co-medications use and DDI before Palbociclib initiation and retrospectively at the end of clinical trial. Patients were classified then according to their risk of DDI potentially leading to inhibition of CYP3A4 and/or P-glycoprotein and gastric pH increase by gastric acid-suppressive (GAS) agents (such as proton pump inhibitors, histamine H2-receptor blockers or alginic acid). Relevant drug known to have an inhibition of CYP3A4 and/or P-glycoprotein or pH-modification activity were checked in databases (e.g. DDI predictor®, Drugs.com®, Pubmed®). Results: To date, after Ctrough analysis of the 35 first cases, the geometric mean (± standard deviation [min-max]) of palbociclib plasma Ctrough was 79.5 ng/ml (± 26.1% [43.6 ng/mL - 133 ng/mL]) at day 15, similar to what reported in the PALOMA trials. No correlation between plasma concentration and body weight, body area or also age of the patients was found in our cohort. Regarding ethnicity, all the included patients were from Caucasian origin. 31% of patients (11/35) were identified of taking drugs that could cause DDI CYP3A4 and P-glycoprotein inhibition mediated (amlodipine n=3, simvastatin n=3, losartan n=2, fluconazole n=1, atorvastatin n=1, ivabradine n=1). These potential DDI interactions were associated with a significantly higher palbociclib concentration DDI subgroup (102 ng/mL vs 69 ng/mL) (p=0.000272) (Table 1). No CYP3A4 and/or P-glycoprotein inductor were reported in cohort. 1.4% of patients (5/35) were identified of taking GAS agents (pantoprazole n=2, ranitidine n=2, alginic acid n=1). We found a significantly reduction of palbociclib concentration (59.2 ng/mL vs 79.8 ng/mL) (p=0.048) in patients taking GAS medications (Table 1).
Conclusion : These preliminary results, in real-life settings, obtained with our recently-published HPLC-MS/MS method, give important information on palbociclib monitoring and pharmacokinetic variability. DDI appear to have a significant impact on palbociclib plasma exposure, GAS agents are already know to modified palbociclib absorption. Additional studies are needed to characterize palbociclib plasma concentration variations between patients, and their clinical impact on efficacy and safety. The study is ongoing and will evaluate additional potential clinical and biological impact of DDI on neutropenia occurrence, on a larger population of patients.
Table 1: Patients’ plasma palbociclib concentration (day 15 of cycle 1 of treatment).Plasma palbociclib concentrations (ng/ml), global cohort (n=35)Geometric mean (CV%) (min;max)79.5 (26.1%) (43.6;133)Plasma palbociclib concentrations (ng/ml), cohort with DDI CYP3A4 and P-gp mediated (n=11)Geometric mean (CV%)102 (24.3%)Plasma palbociclib concentrations (ng/ml), cohort without DDI CYP3A4 and P-gp mediated (n=24)Geometric mean (CV%)69 (19.8%)Plasma palbociclib concentrations (ng/ml), cohort with GAS treatment (n=5)Geometric mean (CV%)59.2 (15.9%)Plasma palbociclib concentrations (ng/ml), cohort without GAS treatment (n=30)Geometric mean (CV%)82.9 (26.1%)
Citation Format: Fanny Leenhardt, Matthieu Gracia, Catherine Perrin, Claudia Muracciole-Bich, Bénédicte Marion, Celine Roques, Marie Alexandre, Nelly Firmin, Stephane Pouderoux, Litaty Mbatchi, Celine Gongora, William Jacot, Alexandre Evrard. Impact of drug-drug interaction on palbociclib serum levels: Interest of therapeutic drug monitoring [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-16.
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Affiliation(s)
| | - Matthieu Gracia
- 2Institut de Recherche en Cancerologie de Montpellier, Montpellier, France
| | | | | | | | - Celine Roques
- 3Institut des Biomolécules Max Mousseron, Montpellier, France
| | | | - Nelly Firmin
- 1Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Celine Gongora
- 2Institut de Recherche en Cancerologie de Montpellier, Montpellier, France
| | - William Jacot
- 1Institut du Cancer de Montpellier, Montpellier, France
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Alhenc-Gelas M, Cabel L, Berger F, Delaloge S, Frenel JS, Levy C, Firmin N, Ladoire S, Desmoulins I, Heudel PE, Dalenc F, Loirat D, Dubot C, Vuagnat P, Deluche E, Mokdad-Adi M, Patsouris A, Annic J, Djerroudi L, Lavigne M, Pierga JY, Coppo P, Bidard FC. Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study. Breast Cancer Res 2021; 23:9. [PMID: 33468209 PMCID: PMC7814553 DOI: 10.1186/s13058-021-01386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA. METHODS Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records. RESULTS Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N = 39, 75%). ER+/HER2-, HER2+ and triple-negative phenotypes accounted for N = 33 (69%), N = 7 (15%) and N = 8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28 days (range 0-1035; Q1:10, Q3:186). Independent prognostic factors for early death (≤ 28 days) were PS > 2 (OR = 7.0 [1.6; 31.8]), elevated bilirubin (OR = 6.9 [1.1; 42.6]), haemoglobin < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]). CONCLUSIONS Breast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.
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Affiliation(s)
- Marion Alhenc-Gelas
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Institut de cancérologie de Montpellier INSERM U1194, Montpellier, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Toulouse, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Elise Deluche
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Meriem Mokdad-Adi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Josselin Annic
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Université de Paris, Paris, France
| | - Paul Coppo
- Reference Center for Thrombotic Microangiopathies (CNR-MAT), AP-HP.SU, INSERM UMRS, 1138, Paris, France.,Sorbonne University, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France. .,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France.
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Moreau-Bachelard C, Toulmonde M, Le Cesne A, Brahmi M, Italiano A, Mir O, Piperno-Neumann S, Laurence V, Firmin N, Chevreau C, Bertucci F, Narciso B, Dubray-Longeras P, Delcambre C, Saada-Bouzid E, Soulié P, Perrin C, Blay JY, Bompas E. 1636P METASYN: Patterns of care and outcomes of 387 METAstatic SYNovial sarcoma: Real-life data from the French Sarcoma Group (GSF/GETO). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1862] [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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Leenhardt F, Gracia M, Perrin C, Muracciole-Bich C, Marion B, Roques C, Alexandre M, Firmin N, Pouderoux S, Mbatchi L, Gongora C, Jacot W, Evrard A. Liquid chromatography-tandem mass spectrometric assay for the quantification of CDK4/6 inhibitors in human plasma in a clinical context of drug-drug interaction. J Pharm Biomed Anal 2020; 188:113438. [PMID: 32623316 DOI: 10.1016/j.jpba.2020.113438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
The CDK4/6 inhibitors palbociclib and ribociclib are kinase inhibitors used in association with hormonal therapy for the management of patients with metastatic breast cancer. Like most kinase inhibitors, therapeutic drug monitoring may be used for personalize their dosage. To this aim, we developed and validated a sensitive and specific HPLC-MS/MS method for palbociclib and ribociclib quantification in blood samples. We then quantified exposure to palbociclib (plasma trough concentration; Ctrough) in a real-life cohort of patients with locally invasive or metastatic breast cancer (n = 18) at day 15 of the first cycle of palbociclib treatment to characterize palbociclib concentration at steady state (Clinicaltrials.gov identifier NCT04025541, IdRCB n° 2018-A00064-51, 03/07/2018). The geometric mean (± standard deviation [min-max]) of palbociclib plasma Ctrough was 88.58 ng/mL (± 26.4 [46.5 ng/mL - 133 ng/mL]) at day 15. Some covariates, such as drug-drug interactions, could explain the concentration variations observed in our Caucasian cohort. These first results in real-life settings obtained with our HPLC-MS/MS method give important information on palbociclib monitoring and pharmacokinetic variability.
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Affiliation(s)
- Fanny Leenhardt
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Service Pharmacie, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France.
| | - Matthieu Gracia
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France
| | - Catherine Perrin
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | | | - Bénédicte Marion
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | - Celine Roques
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247-CNRS-UM-ENSCM, Montpellier, France
| | - Marie Alexandre
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Nelly Firmin
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Stephane Pouderoux
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Litaty Mbatchi
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, France
| | - Celine Gongora
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France
| | - William Jacot
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Alexandre Evrard
- Laboratoire de Pharmacocinétique, Université de Montpellier, Faculté de Pharmacie, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Montpellier, France; Laboratoire de Biochimie et Biologie moléculaire, Centre Hospitalier Universitaire Nîmes, France
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Neron M, Firmin N. ASO Author Reflections: How Far Should We Go in Local Management for a Localized Malignant Phyllodes Tumor of the Breast? Ann Surg Oncol 2020; 27:1828-1829. [DOI: 10.1245/s10434-020-08390-0] [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] [Received: 03/06/2020] [Indexed: 11/18/2022]
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Pons-Tostivint E, Kirova Y, Lusque A, Campone M, Geffrelot J, Rivera S, Mailliez A, Pasquier D, Madranges N, Firmin N, Crouzet A, Gonçalves A, Jankowski C, De La Motte Rouge T, Pouget N, De La Lande B, Mouttet-Boizat D, Ferrero JM, Uwer L, Eymard JC, Mouret-Reynier MA, Petit T, Courtinard C, Filleron T, Robain M, Dalenc F. Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis. Radiother Oncol 2020; 145:109-116. [DOI: 10.1016/j.radonc.2019.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
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Neron M, Sajous C, Thezenas S, Piperno-Neumann S, Reyal F, Laé M, Chakiba C, Michot A, Penel N, Honoré C, Owen C, Bertucci F, Salas S, Saada-Bouzid E, Valentin T, Bompas E, Brahmi M, Ray-Coquard I, Blay JY, Firmin N. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol 2020; 27:1818-1827. [PMID: 31989361 DOI: 10.1245/s10434-020-08217-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. PATIENTS AND METHODS We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. RESULTS Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p < 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. > 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS. CONCLUSIONS This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Christophe Sajous
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Audrey Michot
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Institut Oscar Lambret, Lille, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Clémentine Owen
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Salas
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
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Alexandre M, Maran-Gonzalez A, Viala M, Firmin N, D'Hondt V, Gutowski M, Bourgier C, Jacot W, Guiu S. Decision of Adjuvant Systemic Treatment in HR+ HER2- Early Invasive Breast Cancer: Which Biomarkers Could Help? Cancer Manag Res 2019; 11:10353-10373. [PMID: 31849525 PMCID: PMC6912012 DOI: 10.2147/cmar.s221676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/02/2019] [Accepted: 09/21/2019] [Indexed: 11/23/2022] Open
Abstract
The decision to administer adjuvant chemotherapy in treatment of early invasive breast cancer (EBC) is often complex, particularly for hormone receptor-positive (HR+) diseases, and current guidelines often classify these patients in an intermediate-risk group. Several biomarkers are currently available in this indication, in order to obtain additional and more accurate prognostic information compared to classic clinicopathological characteristics and guide the indication of adjuvant chemotherapy, optimizing the efficacy/toxicity ratio. We conducted a systematic review to evaluate the clinical validity and clinical utility of five biomarkers (uPA/PAI-1, OncotypeDX®, MammaPrint®, PAM50, and EndoPredict®) in HR+/HER2- EBC, whatever the nodal status. A total of 89 studies met the inclusion criteria. Even though data currently available confirm the clinical validity of these biomarkers, there is a lack of data regarding clinical utility for most of them. Prospective studies in well-defined populations are needed to integrate these biomarkers in a decision strategy.
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Affiliation(s)
- Marie Alexandre
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - Aurélie Maran-Gonzalez
- Department of Pathology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - Marie Viala
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.,INSERM U1194 - Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.,University of Montpellier, Montpellier,France
| | - Marian Gutowski
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - Céline Bourgier
- INSERM U1194 - Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.,Department of Radiation Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France
| | - William Jacot
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.,INSERM U1194 - Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.,University of Montpellier, Montpellier,France
| | - Séverine Guiu
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.,INSERM U1194 - Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.,University of Montpellier, Montpellier,France
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Neron M, Sajous C, Thezenas S, Piperno-Neumann S, Reyal F, Laé M, Chakiba C, Penel N, Ryckewaert T, Honoré C, Bertucci F, Monneur A, Salas S, Duffaud F, Saada-Bouzid E, Isambert N, Brahmi M, Ray-Coquard I, Blay JY, Firmin N. Impact of Metastasis Surgery and Alkylating-Agent-Based Chemotherapy on Outcomes of Metastatic Malignant Phyllodes Tumors: A Multicenter Retrospective Study. Ann Surg Oncol 2019; 27:1693-1699. [PMID: 31773519 DOI: 10.1245/s10434-019-08097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Metastatic phyllodes tumors have poor prognosis with median overall survival of 11.5 months. The objective of this study is to identify prognostic factors and the best options for management of metastatic malignant phyllode tumors (MMPTs). PATIENTS AND METHODS A multicentric retrospective study, including cases of MMPT from 10 sarcoma centers, was conducted. The primary end-point was overall survival (OS), and the secondary end-point was the clinical benefit of chemotherapy (CBCT) rate. RESULTS 51 MMPT patients were included. Median time from diagnosis to metastatic recurrence was 13 months. Management of MMPT consisted in surgery of the metastatic disease for 16 patients (31.3%), radiation therapy of the metastatic disease for 15 patients (31.9%), and chemotherapy for 37 patients (72.5%). Median follow-up was 62.1 months [95% confidence interval (CI) 31-80 months]. Median OS was 11.5 months (95% CI 7.5-18.7 months). On multivariate analysis, two or more metastatic sites [hazard ratio (HR) 2.81, 95% CI 1.27-6.19; p = 0.01] and surgery of metastasis (HR 0.33, 95% CI 0.14-0.78; p = 0.01) were independently associated with OS. The CBCT rate was 31.4% and 16.7% for the first and second lines. Polychemotherapy was not superior to single-agent therapy. Alkylating-agent-based chemotherapy, possibly associated with anthracyclines, was associated with a better CBCT rate than anthracyclines alone (p = 0.049). CONCLUSIONS The results of this study emphasize the impact of the number of metastatic sites on survival of MMPT patients and the leading role of metastasis surgery in MMPT management. If systemic therapy is used, it should include alkylating agents, which are associated with a better clinical benefit.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Christophe Sajous
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Audrey Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Salas
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du cancer Montpellier, Univ Montpellier, Montpellier, France
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Pedrono M, Mir O, Chaltiel L, Brahmi M, Italiano A, Decanter G, Rouquette PB, Ropars M, Bompas E, Firmin N, Isambert N, Valentin T, Duffaud F, Gantzer J, Thyss A, Guillemet C, Blay JY, Cesne AL, Chevreau C, Perrin C. Outcome of 98 patients with epithelioid sarcoma treated in curative intent: A retrospective study from the French Sarcoma Group (GSF-GETO). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.022] [Citation(s) in RCA: 1] [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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Saleh K, Carton M, Dieras V, Heudel PE, Brain E, Firmin N, Mailliez A, Patsouris A, Mouret Reynier M, Gonçalves A, Ferrero JM, Petit T, Levy C, Uwer L, Cottu P, Veron L, Deluche E, Savignoni A, Robain M, Delaloge S. Prognostic impact of body mass index (BMI) on overall survival in patients with metastatic breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.062] [Citation(s) in RCA: 1] [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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42
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Blay JY, Honoré C, Stoeckle E, Meeus P, Jafari M, Gouin F, Anract P, Ferron G, Rochwerger A, Ropars M, Carrere S, Marchal F, Sirveaux F, Di Marco A, Le Nail LR, Guiramand J, Vaz G, Machiavello JC, Marco O, Causeret S, Gimbergues P, Fiorenza F, Chaigneau L, Guillemin F, Guilloit JM, Dujardin F, Spano JP, Ruzic JC, Michot A, Soibinet P, Bompas E, Chevreau C, Duffaud F, Rios M, Perrin C, Firmin N, Bertucci F, Le Pechoux C, Le Loarer F, Collard O, Karanian-Philippe M, Brahmi M, Dufresne A, Dupré A, Ducimetière F, Giraud A, Pérol D, Toulmonde M, Ray-Coquard I, Italiano A, Le Cesne A, Penel N, Bonvalot S. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019; 30:1407. [PMID: 31168580 PMCID: PMC6683855 DOI: 10.1093/annonc/mdz170] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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43
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Blay JY, Honoré C, Stoeckle E, Meeus P, Jafari M, Gouin F, Anract P, Ferron G, Rochwerger A, Ropars M, Carrere S, Marchal F, Sirveaux F, Di Marco A, Le Nail LR, Guiramand J, Vaz G, Machiavello JC, Marco O, Causeret S, Gimbergues P, Fiorenza F, Chaigneau L, Guillemin F, Guilloit JM, Dujardin F, Spano JP, Ruzic JC, Michot A, Soibinet P, Bompas E, Chevreau C, Duffaud F, Rios M, Perrin C, Firmin N, Bertucci F, Le Pechoux C, Le Loarer F, Collard O, Karanian-Philippe M, Brahmi M, Dufresne A, Dupré A, Ducimetière F, Giraud A, Pérol D, Toulmonde M, Ray-Coquard I, Italiano A, Le Cesne A, Penel N, Bonvalot S. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019; 30:1143-1153. [PMID: 31081028 PMCID: PMC6637376 DOI: 10.1093/annonc/mdz124] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. PATIENTS AND METHODS Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). RESULTS Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS]. CONCLUSION This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
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Affiliation(s)
- J-Y Blay
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth.
| | - C Honoré
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - E Stoeckle
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - P Meeus
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Jafari
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - F Gouin
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth; Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - P Anract
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - G Ferron
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - A Rochwerger
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Ropars
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - S Carrere
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Marchal
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - F Sirveaux
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - A Di Marco
- Department of Surgical Oncology and Department of Medical Oncology, Centre Paul Strauss & CHU Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - L R Le Nail
- Department of Orthopedics, CHU de Tours, Tours
| | - J Guiramand
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - G Vaz
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - J-C Machiavello
- Department of Medical Oncology and Department of Surgical Oncology, Centre Antoine-Lacassagne, Nice
| | - O Marco
- Oncology Unit, Saint Louis Hospital, Paris
| | - S Causeret
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - P Gimbergues
- Department of Surgery, Centre Jean Perrin/ERTICa EA, Clermont-Ferrand
| | - F Fiorenza
- Department of Medical Oncology and Department of Surgical Oncology, CHU Limoges, Limoges
| | - L Chaigneau
- Medical Oncology Department, CHU Besancon, Besançon
| | - F Guillemin
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - J-M Guilloit
- Department of Surgical Oncology, Centre Francois Baclesse, Caen
| | - F Dujardin
- Department of Surgery, Centre Henri Becquerel, Rouen
| | - J-P Spano
- Medical Oncology Department, APHP La Pitié Salpetriere/Tenon/Bicetre, Paris
| | - J-C Ruzic
- Medical Oncology Department, CHU La Réunion, Saint-Pierre, La Réunion
| | - A Michot
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - P Soibinet
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - E Bompas
- Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - C Chevreau
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - F Duffaud
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Rios
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - C Perrin
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - N Firmin
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Bertucci
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - C Le Pechoux
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - F Le Loarer
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - O Collard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Karanian-Philippe
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Brahmi
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dufresne
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dupré
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - F Ducimetière
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Giraud
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - D Pérol
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Toulmonde
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - I Ray-Coquard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Italiano
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - N Penel
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - S Bonvalot
- Surgery Department, Institut Curie, Paris, France
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Basse C, Italiano A, Penel N, Mir O, Chemin C, Toulmonde M, Duffaud F, Le Cesne A, Chevreau C, Maynou C, Anract P, Gouin F, Rios M, Firmin N, Kurtz JE, Kerbrat P, Piperno-Neumann S, Bertucci F, Rosset P, Isambert N, Bompas E, Dubray-Longeras P, Fiorenza F, Le Maignan C, Chaigneau L, Thyss A, Bouché O, Eymard JC, Delcambre Lair C, Adam J, Karanian M, Lebbé C, Dupré A, Meeus P, Brahmi M, Dufresne A, Ducimetière F, Ray-Coquard I, Blay JY. Sarcomas in patients over 90: Natural history and treatment-A nationwide study over 6 years. Int J Cancer 2019; 145:2135-2143. [PMID: 30924137 PMCID: PMC6767526 DOI: 10.1002/ijc.32307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/15/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
Abstract
Soft tissue sarcomas (STS) are rare tumors accounting for less than 1% of human cancers. While the highest incidence of sarcomas is observed in elderly, this population is often excluded or poorly represented in clinical trials. The present study reports on clinicopathological presentation, and outcome of sarcoma patients over 90 recorded in the Netsarc.org French national database. NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor board (MDTB), funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB, second pathological review, and collection of sarcoma patient characteristics and follow‐up are collected in a database Information of patients registered from January 1, 2010, to December 31, 2016, in NETSARC were collected, analyzed and compared to the younger population. Patients with sarcomas aged >90 have almost exclusively sarcomas with complex genomics (92.0% vs. 66.3%), are less frequently metastatic (5.3% vs. 14·7%) at diagnosis, have more often superficial tumors (39.8% vs. 14.7%), as well as limbs and head and neck sites (75.2% vs. 38.7%) (all p < 0.001). Optimal diagnostic procedures and surgery were less frequently performed in patients over 90 (p < 0.001). These patients were less frequently operated in NETSARC centers, as compared to those of younger age groups including aged 80–90. However, local relapse‐free survival, metastatic relapse‐free survival and relapse‐free survival were not significantly different from those of younger patients, in the whole cohort, as well as in the subgroup of operated patients. As expected overall survival was worse in patients over 90 (p < 0.001). Patients over 90 who were not operated had worse overall survival than younger patients (9.9 vs. 27.3 months, p < 0.001). Patients with STS diagnosed after 90 have distinct clinicopathological features, but comparable relapse‐free survival, unless clinical practice guidelines recommendations are not applied. Standard management should be proposed to these patients if oncogeriatric status allows. What's new? While the highest incidence of soft‐tissue sarcoma (STS) is observed in the elderly, this population is often excluded or poorly represented in clinical trials. Therefore, little is known about the characteristics, treatment, and outcomes of STS in these patients. In this study, the authors analyzed numerous clinical characteristics of patients with sarcoma diagnosed at age 91 or older. They conclude that standard STS management and clinical practice guidelines should be followed for these patients if possible.
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Affiliation(s)
- Clémence Basse
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, CHRU, Lille, France
| | - Olivier Mir
- Department of Orthopedic and Traumatology Surgery, University Hospital, Lille, France
| | - Claire Chemin
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Florence Duffaud
- Department of Medical Oncology, Timone University Hospital, Marseille, France
| | - Axel Le Cesne
- Department of Medicine and Surgery, Gustave Roussy Cancer Campus, Paris, France
| | | | - Carlos Maynou
- Department of Medical Oncology, Centre Oscar Lambret, CHRU, Lille, France
| | - Philippe Anract
- Orthopaedic Department, Cochin University Hospital, Paris, France
| | - François Gouin
- Department of Orthopedic Surgery, Nantes University Hospital, Nantes, France
| | - Maria Rios
- Department of Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Nelly Firmin
- Department of Medicine, Val d'Aurelle Institute, Montpellier, France
| | - Jean-Emmanuel Kurtz
- Medical Oncology & Orthopedy Department, Strasbourg University Hospital, Rennes, France
| | | | | | - François Bertucci
- Département of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Philippe Rosset
- Department of Orthopedic and Traumatology Surgery, Tours University Hospital, Tours, France
| | | | - Emmanuelle Bompas
- Medical Oncology Department, René Gauducheau, Saint-Herblain, France
| | | | - Fabrice Fiorenza
- Department of Orthopedics Surgery and Traumatology, Limoges University Hospital, Limoges, France
| | - Christine Le Maignan
- Department of Dermatology and INSERM Unité 976, Saint Louis University Hospital, Paris, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Jean Minjoz University Hospital, Besançon, France
| | - Antoine Thyss
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Olivier Bouché
- Institut Jean Godinot & Reims University Hospital, Reims, France
| | | | | | - Julien Adam
- Department of Medical Oncology, Timone University Hospital, Marseille, France
| | - Marie Karanian
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Céleste Lebbé
- Department of Dermatology and INSERM Unité 976, Saint Louis University Hospital, Paris, France
| | - Aurélien Dupré
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Pierre Meeus
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Mehdi Brahmi
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Armelle Dufresne
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | | | | | - Jean-Yves Blay
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
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Jacot W, Firmin N, Touraine C, Pouderoux S, Viala M, Metge M, Rifai L, Romieu G, Roca L, Guiu S, D'Hondt V. Abstract P3-14-03: Changes in vitamin D and calcium metabolism markers in patients undergoing adjuvant chemotherapy for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-14-03] [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:Vitamin D (VitD) insufficiency affects the majority of patients with early breast cancer (EBC). Breast cancer treatment may lead to bone loss, due to premature ovarian failure or direct chemotherapy (CT) cytotoxic effects. These increase the risk of skeletal morbidity compared to women without breast cancer history. However, even if these evidences are well described, the evolution of calcium metabolism under CT is unknown in this population with a high cure rate. We report the evolution of VitD and calcium metabolism markers in patients undergoing adjuvant CT for EBC.
Material and methods: We evaluated the VitD and calcium parameters (blood calcium, phosphorus and parathormone [PTH] levels, urinary calcium excretion) in EBC patients treated with 6 cycles of adjuvant CT without high dose calcium and VitD treatment. Variables of interest were recorded at inclusion, then every 3 weeks, at each chemotherapy cycle initiation. Primary endpoint was the occurrence of a hypercalciuria during the course of adjuvant CT (between Day 1, Cycle 1 [D1C1] and Day 1, Cycle 6 [D1C6]).
Results: 82 patients were evaluable for the primary endpoint. The median age was 53 years (range 20-71). CT consisted of a sequential anthracyclines and taxane regimen in 96.3% of the cases. Eleven (26.8%) patients received adjuvant trastuzumab. Most patients (66, 80.5%) presented with baseline VitD insufficiency (<30 ng/mL). Median baseline VitD level was 20.65ng/mL (range 2.9-55). Nine patients (8 VitD insufficient, 1 VitD sufficient [calcium only]) received low-dose VitD and/or calcium supplementation during the CT cycles. No baseline clinical parameter was statistically predictive of a VitD baseline insufficiency, while baseline blood calcium level was statistically predictive of a VitD baseline insufficiency (p=0.051). 94% of the patients presented with VitD insufficiency at D1C6 (median VitD level 20ng/mL; 9-39). No case of hypercalcemia was recorded. 29 patients (35.4%; 95%CI: 25.6-46.5) developed hypercalciuria between D1C1 and D1C6, none clinically significant. This percentage was not significantly different between VitD insufficient patients and the others (34.8% vs. 37.5%), nor between supplemented and not supplemented patients (37.5% vs. 34.5%). In multivariate analysis, weight and BMI were significantly associated with the occurrence of a hypercalciuria, while a trend was detected for baseline VitD (p=0.085) and albumin blood level (p=0.072). Baseline PTH level was elevated in 12.7% of the VitD insufficient patients vs. none of the patients with a normal VitD level. These percentages increased to 52.5% and 50% respectively at D1C6.
Conclusions: We report here, to our knowledge, the first comprehensive study of the kinetics of VitD and calcium biomarkers during EBC adjuvant CT. This population appears highly VitD insufficient, with a compensatory elevation in blood PTH levels during the course of treatment. Hypercalciuria, while asymptomatic, is a highly prevalent abnormality in this setting, and must not be a limitation for high dose VitD supplementation.
Citation Format: Jacot W, Firmin N, Touraine C, Pouderoux S, Viala M, Metge M, Rifai L, Romieu G, Roca L, Guiu S, D'Hondt V. Changes in vitamin D and calcium metabolism markers in patients undergoing adjuvant chemotherapy for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-03.
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Affiliation(s)
- W Jacot
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - N Firmin
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - C Touraine
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - S Pouderoux
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - M Viala
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - M Metge
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - L Rifai
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - G Romieu
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - L Roca
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - S Guiu
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
| | - V D'Hondt
- ICM Val d'Aurelle, Montpellier, France; Montpellier University, Montpellier, France; INSERM U1194 – IRCM, Montpellier, France; Clinical Research Center, ICM Val d'Aurelle, Montpellier, France
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Darlix A, Hirtz C, Thezenas S, Maceski A, Gabelle A, Lopez-Crapez E, De Forges H, Firmin N, Guiu S, Jacot W, Lehmann S. The prognostic value of the Tau protein serum level in metastatic breast cancer patients and its correlation with brain metastases. BMC Cancer 2019; 19:110. [PMID: 30700265 PMCID: PMC6354387 DOI: 10.1186/s12885-019-5287-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/07/2019] [Indexed: 01/24/2023] Open
Abstract
Background Metastatic breast cancer (MBC) prognosis is variable, depending on several clinical and biological factors. A better prediction of a patient’s outcome could allow for a more accurate choice of treatments. The role of serum biomarkers in predicting outcome remains unclear in this setting. Tau, a microtubule-associated protein, is a neuronal marker that is also expressed in normal breast epithelial cells and cancer cells. Its tissue expression is associated with prognosis in MBC. However, the prognostic value of Tau serum levels in these patients is unknown. We aimed at evaluating the prognostic value of Tau (and other classical biomarkers) in MBC patients, and to assess its association with the presence of brain metastases (BM). Methods 244 MBC patients treated at our institution (2007–2015) were retrospectively selected. The usual MBC clinical and pathological variables were collected, altogether with CA15–3, CEA and HER2 extra-cellular domain (ECD) serum levels. Tau serum levels were measured with a novel immunoassay (digital ELISA) using Single Molecule Array (Simoa) technology. Overall survival (OS) was estimated with the Kaplan-Meier method. To investigate prognostic factors, a multivariate analysis was performed. Cut-offs were set using the Youden index method associated with receiver-operating characteristics (ROC) curves to evaluate the accuracy of biomarkers to identify patients with BM. Results With a median follow-up of 40.8 months, median OS was 15.5 months (95%CI 12.4–20.2). Elevated serum levels of Tau were independently associated with a poor outcome in the whole population as well as in patients with (n = 86) and without BM (n = 158). Median serum Tau levels tended to be higher in patients with BM (p = 0.23). In univariate analysis, patients with BM had an increased risk of serum Tau > 3.17 pg/mL (OR = 2.2, p = 0.049). In multivariate analysis, high values of Tau (OR = 3.98, p = 0.034) accurately identified patients with BM in our cohort. Conclusions Tau is a new biomarker of interest in MBC. Its serum level could represent an independent prognostic factor in these patients (both with and without BM). It also seems to be associated with the presence of BM. A validation of these results in an independent set of MBC patients is necessary to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12885-019-5287-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France.
| | - Christophe Hirtz
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Simon Thezenas
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Aleksandra Maceski
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Audrey Gabelle
- Memory Resources and Research Center, University of Montpellier MUSE, CHU Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Evelyne Lopez-Crapez
- Translational Research Unit, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Hélène De Forges
- Clinical Research Unit, Institut Régional du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Sylvain Lehmann
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
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Pons-Tostivint E, Kirova Y, Lusque A, Campone M, Geffrelot J, Mazouni C, Mailliez A, Pasquier D, Madranges N, Firmin N, Crouzet A, Gonçalves A, Jankowski C, De La Motte Rouge T, Pouget N, de La Lande B, Mouttet-Boizat D, Ferrero JM, Uwer L, Eymard JC, Mouret-Reynier MA, Petit T, Robain M, Filleron T, Cailliot C, Dalenc F. Survival Impact of Locoregional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancers in a Large Multicentric Cohort Study: A Propensity Score-Matched Analysis. Ann Surg Oncol 2018; 26:356-365. [DOI: 10.1245/s10434-018-6831-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 12/16/2022]
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Carrère S, Tetreau R, Honoré C, Tzanis D, Delhorme JB, Fau M, Decanter G, Llacer C, Firmin N, Stoeckle E, Meeus P, Ferron G, Cupissol D, Quénet F, Meunier B, Bonvalot S. [What is the best management for a spermatic cord sarcoma in 2018?]. Prog Urol 2018; 29:12-17. [PMID: 30340845 DOI: 10.1016/j.purol.2018.09.010] [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: 04/12/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022]
Abstract
Spermatic cord sarcomas are rare tumors for which the most important is the initial diagnostic procedure. They are frequently misdiagnosed after surgery for inguinal hernia, inguinal lymphadenectomy or testicular malignancy. Any clinical suspicion has to lead to perform imaging with MRI and a core needle biopsy in order to obtain an accurate preoperative diagnosis. Liposarcoma and leiomyosarcoma are the most common histological subtypes in elderly adults, rhabdomyosarcoma in children or in young adults. A CT scan will precede the treatment in order to look for distant metastasis and abdominal involvement. The therapeutic strategy as well as the surgical planning are then adapted to the histological, morphological and prognostic factors. Surgery is the cornerstone for the treatment of spermatic cord sarcoma. The minimum requirements for the surgical procedure are a wide excision of the tumor en bloc with radical orchidectomy, excision of the ipsilateral scrotum and high spermatic cord ligation. It could be enlarged to the anterior abdominal wall and adjacent organs some required a soft tissue flap. Spermatic cord sarcoma and trunk wall sarcoma have the same prognosis for which local recurrence could significantly decrease survival. Consequently, surgeon in charge with these tumors has to be familiar with soft tissue sarcoma and the management of these patients must be carried out under the supervision of a multidisciplinary team within the Netsarc network.
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Affiliation(s)
- S Carrère
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France.
| | - R Tetreau
- Service de radiologie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - C Honoré
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - D Tzanis
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - J-B Delhorme
- Service de chirurgie, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - M Fau
- Service de chirurgie, centre Alexis Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - G Decanter
- Service de chirurgie, centre Oscar Lambret, 3, rue Fréderic Combemale, 59000 Lille, France
| | - C Llacer
- Service de radiothérapie, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - N Firmin
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - E Stoeckle
- Service de chirurgie, insitut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène Jollio-Curie, 31059 Toulouse cedex 9, France
| | - D Cupissol
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - F Quénet
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - B Meunier
- Service de chirurgie, centre hospitalo-universitaire de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
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Blay JY, Toulmonde M, Penel N, Mir O, Chevreau C, Anract P, Bompas E, Rios M, Firmin N, Italiano A, Piperno-Neumann S, Kurtz JE, Duffaud F, Rosset P, Bertucci F, Perrin C, Chemin C, Ducimetiere F, Gouin F, Le Cesne A. Natural history of sarcomas and impact of reference centers in the nationwide NETSARC study on 35,784 patients (pts) from 2010 to 2017. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Griguolo G, Pouderoux S, Dieci MV, Jacot W, Bourgier C, Miglietta F, Firmin N, Conte P, Viala M, Guarneri V, Darlix A. Clinicopathological and Treatment-Associated Prognostic Factors in Patients with Breast Cancer Leptomeningeal Metastases in Relation to Tumor Biology. Oncologist 2018; 23:1289-1299. [PMID: 30120164 DOI: 10.1634/theoncologist.2018-0200] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/04/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is one of the solid tumors most commonly associated with leptomeningeal disease (LMD). LMD carries a devastating prognosis; however, disease presentation and prognostic factors are uncertain. SUBJECTS, MATERIALS, AND METHODS In order to describe patient characteristics, treatment patterns, and factors associated with survival in a contemporary multicentric cohort, 153 consecutive BC patients diagnosed with LMD at two European institutions (2002-2017) were included. Time to LMD and overall survival (OS) after LMD diagnosis were evaluated using the Kaplan-Meier method and Cox proportional hazards models. RESULTS Median age at LMD diagnosis was 58 years (25-84). Tumor phenotype distribution was as follows: hormone receptor (HR) positive (HR+)/human epidermal growth receptor 2 (HER2) negative 51.0%, triple-negative 15.0%, HR+/HER2 positive (HER2+) 13.1% and HR negative/HER2+ 7.2%. Most patients received active anticancer treatments (radiation therapy [RT] n = 42, systemic therapy n = 110, intrathecal treatment n = 103).Median OS was 3.9 months (95% confidence interval [CI] 2.4-5.5). Eastern Cooperative Oncology Group performance status (ECOG PS) >2, high white blood cells count, low glucose, and high protein in cerebrospinal fluid (CSF) were poor prognostic factors. Having received RT or systemic treatment was associated with better prognosis. In multivariate analysis, ECOG PS (hazard ratio 2.22, 95% CI 1.25-3.94), CSF glucose levels (hazard ratio 1.74, 95% CI 1.05-2.88), and having received systemic treatment (hazard ratio 0.17, 95% CI 0.09-0.32) were confirmed as independent prognostic factors. In HER2+ BC patients, having received systemic HER2-targeted therapy was the only factor maintaining independent prognostication (hazard ratio 0.12, 95% CI 0.02-0.67) in multivariate analysis. CONCLUSION Despite being limited by their retrospective nature, these results highlight the need for clinical trials in BC LMD, stratified on tumor biology. IMPLICATIONS FOR PRACTICE Leptomeningeal disease (LMD) is a devastating complication of breast cancer (BC), and its optimal therapy is still not defined. Here, patient characteristics, treatment patterns, and prognostic factors from a contemporary cohort of 153 BC-related LMD patients are reported. In multivariate analysis, Eastern Cooperative Oncology Group performance status, cerebrospinal fluid glucose levels, and having received systemic treatment were confirmed as independent prognostic factors in the overall population, whereas in human epidermal growth receptor 2 (HER2) positive BC patients, having received systemic HER2-targeted therapy was the only factor maintaining independent prognostication in multivariate analysis. These results highlight the need to consider stratification on tumor biology in the treatment of BC LMD.
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Affiliation(s)
- Gaia Griguolo
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stephane Pouderoux
- Departments of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Maria Vittoria Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - William Jacot
- Departments of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Céline Bourgier
- Radiation Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier INSERM U1194, Université de Montpellier, ICM, Montpellier, France
| | - Federica Miglietta
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nelly Firmin
- Departments of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Pierfranco Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Marie Viala
- Departments of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Amélie Darlix
- Departments of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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