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Muller M, Hammel P, Couvelard A, Védie AL, Cros J, Burnichon N, Hercent A, Sauvanet A, Richard S, de Mestier L. Pancreatic neuroendocrine tumors in French VHL mutation carriers: a multicentric retrospective study. J Clin Endocrinol Metab 2024:dgae310. [PMID: 38706378 DOI: 10.1210/clinem/dgae310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Von Hippel-Lindau disease (VHL) is a rare autosomal dominant hereditary cancer-predisposition syndrome caused by germline pathogenic variants (PV) in VHL gene. It is associated with a high penetrance of benign and malignant vascular tumors in multiples organs, including pancreatic neuroendocrine tumors (PanNETs), whose long-term natural history is ill-known. METHODS Patients with both documented germline PV in VHL gene and PanNETs included in the French PREDIR database between 1995 and 2022 were included. Primary endpoint was the proportion of patients with PanNET-related metastases and secondary endpoint was overall survival (OS). Genotype/phenotype correlations were studied. RESULTS We included 121 patients with 259 PanNETs. Median age at diagnosis was 38 years. Median follow-up was 89.5 months. PanNET surgical resection was performed in 51 patients. Overall, 29 patients (24%) had metastases (5 synchronous, 10 metachronous), with a higher risk in case of larger PanNET size (p=0.0089; best threshold 28 mm) and grade 2 PanNET (p=0.048), and a pejorative prognostic impact (p=0.043). Patients with PV in VHL exon 1 had larger PanNETs (p=0.018), more often metastatic disease (48% vs 11.5%; p < 0.001) and a trend toward shorter OS (p=0.16). CONCLUSION The risk of metastases associated to VHL-related PanNETs remains low (24%) but increases with tumor size >28 mm, higher grade and in case of PV located VHL exon 1. These data might help improving the management of these patients, who should be referred to an expert center.
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Affiliation(s)
- Marie Muller
- University of Lorraine, Department of Gastroenterology, Nancy University Hospital, Nancy, France
| | - Pascal Hammel
- University Paris-Saclay, Paul Brousse Hospital (AP-HP), Villejuif, France
| | - Anne Couvelard
- University Paris-Cité, Department of Pathology, Bichat Hospital (AP-HP), Paris, France
| | - Anne-Laure Védie
- University Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (AP-HP), Clichy, France
| | - Jérôme Cros
- University Paris-Cité, Department of Pathology, Bichat Hospital (AP-HP), Paris, France
| | - Nelly Burnichon
- University Paris Cité, Inserm, PARCC, F-75015 Paris, France
- Department of Tumor and Cancer Genomic Medicine, Federation of Genetics and Genomic Medicine, AP-HP Centre, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Agathe Hercent
- University Paris-Cité, Department of Genetics, Bichat Hospital (AP-HP), Paris, France
| | - Alain Sauvanet
- University Paris-Cité, Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital (AP-HP), Clichy, France
| | - Stéphane Richard
- Institut Gustave Roussy (GR), UMR 9019 CNRS/Univ. Paris-Saclay/GR/EPHE, Villejuif, France
| | - Louis de Mestier
- University Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (AP-HP), Clichy, France
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Rodriguez R, Cañeque T, Baron L, Müller S, Carmona A, Colombeau L, Versini A, Sabatier M, Sampaio J, Mishima E, Picard-Bernes A, Solier S, Zheng J, Proneth B, Thoidingjam L, Gaillet C, Grimaud L, Fraser C, Szylo K, Bonnet C, Charafe E, Ginestier C, Santofimia P, Dusetti N, Iovanna J, Sa Cunha A, Pittau G, Hammel P, Tzanis D, Bonvalot S, Watson S, Stockwell B, Conrad M, Ubellacker J. Activation of lysosomal iron triggers ferroptosis in cancer. Res Sq 2024:rs.3.rs-4165774. [PMID: 38659936 PMCID: PMC11042398 DOI: 10.21203/rs.3.rs-4165774/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Iron catalyses the oxidation of lipids in biological membranes and promotes a form of cell death referred to as ferroptosis1-3. Identifying where this chemistry takes place in the cell can inform the design of drugs capable of inducing or inhibiting ferroptosis in various disease-relevant settings. Whereas genetic approaches have revealed underlying mechanisms of lipid peroxide detoxification1,4,5, small molecules can provide unparalleled spatiotemporal control of the chemistry at work6. Here, we show that the ferroptosis inhibitor liproxstatin-1 (Lip-1) exerts a protective activity by inactivating iron in lysosomes. Based on this, we designed the bifunctional compound fentomycin that targets phospholipids at the plasma membrane and activates iron in lysosomes upon endocytosis, promoting oxidative degradation of phospholipids and ferroptosis. Fentomycin effectively kills primary sarcoma and pancreatic ductal adenocarcinoma cells. It acts as a lipolysis-targeting chimera (LIPTAC), preferentially targeting iron-rich CD44high cell-subpopulations7,8 associated with the metastatic disease and drug resistance9,10. Furthermore, we demonstrate that fentomycin also depletes CD44high cells in vivo and reduces intranodal tumour growth in an immunocompetent murine model of breast cancer metastasis. These data demonstrate that lysosomal iron triggers ferroptosis and that lysosomal iron redox chemistry can be exploited for therapeutic benefits.
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Affiliation(s)
| | | | | | - Sebastian Müller
- Institut Curie, CNRS, INSERM, PSL Research University, Equipe Labellisée Ligue Contre le Cancer
| | | | | | | | | | | | - Eikan Mishima
- Institute of Metabolism and Cell Death, Molecular Targets & Therapeutics Center, Helmholtz Munich, Neuherberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille, CRCM, Inserm, CNRS, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Juan Iovanna
- Centre de Recherche en cancerelogie de Marseille
| | | | | | | | | | | | | | | | - Marcus Conrad
- Institute of Metabolism and Cell Death, Molecular Targets & Therapeutics Center, Helmholtz Munich, Neuherberg, Germany
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Nicolle R, Bachet JB, Harlé A, Iovanna J, Hammel P, Rebours V, Turpin A, Ben Abdelghani M, Wei A, Mitry E, Lopez A, Biagi J, François E, Artru P, Lambert A, Renouf DJ, Monard L, Mauduit M, Dusetti N, Conroy T, Cros J. Prediction of Adjuvant Gemcitabine Sensitivity in Resectable Pancreatic Adenocarcinoma Using the GemPred RNA Signature: An Ancillary Study of the PRODIGE-24/CCTG PA6 Clinical Trial. J Clin Oncol 2024; 42:1067-1076. [PMID: 37963313 PMCID: PMC10950182 DOI: 10.1200/jco.22.02668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/02/2023] [Accepted: 09/07/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE GemPred, a transcriptomic signature predictive of the efficacy of adjuvant gemcitabine (GEM), was developed from cell lines and organoids and validated retrospectively. The phase III PRODIGE-24/CCTG PA6 trial has demonstrated the superiority of modified folinic acid, fluorouracil, irinotecan, and oxaliplatin (mFOLFIRINOX) over GEM as adjuvant therapy in patients with resected pancreatic ductal adenocarcinoma at the expense of higher toxicity. We evaluated the potential predictive value of GemPred in this population. PATIENTS AND METHODS Routine formalin-fixed paraffin-embedded surgical specimens of 350 patients were retrieved for RNA sequencing and GemPred prediction (167 in the GEM arm and 183 in the mFOLFIRINOX [mFFX] arm). Survival analyses were stratified by resection margins, lymph node status, and cancer antigen 19-9 level. RESULTS Eighty-nine patients' tumors (25.5%) were GemPred+ and were thus predicted to be gemcitabine-sensitive. In the GEM arm, GemPred+ patients (n = 50, 30%) had a significantly longer disease-free survival (DFS) than GemPred- patients (n = 117, 70%; median 27.3 v 10.2 months, hazard ratio [HR], 0.43 [95% CI, 0.29 to 0.65]; P < .001) and cancer-specific survival (CSS; median 68.4 v 28.6 months, HR, 0.42 [95% CI, 0.27 to 0.66]; P < .001). GemPred had no prognostic value in the mFFX arm. DFS and CSS were similar in GemPred+ patients who received adjuvant GEM and mFFX (median 27.3 v 24.0 months, and 68.4 v 51.4 months, respectively). The statistical interaction between GEM and GemPred+ status was significant for DFS (P = .008) and CSS (P = .004). GemPred+ patients had significantly more adverse events of grade ≥3 in the mFFX arm (76%) compared with those in the GEM arm (40%; P = .001). CONCLUSION This ancillary study of a phase III randomized trial demonstrates that among the quarter of patients with a GemPred-positive transcriptomic signature, survival was comparable with that of mFOLFIRINOX, whereas those receiving adjuvant gemcitabine had fewer adverse events.
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Affiliation(s)
- Rémy Nicolle
- Université Paris Cité, Centre de Recherche sur l'Inflammation (CRI), INSERM, U1149, CNRS, ERL 8252, F-75018, Paris, France
| | - Jean-Baptiste Bachet
- Service d'Hépato—Gastro—Entérologie, Hôpital Pitié Salpêtrière, Assistance Publique—Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Alexandre Harlé
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS UMR 7039 CRAN, Vandœuvre-lès-Nancy CEDEX, France
| | - Juan Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes; Parc Scientifique et Technologique de Luminy, Marseille, France
| | - Pascal Hammel
- Digestive and Medical Oncology, Paul Brousse Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Université of Paris Saclay, Villejuif, France
| | - Vinciane Rebours
- Université Paris Cité, Centre de Recherche sur l'Inflammation (CRI), INSERM, U1149, CNRS, ERL 8252, F-75018, Paris, France
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP, Clichy and Centre de Référence des Maladies Rares du Pancréas—PAncreaticRaresDISeases (PaRaDis), Paris, France
| | - Anthony Turpin
- Department of Oncology, Lille University Hospital; CNRS UMR9020, INSERM UMR1277, University of Lille, Institut Pasteur, Lille, France
| | | | - Alice Wei
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emmanuel Mitry
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Anthony Lopez
- Hepatogastroenterology Department, University Hospital, Nancy, France
| | - James Biagi
- Department of Oncology, Queen's University, Kingston, Canada
| | - Eric François
- Hepatogastroenterology department, Hôpital Jean-Mermoz, Lyon, France
| | - Pascal Artru
- Medical Oncology department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Aurélien Lambert
- Medical Oncology department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Daniel J. Renouf
- Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes; Parc Scientifique et Technologique de Luminy, Marseille, France
| | - Thierry Conroy
- Medical Oncology department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Jérome Cros
- Université Paris Cité, Centre de Recherche sur l'Inflammation (CRI), INSERM, U1149, CNRS, ERL 8252, F-75018, Paris, France
- Université Paris Cité, Department of Pathology, Beaujon/Bichat University Hospital (APHP), Clichy/Paris, France
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Hilmi M, Delaye M, Muzzolini M, Nicolle R, Cros J, Hammel P, Cardot-Ruffino V, Neuzillet C. The immunological landscape in pancreatic ductal adenocarcinoma and overcoming resistance to immunotherapy. Lancet Gastroenterol Hepatol 2023; 8:1129-1142. [PMID: 37866368 DOI: 10.1016/s2468-1253(23)00207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 10/24/2023]
Abstract
Pancreatic ductal adenocarcinoma is associated with a poor prognosis and there are few treatment options. The development of immunotherapy in pancreatic ductal adenocarcinoma has been difficult, and immune checkpoint inhibitors are only effective in a very small subset of patients. Most obstacles for treatment have been related to intertumoural and intratumoural heterogeneity, the composition of tumour stroma, and crosstalk with cancer cells. Improved molecular characterisation of pancreatic ductal adenocarcinoma and a better understanding of its microenvironment have paved the way for novel immunotherapy strategies, including the identification of predictive biomarkers, the development of rational combinations to optimise effectiveness, and the targeting of new mechanisms. Future immunotherapy strategies should consider individual characteristics to move beyond the traditional immune targets and circumvent the resistance to therapies that have been developed so far.
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Affiliation(s)
- Marc Hilmi
- Gastrointestinal Oncology, Medical Oncology Department, Institut Curie, Université Versailles Saint-Quentin-Université Paris-Saclay, Saint-Cloud, France; Molecular Oncology, PSL Research University, CNRS, UMR 144, Institut Curie, Paris, France
| | - Matthieu Delaye
- Gastrointestinal Oncology, Medical Oncology Department, Institut Curie, Université Versailles Saint-Quentin-Université Paris-Saclay, Saint-Cloud, France; Molecular Oncology, PSL Research University, CNRS, UMR 144, Institut Curie, Paris, France
| | - Milena Muzzolini
- Digestive Surgery Department, Ambroise Paré Hospital, APHP, Université Versailles Saint-Quentin-Université Paris-Saclay, Boulogne Billancourt, France
| | - Rémy Nicolle
- Université Paris Cité, Centre de Recherche sur l'Inflammation (CRI), INSERM, U1149, CNRS, ERL 8252, Paris, France
| | - Jérôme Cros
- Université Paris Cité, Pathology Department, Beaujon Hospital, FHU MOSAIC, AP-HP, Clichy, France
| | - Pascal Hammel
- Université Paris-Saclay, Department of Digestive and Medical Oncology, Paul-Brousse Hospital (APHP Sud), Villejuif, France
| | | | - Cindy Neuzillet
- Gastrointestinal Oncology, Medical Oncology Department, Institut Curie, Université Versailles Saint-Quentin-Université Paris-Saclay, Saint-Cloud, France; Molecular Oncology, PSL Research University, CNRS, UMR 144, Institut Curie, Paris, France.
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5
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Neuzillet C, Bouché O, Tournigand C, Chibaudel B, Bauguion L, Bengrine-Lefevre L, Lopez-Trabada Ataz D, Mabro M, Metges JP, Péré-Vergé D, Conroy T, Lièvre A, Andre M, Desseigne F, Goldwasser F, Henriques J, Anota A, Hammel P. Effect of Adapted Physical Activity in Patients With Advanced Pancreatic Cancer: The APACaP GERCOR Randomized Trial. J Natl Compr Canc Netw 2023; 21:1234-1242.e17. [PMID: 38081120 DOI: 10.6004/jnccn.2023.7065] [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: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The impact of adapted physical activity (APA) on health-related quality of life (HRQoL) in patients with advanced pancreatic ductal adenocarcinoma (aPDAC) is unknown. This study evaluated whether APA in addition to standard care improved HRQoL in patients who have aPDAC who are receiving first-line chemotherapy. PATIENTS AND METHODS Patients with locally advanced/metastatic PDAC and an ECOG performance status of 0 to 2 were randomized (1:1) to receive standard care (standard arm) or standard care plus a home-based 16-week APA program (APA arm). The primary objective was the effect of the APA program on 3 dimensions of the EORTC QLQ-C30: global health status, physical function, and fatigue at week 16 (W16), with a one-sided type I error of 0.017 for each dimension. The primary HRQoL analysis was performed in patients with available baseline and W16 scores for the dimensions (ie, the modified intention-to-treat population 1 [mITT1]), and secondary longitudinal HRQoL analyses using the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods were performed in the mITT1 population and in patients with baseline and at least one follow-up questionnaire (mITT2 population). A difference of ≥5 points was considered to be clinically relevant. RESULTS Of 326 included patients, 313 were randomized to the standard (n=157) or APA (n=156) arms. In the mITT1 population (n=172), the mean differences in global health status, physical function, and fatigue at W16 adjusted from baseline were -0.98 (SD, 23.9; P=.39), -2.08 (SD, 21.3; P=.26), and 4.16 (SD, 29.2; P=.17), respectively, showing a non-statistically significant benefit with APA. In the mITT2 population (n=259), APA was associated with statistically significant and clinically relevant improvement in 5 and 8 dimensions of the HRQoL in the longitudinal MMRM and TUDD analyses, respectively. CONCLUSIONS APA improved several dimensions of HRQoL in patients with aPDAC receiving first-line chemotherapy and standard care.
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Affiliation(s)
- Cindy Neuzillet
- GERCOR, Paris, France
- Department of Medical Oncology, Institut Curie - Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - Olivier Bouché
- Department of Digestive Oncology, Université de Reims Champagne-Ardenne, CHU Reims, Reims, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, University Paris Est Créteil, Créteil, France
| | - Benoist Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois Perret, France
| | - Lucile Bauguion
- Department of Hepato-Gastroenterology, Hospital Center Departmental Vendée, La Roche-sur-Yon, France
| | - Leïla Bengrine-Lefevre
- Department of Medical Oncology, Georges-François Leclerc Cancer Center, UNICANCER, Dijon, France
| | | | - May Mabro
- Department of Medical Oncology, Foch Hospital, Suresnes, France
| | | | - Denis Péré-Vergé
- Department of Hepato-Gastroenterology, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Astrid Lièvre
- Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France
| | - Morgan Andre
- Department of Gastroenterology, Centre Hospitalier Intercommunal Mont-de-Marsan-Pays des Sources, Mont de Marsan, France
| | | | - François Goldwasser
- Department of Medical Oncology, CARPEM, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Julie Henriques
- Unit of Methodology and Quality of Life in Oncology, Besançon University Hospital, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Amélie Anota
- Unit of Methodology and Quality of Life in Oncology, Besançon University Hospital, Besançon, France
- Department of Clinical Research and Innovation & Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Pascal Hammel
- GERCOR, Paris, France
- Department of Medical and Digestive Oncology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
- Department of Digestive and Medical Oncology, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Villejuif, France
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Golan T, Casolino R, Biankin AV, Hammel P, Whitaker KD, Hall MJ, Riegert-Johnson DL. Germline BRCA testing in pancreatic cancer: improving awareness, timing, turnaround, and uptake. Ther Adv Med Oncol 2023; 15:17588359231189127. [PMID: 37720496 PMCID: PMC10504836 DOI: 10.1177/17588359231189127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Prognosis is generally poor for patients with pancreatic ductal adenocarcinoma. However, patients with germline BRCA1 or BRCA2 mutations (gBRCAm) may benefit from first-line platinum-based chemotherapy and maintenance therapy with the poly(adenosine diphosphate-ribose) polymerase inhibitor olaparib following at least 16 weeks of first-line platinum-based chemotherapy without disease progression. Germline breast cancer gene (BRCA) testing is therefore important to ensure that patients receive the most effective treatment. In addition, testing for other DNA damage response gene mutations beyond gBRCAm may also guide treatment decisions. However, clinical pathways for genetic testing are often suboptimal, leading to delays in treatment initiation or missed opportunities for personalized therapy. Barriers to testing include low rates of referral and uptake, delays to referral and slow result turnaround times, cost, and biopsy and assay limitations if somatic testing is performed, leading to the requirement for subsequent dedicated germline testing. Low rates of referral may result from lack of awareness among physicians of the clinical value of testing, coupled with low confidence in interpreting test results and poor availability of genetic counseling services. Among patients, barriers to uptake may include similar lack of awareness of the clinical value of testing, anxiety regarding the implications of test results, lack of insurance coverage, fear of negative insurance implications, and socioeconomic factors. Potential solutions include innovative approaches to testing pathways, including 'mainstreaming' of testing in which BRCA tests are routinely arranged by the treating oncologist, with the involvement of genetic counselors if a patient is found to have a gBRCAm. More recently, the utility of multigene panel analyses has also been explored. Access to genetic counseling may also be improved through initiatives such as having a genetic counseling appointment for all new patient visits and telemedicine approaches, including the use of telephone consultations or DVD-assisted counseling. Educational programs will also be beneficial, and cost effectiveness is likely to improve as the number of targeted treatments increases and when the earlier detection of tumors in family members following cascade testing is considered.
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Affiliation(s)
- Talia Golan
- Institute of Oncology, Sheba Medical Center, Tel Hashomer 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Andrew V. Biankin
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, Australia
| | - Pascal Hammel
- Department of Digestive and Medical Oncology, University Paris-Saclay, Paul Brousse Hospital (AP-HP), Villejuif, France
| | - Kristen D. Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael J. Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
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Hautefeuille V, Walter T, Do Cao C, Coriat R, Dominguez S, Mineur L, Cadiot G, Terrebonne E, Sobhani I, Gueguen D, Houchard A, Mouawad C, Anota A, Hammel P. OPERA: perception of information in patients with gastroenteropancreatic neuroendocrine tumors on lanreotide autogel. Eur J Endocrinol 2023; 189:281-289. [PMID: 37542470 DOI: 10.1093/ejendo/lvad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023]
Abstract
IMPORTANCE Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) can affect patient health-related quality of life (HRQoL). Appropriate information may improve their adherence to treatment and quality of life. OBJECTIVE To evaluate the change in patient's perceptions of the level of information at lanreotide (LAN) treatment initiation for GEP-NETs vs after 6 months. DESIGN OPERA (NCT03562091) was a prospective, longitudinal, noninterventional study. SETTING Thirty-one centers in France specialized in the management of patients with NETs. INTERVENTION Planned clinical visits at enrollment and end-of-study visits at month 6, with completion of the European Organisation for Research and Treatment of Cancer 25-item Quality of Life Questionnaire-Information Module (QLQ-INFO25) and 30-item Quality of Life Questionnaire-Core. MAIN OUTCOME Absolute change in the patient's perception of the information between baseline and month 6, using the relevant domains of the QLQ-INFO25. Endpoints measured at baseline and month 6 for at least 1 of the 3 targeted QLQ-INFO25 dimensions of the primary endpoint. RESULTS Ninety-three of the 115 patients enrolled completed ≥1 primary endpoint information dimension. Mean (SD) scores for the primary endpoint information dimensions were high at baseline (disease, 63.41 [20.71]; treatment, 58.85 [19.00]; supportive care, 26.53 [24.69]; maximum 100). There were no significant changes between baseline (98.34% CI) and 6 months (disease, -2.84 [-8.69, 3.01; P = .24]; treatment, -4.37 [-11.26, 2.52; P = .13]; supportive care, 0.46 [-6.78, 7.70; P = .88]), and in HRQoL between baseline and 6 months. CONCLUSIONS AND RELEVANCE The lack of change in patient's perceptions of the disease, treatment, and supportive care information provided over the first 6 months of LAN treatment may suggest that physicians provided adequate information at the treatment initiation.
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Affiliation(s)
| | | | | | - Romain Coriat
- Hôpital Cochin, GH AP-HP Centre-University Paris Cite, Paris, France
| | - Sophie Dominguez
- Hemato-Oncology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | | | | | | | | | | | | | | | | | - Pascal Hammel
- Paul Brousse Hospital APHP, University Paris-Saclay, Villejuif, France
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Vienot A, Jacquin M, Rebucci-Peixoto M, Pureur D, Ghiringhelli F, Assenat E, Hammel P, Rosmorduc O, Stouvenot M, Allaire M, Bouattour M, Regnault H, Fratte S, Raymond E, Soularue E, Husson-Wetzel S, Di Martino V, Muller A, Clairet AL, Fagnoni-Legat C, Adotevi O, Meurisse A, Vernerey D, Borg C. Evaluation of the interest to combine a CD4 Th1-inducer cancer vaccine derived from telomerase and atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma: a randomized non-comparative phase II study (TERTIO - PRODIGE 82). BMC Cancer 2023; 23:710. [PMID: 37516867 PMCID: PMC10387199 DOI: 10.1186/s12885-023-11065-0] [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: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Several cancer immunotherapies that target the PD-L1/PD-1 pathway show promising clinical activity in patients with hepatocellular carcinoma (HCC). However, the standard of care in first-line treatment with atezolizumab (anti-PD-L1 therapy) in combination with bevacizumab is associated with a limited objective response rate. Telomerase reverse transcriptase (TERT) activation meets the criteria of oncogenic addiction in HCC and could be actionable therapeutic target and a relevant tumor antigen. Therefore we hypothesized that combining anti-PD-1/PD-L1 therapy with an anti-telomerase vaccine might be an attractive therapy in HCC. UCPVax is a therapeutic cancer vaccine composed of two separate peptides derived from telomerase (human TERT). UCPVax has been evaluated in a multicenter phase I/II study in non-small cell lung cancers and has demonstrated to be safe and immunogenic, and is under evaluation in combination with atezolizumab in a phase II clinical trial in tumors where telomerase reactivation contributes to an oncogene addiction (HPV+ cancers). The aim of the TERTIO study is to determine the clinical interest and immunological efficacy of a treatment combining the CD4 helper T-inducer cancer anti-telomerase vaccine (UCPVax) with atezolizumab and bevacizumab in unresectable HCC in a multicenter randomized phase II study. METHODS Patients with locally advanced, metastatic or unresectable HCC who have not previously received systemic anti-cancer treatment are eligible. The primary end point is the objective response rate at 6 months. Patients will be allocated to a treatment arm with a randomization 2:1. In both arms, patients will receive atezolizumab at fixed dose of 1200 mg IV infusion and bevacizumab at fixed dose of 15 mg/kg IV infusion, every 3 weeks, according to the standard of care. In the experimental arm, these treatments will be combined with the UCPVax vaccine at 0.5 mg subcutaneously. DISCUSSION Combining anti-PD-1/PD-L1 therapy with an anti-telomerase vaccine gains serious consideration in HCC, in order to extend the clinical efficacy of anti-PD-1/PD-L1. Indeed, anti-cancer vaccines can induce tumor-specific T cell expansion and activation and therefore restore the cancer-immunity cycle in patients lacking pre-existing anti-tumor responses. Thus, there is a strong rational to combine immune checkpoint blockade therapy and anticancer vaccine (UCPVax) in order to activate antitumor T cell immunity and bypass the immunosuppression in the tumor microenvironment in HCC. This pivotal proof of concept study will evaluate the efficacy and safety of the combination of a CD4 Th1-inducer cancer vaccine derived from telomerase (UCPVax) and atezolizumab plus bevacizumab in unresectable HCC, as well as confirming their synergic mechanism, and settling the basis for a new combination for future clinical trials. TRIAL REGISTRATION NCT05528952.
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Affiliation(s)
- Angélique Vienot
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France.
- Clinical Investigational Center, CIC-1431, Besançon, France.
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France.
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France.
| | - Marion Jacquin
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Clinical Investigational Center, CIC-1431, Besançon, France
| | - Magali Rebucci-Peixoto
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Clinical Investigational Center, CIC-1431, Besançon, France
| | - Dimitri Pureur
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Georges François Leclerc Cancer Center-UNICANCER, Dijon, France
| | - Eric Assenat
- Department of Medical Oncology, Saint Eloi Hospital, University Hospital, Montpellier of Montpellier, France
| | - Pascal Hammel
- Department of Digestive and Medical Oncology, Paul-Brousse Hospital, Villejuif, France
| | - Olivier Rosmorduc
- Department of Hepato-Biliary, Paul-Brousse Hospital, Villejuif, France
| | - Morgane Stouvenot
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Manon Allaire
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France
| | | | - Hélène Regnault
- Department of Gastroenterology and Hepatology, Henri Mondor Hospital, Creteil, France
| | - Serge Fratte
- Department of Gastroenterology, Nord Franche Comté Hospital, Montbéliard, France
| | - Eric Raymond
- Department of Medical Oncology, Paris Saint-Joseph Hospital, Paris, France
| | - Emilie Soularue
- Department of Medical Oncology, Institute Mutualiste Montsouris, Paris, France
| | - Stéphanie Husson-Wetzel
- Department of Gastroenterology, Groupe Hospitalier de La Région Mulhouse Sud Alsace, Mulhouse, France
| | - Vincent Di Martino
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Allison Muller
- Department of Clinical Research and Innovation, Vigilance Unit, University Hospital of Besançon, Besançon, France
| | - Anne-Laure Clairet
- Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | | | - Olivier Adotevi
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Clinical Investigational Center, CIC-1431, Besançon, France
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
| | - Aurélia Meurisse
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Dewi Vernerey
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
- Clinical Investigational Center, CIC-1431, Besançon, France
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
- Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR) Oncology Multidisciplinary Group, Paris, France
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Saillard C, Delecourt F, Schmauch B, Moindrot O, Svrcek M, Bardier-Dupas A, Emile JF, Ayadi M, Rebours V, de Mestier L, Hammel P, Neuzillet C, Bachet JB, Iovanna J, Dusetti N, Blum Y, Richard M, Kermezli Y, Paradis V, Zaslavskiy M, Courtiol P, Kamoun A, Nicolle R, Cros J. Pacpaint: a histology-based deep learning model uncovers the extensive intratumor molecular heterogeneity of pancreatic adenocarcinoma. Nat Commun 2023; 14:3459. [PMID: 37311751 DOI: 10.1038/s41467-023-39026-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Two tumor (Classical/Basal) and stroma (Inactive/active) subtypes of Pancreatic adenocarcinoma (PDAC) with prognostic and theragnostic implications have been described. These molecular subtypes were defined by RNAseq, a costly technique sensitive to sample quality and cellularity, not used in routine practice. To allow rapid PDAC molecular subtyping and study PDAC heterogeneity, we develop PACpAInt, a multi-step deep learning model. PACpAInt is trained on a multicentric cohort (n = 202) and validated on 4 independent cohorts including biopsies (surgical cohorts n = 148; 97; 126 / biopsy cohort n = 25), all with transcriptomic data (n = 598) to predict tumor tissue, tumor cells from stroma, and their transcriptomic molecular subtypes, either at the whole slide or tile level (112 µm squares). PACpAInt correctly predicts tumor subtypes at the whole slide level on surgical and biopsies specimens and independently predicts survival. PACpAInt highlights the presence of a minor aggressive Basal contingent that negatively impacts survival in 39% of RNA-defined classical cases. Tile-level analysis ( > 6 millions) redefines PDAC microheterogeneity showing codependencies in the distribution of tumor and stroma subtypes, and demonstrates that, in addition to the Classical and Basal tumors, there are Hybrid tumors that combine the latter subtypes, and Intermediate tumors that may represent a transition state during PDAC evolution.
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Affiliation(s)
| | - Flore Delecourt
- Université Paris Cité, Dpt of Pathology - FHU MOSAIC, Beaujon Hospital, INSERM U1149, Clichy, France
| | | | | | - Magali Svrcek
- Dpt of Pathology, Saint-Antoine Hospital - Sorbonne Universités, Paris, France
| | | | - Jean Francois Emile
- Dpt of Pathology, Ambroise Paré Hospital - Université Saint Quentin en Yvelines, Paris, France
| | - Mira Ayadi
- Integragen, Genomic Services & Precision Medicine, Paris, France
| | - Vinciane Rebours
- Université Paris Cité, Dpt of Pancreatology - FHU MOSAIC, Beaujon Hospital, INSERM U1149, Clichy, France
| | - Louis de Mestier
- Université Paris Cité, Dpt of Pancreatology - FHU MOSAIC, Beaujon Hospital, INSERM U1149, Clichy, France
| | - Pascal Hammel
- Dpt of Medical oncology, Paul Brousse Hospital, Villejuif, France
| | | | - Jean Baptiste Bachet
- Dpt of Gastroenterology, Pitié-Salpêtrière Hospital - Sorbonne Universités, Paris, France
| | - Juan Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, Institut Paoli-Calmettes, Aix Marseille Université, CNRS UMR 7258, Marseille, France
| | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, Institut Paoli-Calmettes, Aix Marseille Université, CNRS UMR 7258, Marseille, France
| | - Yuna Blum
- Institut Génétique et Développement de Rennes (IGDR), CNRS, Université de Rennes 1, UMR 6290, Rennes, France
| | - Magali Richard
- Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble (TIMC-IMAG), CNRS, Université Grenoble-Alpes, UMR5525, Grenoble, France
| | - Yasmina Kermezli
- Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble (TIMC-IMAG), CNRS, Université Grenoble-Alpes, UMR5525, Grenoble, France
| | - Valerie Paradis
- Université Paris Cité, Dpt of Pathology - FHU MOSAIC, Beaujon Hospital, INSERM U1149, Clichy, France
| | | | | | | | - Remy Nicolle
- Université Paris Cité, FHU MOSAIC, Centre de Recherche sur l'Inflammation (CRI), INSERM, U1149, CNRS, ERL 8252, F-75018, Paris, France
| | - Jerome Cros
- Université Paris Cité, Dpt of Pathology - FHU MOSAIC, Beaujon Hospital, INSERM U1149, Clichy, France.
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10
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Bouchahda M, Ulusakarya A, Thirot-Bidault A, Attari A, Bossevot R, Tuligenga R, Hammel P, Adam R, Levi F. Multicentre, interventional, single-arm study protocol of telemonitored circadian rhythms and patient-reported outcomes for improving mFOLFIRINOX safety in patients with pancreatic cancer (MultiDom, NCT04263948). BMJ Open 2023; 13:e069973. [PMID: 37286324 DOI: 10.1136/bmjopen-2022-069973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Circadian clocks regulate cellular proliferation and drug effects. Tolerability and/or efficacy of anticancer therapies have been improved by their administration according to circadian rhythms, while being predicted by circadian robustness. The combination of leucovorin, fluorouracil, irinotecan and oxaliplatin (mFOLFIRINOX) is a standard treatment for pancreatic ductal adenocarcinoma (PDAC), that generates grades 3-4 adverse events in the majority of patients and an estimated 15%-30% emergency admission rate. The MultiDom study evaluates whether mFOLFIRINOX safety can be improved using a novel circadian-based telemonitoring-telecare platform in patients at home. The detection of early warning signals of clinical toxicities could guide their early management, possibly preventing emergency hospital admissions. METHODS AND ANALYSIS This multicentre, interventional, prospective, longitudinal, single-arm study hypothesises that the mFOLFIRINOX-related emergency admission rate will be 5% (95% CI 1.7% to 13.7%), among 67 patients with advanced PDAC. Study participation is 7 weeks for each patient, including a reference week before chemotherapy onset and 6 weeks afterwards. Accelerometry and body temperature are measured q1-min using a continuously worn telecommunicating chest surface sensor, daily body weight is self-measured with a telecommunicating balance and 23 electronic patient-reported outcomes (e-PROs) are self-rated using a tablet. Hidden Markov model, spectral analyses and other algorithms automatically compute physical activity, sleep, temperature, body weight change, e-PRO severity and 12 circadian sleep/activity parameters, including the dichotomy index I<O (% activity 'in-bed' below median activity 'out-of-bed'), once to four times daily. Health professionals access visual displays of near-real time parameter dynamics and receive automatic alerts, with trackable digital follow-up. ETHICS AND DISSEMINATION The study has been approved by the National Agency for Medication and Health Product Safety (ANSM) and Ethics Committee West V (2 July 2019; third amendment, 14 June 2022). The data will be disseminated at conferences and in peer-reviewed journals and will support large-scale randomised evaluation. TRIAL REGISTRATION NUMBERS NCT04263948 and ID RCB-2019-A00566-51.
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Affiliation(s)
- Mohamed Bouchahda
- Oncology Unit, Clinique du Mousseau, Ramsay-Sante, Evry, France
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Oncology Unit, Clinique de St Jean, Melun, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Ayhan Ulusakarya
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | | | - Amal Attari
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Future of Healthcare Program Research & Innovation Direction| France, Altran/Cap Gemini, Meudon, France
| | - Rachel Bossevot
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | | | - Pascal Hammel
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - René Adam
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Hepato-Biliary Centre, APHP Paul Brousse Hospital, Villejuif, France
| | - Francis Levi
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
- Warwick University, Warwick, UK
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11
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Auvray Kuentz M, Hautefeuille V, de Mestier L, Coutzac C, Lecomte T, Nardon V, Artru P, Turpin A, Drouillard A, Malka D, Tran-Minh ML, Trouilloud I, Lièvre A, Williet N, Pernot S, Touchefeu Y, Taieb J, Hammel P, Zaanan A. Chemotherapy in advanced pancreatic adenosquamous carcinoma: A retrospective multicenter AGEO study. Int J Cancer 2023; 152:1894-1902. [PMID: 36562310 DOI: 10.1002/ijc.34414] [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: 10/30/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Pancreatic adenosquamous carcinoma (PASC) account for <5% of pancreatic malignancies. The efficacy of modern chemotherapy regimens in patients with advanced PASC is unknown. Patients with advanced PASC from 2008 to 2021 were consecutively included in this retrospective multicenter study. Overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier method. Ninety-four PASC from 16 French centers were included (median age, 67.3 years; males, 56.4%; metastatic disease, 85.1%). The first-line treatment was chemotherapy for 79 patients (84.0%) (37 FOLFIRINOX (FX), 7 Gemcitabine-nab paclitaxel (GN) and 35 for all other regimen) or best supportive care (BSC) alone for 15 patients (16.0%). No significant difference was observed between FX and GN in terms of PFS (P = .67) or OS (P = .5). Modern regimens pooled together (FX and GN) as compared to all others chemotherapy regimens showed an improvement of overall response rate (39.5% and 9.7%, P = .002), PFS (median, 7.8 vs 4.7 months, P = .02) and OS (median, 12.7 vs 9.2 months, P = .35). This large study evaluating first-line treatment regimens in advanced PASC suggests that modern regimens as FX or GN may be preferable to all other chemotherapy regimens. These results deserve confirmation in prospective studies.
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Affiliation(s)
- Marie Auvray Kuentz
- Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance publique-hôpitaux de Paris (APHP)-Centre, Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Amiens Picardie, Amiens, France
| | - Louis de Mestier
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Clichy, France
| | - Clélia Coutzac
- Department of Medical Oncology, Centre Leon Bérard, Lyon, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU de Tours, Hôpital Trousseau, Inserm UMR 1069, "Nutrition, Croissance et Cancer", University of Tours, Tours, France
| | - Victor Nardon
- Medical Oncology Department, Institut Cancérologie Strasbourg Europe, Strasbourg, France
| | - Pascal Artru
- Department of Hepato-Gastroenterology, Jean Mermoz Hospital, Lyon, France
| | | | | | - David Malka
- Department of Cancer Medicine, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - My-Linh Tran-Minh
- Department of Hepato-Gastroenterology, Saint-Louis Hospital, Paris, France
| | | | - Astrid Lièvre
- Department of Hepato-Gastroenterology, CHU Pontchaillou Rennes, Rennes 1 University, COSS (Chemistry Oncogenesis Stress Signaling), Rennes, France
| | - Nicolas Williet
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU de Saint-Etienne, Saint-Etienne, France
| | - Simon Pernot
- Department of Digestive Oncology, Institut Bergonié, Bordeaux, France
| | - Yann Touchefeu
- Department of Digestive Oncology, IMAD University Hospital, Nantes, France
| | - Julien Taieb
- Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance publique-hôpitaux de Paris (APHP)-Centre, Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
| | - Pascal Hammel
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Clichy, France
| | - Aziz Zaanan
- Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance publique-hôpitaux de Paris (APHP)-Centre, Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
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12
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Chaigneau T, Aguilera Munoz L, Oger C, Gourdeau C, Hentic O, Laurent L, Muller N, Dioguardi Burgio M, Gagaille MP, Lévy P, Rebours V, Hammel P, de Mestier L. Efficacy and tolerance of LV5FU2-carboplatin chemotherapy in patients with advanced pancreatic ductal adenocarcinoma after failure of standard regimens. Ther Adv Med Oncol 2023; 15:17588359231163776. [PMID: 37007630 PMCID: PMC10052496 DOI: 10.1177/17588359231163776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Chemotherapy options in patients with advanced pancreatic ductal adenocarcinoma (PDAC) after failure of standard chemotherapies are limited. Objectives: We aimed to report the efficacy and safety of the leucovorin and 5-fluorouracil (LV5FU2) and carboplatin combination in this setting. Design: We performed a retrospective study including consecutive patients with advanced PDAC who received LV5FU2–carboplatin between 2009 and 2021 in an expert center. Methods: We measured overall survival (OS) and progression-free survival (PFS), and explored associated factors using Cox proportional hazard models. Results: In all, 91 patients were included (55% male, median age 62), with a performance status of 0/1 in 74% of cases. LV5FU2–carboplatin was mainly used in third (59.3%) or fourth line (23.1%), with three (interquartile range: 2.0–6.0) cycles administered on average. The clinical benefit rate was 25.2%. Median PFS was 2.7 months (95% CI: 2.4–3.0). At multivariable analysis, no extrahepatic metastases (p = 0.083), no ascites or opioid-requiring pain (p = 0.023), <2 prior treatment lines (p < 0.001), full dose of carboplatin (p = 0.004), and treatment initiation >18 months after initial diagnosis (p < 0.001) were associated with longer PFS. Median OS was 4.2 months (95% CI: 3.48–4.92) and was influenced by the presence of extrahepatic metastases (p = 0.058), opioid-requiring pain or ascites (p = 0.039), and number of prior treatment lines (0.065). Prior tumor response under oxaliplatin did not impact either PFS or OS. Worsening of preexisting residual neurotoxicity was infrequent (13.2%). The most common grade 3–4 adverse events were neutropenia (24.7%) and thrombocytopenia (11.8%). Conclusion: Although the efficacy of LV5FU2–carboplatin appears limited in patients with pretreated advanced PDAC, it may be beneficial in selected patients.
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Affiliation(s)
- Thomas Chaigneau
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Department of Hepatology, Gastroenterology, and Nutrition, Caen-Normandie University Hospital, Caen, France
| | - Lina Aguilera Munoz
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Caroline Oger
- Université Paris-Cité, Department of Pharmacy and Chemotherapy, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Clémence Gourdeau
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Department of Hepatology and Gastroenterology, Rouen University Hospital, Rouen, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Lucie Laurent
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Nelly Muller
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Marco Dioguardi Burgio
- Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Marie-Pauline Gagaille
- Université Paris-Cité, Department of Pharmacy and Chemotherapy, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Philippe Lévy
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Vinciane Rebours
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Pascal Hammel
- Université Paris-Cité, Department of Digestive and Medical Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Saclay, Department of Digestive and Medical Oncology, Paul-Brousse Hospital (APHP.Sud), Villejuif, France
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13
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Conroy T, Castan F, Hammel P. Overall Survival With Adjuvant mFOLFIRINOX for Pancreatic Cancer-Reply. JAMA Oncol 2023; 9:436-437. [PMID: 36701135 DOI: 10.1001/jamaoncol.2022.7361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine and APEMAC, équipe MICS, Université de Lorraine, Nancy, France
| | - Florence Castan
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Pascal Hammel
- Digestive and Medical Oncology department, Hôpital Paul Brousse and University Paris-Saclay, Villejuif, France
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14
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Rousseau B, Falcoz A, Toullec C, Lecomte T, Lambert A, Tournigand C, Guerin-Meyer V, Louvet C, Trouilloud I, Rinaldi Y, Coriat R, Dauba J, Neuzillet C, Andre T, Bachet JB, Cros J, De La Fouchardiere C, Garcia-Larnicol ML, De Gramont A, Hammel P. Assessment of an emergency 14-day (d) integrative supportive care program (14-EISCP) followed by early chemotherapy (CTx) in symptomatic patients (pts) with advanced pancreatic ductal adenocarcinoma (aPDAC): A prospective ARCAD cohort study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.700] [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: 01/25/2023] Open
Abstract
700 Background: Pts with aPDAC often have general health impairment due to high symptom burden at diagnosis. We investigated prospectively the clinical benefit (CB) of an EISCP followed by CTx as early as suspicion of aPDAC in pts with ECOG performance status (PS)≥2. Methods: In this multicenter study, PS≥2 pts with pathologically confirmed or suspected aPDAC on imaging were included at first oncology visit (V1) in a personalized 14-d EISCP including pain, nutritional, diagnostic/stenting procedures. Post-EISCP PS≤1 pts received mFOLFIRINOX or gemcitabine(Gem)/Nab-paclitaxel(NP), PS≥2 received mFOLFOX7 or investigator choice CTx or best supportive care (BSC). The primary endpoint was the 14-EISCP success on both feasibility of procedures within 14-d±2 and CB defined by post-EISCP PS≤1, ≥5 points improvement of either fatigue/pain/global health EORTC QLQ-C15-PAL quality of life (QOL) scores, or CTx start ≤30d, aiming 59% success for clinical relevance. Secondary endpoint included uni/multivariate median overall survival (mOS) analyses. Results: As of 07/2022, 106 pts were included; 93 pts were evaluable for primary endpoint: male 46%, mean age 74 yrs, PS2/3 79%/21%, metastases (M1) 62%, pathological diagnosis needed 53%, biliary stenting 16%. V1 mean QOL global health score was 48±23. mOS was 4.1 months (IC95 2.8-5.7). The 14-d feasibility was achieved in 71%. Post-EISCP CB was observed in 82% of pts: 13%, PS improvement to 0/1, 23% QOL improvement and/or 73% CTx start ≤30-d. Eight pts (9%) died during the EISCP. The primary endpoint was achieved in 59% of pts (n=55). Overall, 17 pts (16%) received mFOLFIRINOX/GemNP, 32 (30%) FOLFOX, 29 (27%) Gem or 5FU alone, and 28 (27%) BSC. OS analyses are shown. At d30, pts receiving CTx had a mean change of QOL global health score from 51±23 to 60±23. Conclusions: In PS≥2 pts with aPDAC, a personalized 14-EISCP is feasible and lead to a meaningful CB allowing the administration of doublet/triplet CTx in nearly half of the pts. Pts starting CTx within 30d had improved OS. Clinical trial information: NCT02979483 . [Table: see text]
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Affiliation(s)
- Benoit Rousseau
- GI Oncology - Memorial Sloan Kettering Cancer Center, New York, NY
| | - Antoine Falcoz
- Methodology and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | | | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - Aurélien Lambert
- Medical Oncology Department, Lorraine Cancer Institute, Nancy, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor Hospital, AP-HP, Paris-East Créteil University, INSERM, IMRB, Créteil, France
| | | | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | | | - Yves Rinaldi
- Department of Gastroenterology, Hôpital Européen, Marseille, France
| | - Romain Coriat
- Gastroenterology and Endoscopy Unit, Hopital Cochin, Paris, Paris, France
| | - Jerome Dauba
- Department of Oncology, Mont de Marsan Hospital, Mont De Marsan, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Saint-Cloud, France
| | - Thierry Andre
- Department of Medical Oncology, Hopital Saint-Antoine, APHP, Paris, France
| | - Jean-Baptiste Bachet
- Sorbonne University, Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Jerome Cros
- Department of Pathology, Beaujon Hospital, APHP-INSERM U1149 Universite Paris Diderot, Clichy, France
| | | | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Hospital, Levallois-Perret, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Hospital Paul Brousse, University Paris-Saclay, Villejuif, France
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15
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Debbabi I, Vacher S, Neuzillet C, Cros J, Revillon F, Petitalot A, Turpin A, Antonio S, Girard E, Dupain C, Kamal M, Hammel P, Bièche I, Masliah-Planchon J, Caputo SM. Identification of a large intra-exonic deletion in BRCA2 exon 18 in a pancreatic ductal adenocarcinoma. Ther Adv Med Oncol 2023; 15:17588359221146132. [PMID: 36700131 PMCID: PMC9869184 DOI: 10.1177/17588359221146132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/30/2022] [Indexed: 01/19/2023] Open
Abstract
By 2030, pancreatic cancer will become the second leading cause of cancer-related deaths in the United States and in Europe. The management of patients with advanced pancreatic cancer relies on chemotherapy and poly (ADP-ribose) polymerase inhibitors for patients who carry BRCA1/2 inactivating alterations. Some variants, such as large insertion/deletions (Indels), inactivating BRCA1/2 and therefore of clinical relevance can be hard to detect by next-generation sequencing techniques. Here we report a 47-year-old patient presenting with pancreatic cancer whose tumour harbours a large somatic intra-exonic deletion of BRCA2 of 141 bp. This BRCA2 deletion, located in the C-terminal domain, can be considered as pathogenic and consequently affect tumorigenesis because it is involved in the interaction between the DSS1 protein and DNA. Thanks to the optimized bioinformatics algorithm, this intermediate size deletion in BRCA2 was identified, enabling personalized patient management via the inclusion of the patients in a clinical trial.
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Affiliation(s)
- Inès Debbabi
- Department of Genetics, Institut Curie, Paris, France
| | - Sophie Vacher
- Department of Genetics, Institut Curie, Paris, France,PSL Research University, Paris, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Curie Institute, Versailles Saint Quentin University, Paris, France
| | - Jérome Cros
- INSERM UMR1149, Beaujon University Hospital, Paris University, Paris, France,Department of Pathology, Beaujon University, Hospital Paris 7 Diderot University, Paris, France
| | | | - Ambre Petitalot
- Department of Genetics, Institut Curie, Paris, France,PSL Research University, Paris, France
| | - Anthony Turpin
- ULR9020-UMR-S 1277 Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France,Medical Oncology Department, CHU Lille, University of Lille, France
| | - Samantha Antonio
- Department of Genetics, Institut Curie, Paris, France,PSL Research University, Paris, France
| | | | - Célia Dupain
- Department of Drug Development and Innovation, Institut Curie, PSL Research University, Paris
| | - Maud Kamal
- Department of Drug Development and Innovation, Institut Curie, PSL Research University, Paris
| | - Pascal Hammel
- Department of Digestive and Medical Oncology, Paris-Saclay University, Hôpital Paul Brousse, Villejuif, France
| | - Ivan Bièche
- Department of Genetics, Institut Curie, Paris, France,Université de Paris, Paris, France
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16
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Kindler HL, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall MJ, Park JO, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly EM, Bordia S, McGuinness D, Cui K, Locker GY, Golan T. Overall Survival Results From the POLO Trial: A Phase III Study of Active Maintenance Olaparib Versus Placebo for Germline BRCA-Mutated Metastatic Pancreatic Cancer. J Clin Oncol 2022; 40:3929-3939. [PMID: 35834777 PMCID: PMC10476841 DOI: 10.1200/jco.21.01604] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/21/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The phase III POLO study demonstrated significant progression-free survival (PFS) benefit for active olaparib maintenance therapy versus placebo for patients with metastatic pancreatic adenocarcinoma and a germline BRCA mutation. Here, we report the final analysis of overall survival (OS) and other secondary end points. PATIENTS AND METHODS Patients with a deleterious or suspected deleterious germline BRCA mutation whose disease had not progressed after ≥ 16 weeks of first-line platinum-based chemotherapy were randomly assigned 3:2 to active maintenance olaparib (300 mg twice daily) or placebo. The primary end point was PFS; secondary end points included OS, time to second disease progression or death, time to first and second subsequent cancer therapies or death, time to discontinuation of study treatment or death, and safety and tolerability. RESULTS In total, 154 patients were randomly assigned (olaparib, n = 92; placebo, n = 62). No statistically significant OS benefit was observed (median 19.0 v 19.2 months; hazard ratio [HR], 0.83; 95% CI, 0.56 to 1.22; P = .3487). Kaplan-Meier OS curves separated at approximately 24 months, and the estimated 3-year survival after random assignment was 33.9% versus 17.8%, respectively. Median time to first subsequent cancer therapy or death (HR, 0.44; 95% CI, 0.30 to 0.66; P < .0001), time to second subsequent cancer therapy or death (HR, 0.61; 95% CI, 0.42 to 0.89; P = .0111), and time to discontinuation of study treatment or death (HR, 0.43; 95% CI, 0.29 to 0.63; P < .0001) significantly favored olaparib. The HR for second disease progression or death favored olaparib without reaching statistical significance (HR, 0.66; 95% CI, 0.43 to 1.02; P = .0613). Olaparib was well tolerated with no new safety signals. CONCLUSION Although no statistically significant OS benefit was observed, the HR numerically favored olaparib, which also conferred clinically meaningful benefits including increased time off chemotherapy and long-term survival in a subset of patients.
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Affiliation(s)
| | - Pascal Hammel
- Paul Brousse Hospital (AP-HP), University Paris-Saclay, Villejuif, France
| | - Michele Reni
- IRCCS Ospedale, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium
| | - Teresa Macarulla
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Giampaolo Tortora
- Fondazione Policlinico A Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hana Algül
- Klinikum rechts der Isar, Comprehensive Cancer Center Munich TUM, Technische Universität München, Munich, Germany
| | | | | | | | | | | | - Talia Golan
- The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
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17
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Conroy T, Castan F, Lopez A, Turpin A, Ben Abdelghani M, Wei AC, Mitry E, Biagi JJ, Evesque L, Artru P, Lecomte T, Assenat E, Bauguion L, Ychou M, Bouché O, Monard L, Lambert A, Hammel P. Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial. JAMA Oncol 2022; 8:1571-1578. [PMID: 36048453 PMCID: PMC9437831 DOI: 10.1001/jamaoncol.2022.3829] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [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: 04/20/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023]
Abstract
Importance Early results at 3 years from the PRODIGE 24/Canadian Cancer Trials Group PA6 randomized clinical trial showed survival benefits with adjuvant treatment with modified FOLFIRINOX vs gemcitabine in patients with resected pancreatic ductal adenocarcinoma; mature data are now available. Objective To report 5-year outcomes and explore prognostic factors for overall survival. Design, Setting, and Participants This open-label, phase 3 randomized clinical trial was conducted at 77 hospitals in France and Canada and included patients aged 18 to 79 years with histologically confirmed pancreatic ductal adenocarcinoma who had undergone complete macroscopic (R0/R1) resection within 3 to 12 weeks before randomization. Patients were included from April 16, 2012, through October 3, 2016. The cutoff date for this analysis was June 28, 2021. Interventions A total of 493 patients were randomized (1:1) to receive treatment with modified FOLFIRINOX (oxaliplatin, 85 mg/m2 of body surface area; irinotecan, 150-180 mg/m2; leucovorin, 400 mg/m2; and fluorouracil, 2400 mg/m2, every 2 weeks) or gemcitabine (1000 mg/m2, days 1, 8, and 15, every 4 weeks) as adjuvant therapy for 24 weeks. Main Outcomes and Measures Primary end point was disease-free survival. Secondary end points included overall survival, metastasis-free survival, and cancer-specific survival. Prognostic factors for overall survival were determined. Results Of the 493 patients, 216 (43.8%) were women, and the mean (SD) age was 62.0 (8.9) years. At a median of 69.7 months' follow-up, 367 disease-free survival events were observed. In patients receiving chemotherapy with modified FOLFIRINOX vs gemcitabine, median disease-free survival was 21.4 months (95% CI, 17.5-26.7) vs 12.8 months (95% CI, 11.6-15.2) (hazard ratio [HR], 0.66; 95% CI, 0.54-0.82; P < .001) and 5-year disease-free survival was 26.1% vs 19.0%; median overall survival was 53.5 months (95% CI, 43.5-58.4) vs 35.5 months (95% CI, 30.1-40.3) (HR, 0.68; 95% CI, 0.54-0.85; P = .001), and 5-year overall survival was 43.2% vs 31.4%; median metastasis-free survival was 29.4 months (95% CI, 21.4-40.1) vs 17.7 months (95% CI, 14.0-21.2) (HR, 0.64; 95% CI, 0.52-0.80; P < .001); and median cancer-specific survival was 54.7 months (95% CI, 45.8-68.4) vs 36.3 months (95% CI, 30.5-43.9) (HR, 0.65; 95% CI, 0.51-0.82; P < .001). Multivariable analysis identified modified FOLFIRINOX, age, tumor grade, tumor staging, and larger-volume center as significant favorable prognostic factors for overall survival. Shorter relapse delay was an adverse prognostic factor. Conclusions and Relevance The final 5-year results from the PRODIGE 24/Canadian Cancer Trials Group PA6 randomized clinical trial indicate that adjuvant treatment with modified FOLFIRINOX yields significantly longer survival than gemcitabine in patients with resected pancreatic ductal adenocarcinoma. Trial Registration EudraCT: 2011-002026-52; ClinicalTrials.gov Identifier: NCT01526135.
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Affiliation(s)
- Thierry Conroy
- Medical Oncology department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France and Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Florence Castan
- Biometry Department, ICM Regional Cancer Institute of Montpellier, Montpellier, France and Montpellier University, Montpellier, France
| | - Anthony Lopez
- Hepatogastroenterology department, University Hospital, Nancy, France
| | - Anthony Turpin
- Medical Oncology Department, University hospital, Lille, France and University of Lille, Lille, France
| | | | - Alice C. Wei
- Surgery department, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Emmanuel Mitry
- Medical Oncology department, Institut Paoli-Calmettes, Marseille, France
| | | | - Ludovic Evesque
- Medical oncology department, Centre Antoine-Lacassagne, Nice, France
| | - Pascal Artru
- Hepatogastroenterology department, Hôpital Jean-Mermoz, Lyon, France
| | - Thierry Lecomte
- Hepatogastroenterology department, Hôpital Trousseau, Tours, France and INSERM UMR 6239, Tours University, Tours, France
| | - Eric Assenat
- Medical oncology department, Centre Hospitalier Universitaire de Saint-Eloi, Montpellier, France
| | - Lucile Bauguion
- Hepatogastroenterology department, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Marc Ychou
- Oncology department, ICM Regional Cancer Institute of Montpellier, Montpellier, France and Montpellier University, Montpellier, France
| | - Olivier Bouché
- Digestive oncology department, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | - Aurélien Lambert
- Medical Oncology department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France and Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Pascal Hammel
- Digestive and Medical Oncology department, Hôpital Paul Brousse and University Paris-Saclay, Villejuif, France
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18
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Balzano V, Laurent E, Florence AM, Lecuyer AI, Lefebvre C, Heitzmann P, Hammel P, Lecomte T, Grammatico-Guillon L. Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data. Ther Adv Med Oncol 2022; 14:17588359221113264. [PMID: 36090802 PMCID: PMC9449516 DOI: 10.1177/17588359221113264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Excessive waiting time intervals for the diagnosis and treatment of patients with pancreatic cancer can influence their prognosis but they remain unclear. The objective was to describe time intervals from the medical visit to diagnostic imaging and to treatment and their prognostic impact in pancreatic cancer in one French region. Methods: This retrospective observational multicentre study included all patients with pancreatic cancer seen for the first time in 2017 in multidisciplinary team meetings (MTMs), where clinical data were collected. A probabilistic matching with the medico-administrative data from the French national healthcare database (Système National des Données de Santé) was performed to define the care pathway from clinical presentation to the beginning of treatment. Median key time intervals were estimated for both resected and unresected tumours. Factors associated with 1-year survival were studied using Cox model. Results: A total of 324 patients (88% of total patients with MTM presentation) were matched and included: male 54%, mean age 72 years ±9.2, Eastern Cooperative Oncology Group (ECOG) PS > 1 19.5%, metastatic disease at diagnosis 47.4%, tumour resection 16%. At 1 year, 57% had died (65% in the unresected group and 17% in the resected group). The median time interval from the medical visit to diagnostic imaging was 15 days [Q1–Q3: 8–44]. After imaging, median time intervals to definite diagnosis and to first treatment were 11 and 20 days, respectively. Significant prognostic factors associated with the risk of death at 1 year were ECOG PS > 1 (hazard ratio (HR) 2.1 [1.4–3.0]), metastasis (HR 2.7 [1.9–3.9]), no tumour resection (HR 2.7 [1.3–5.6]) and time interval between the medical visit and diagnostic imaging ⩾25 days (HR 1.7 [1.2–2.3]). Conclusion: Delay in access to diagnostic imaging impacted survival in patients with pancreatic cancer, regardless of whether tumour resection had been performed.
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Affiliation(s)
- Vittoria Balzano
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France.,Gastroenterology and Digestive Oncology Department, Teaching Hospital of Tours, Tours, France
| | - Emeline Laurent
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Research Unit EA7505 "Education, Ethics and Health", University of Tours, Tours, France
| | - Aline-Marie Florence
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Department of Public Healht, Faculty of Medicine,University of Tours, France
| | - Anne-Isabelle Lecuyer
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Research Unit EA7505 "Education, Ethics and Health", University of Tours, Tours, France
| | - Carole Lefebvre
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France
| | - Patrick Heitzmann
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Paul Brousse University Hospital, Villejuif, France.,Paris-Saclay University, Villejuif, France
| | - Thierry Lecomte
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France.,University of Tours, Faculty of Medicine, Tours, France.,Gastroenterology and Digestive Oncology Department, Teaching Hospital of Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Department of Public Healht, Faculty of Medicine, University of Tours, France.,Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours cedex 9, France
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19
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Turpin A, Neuzillet C, Colle E, Dusetti N, Nicolle R, Cros J, de Mestier L, Bachet JB, Hammel P. Therapeutic advances in metastatic pancreatic cancer: a focus on targeted therapies. Ther Adv Med Oncol 2022; 14:17588359221118019. [PMID: 36090800 PMCID: PMC9459481 DOI: 10.1177/17588359221118019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Mortality from pancreatic ductal adenocarcinoma (PDAC) is increasing worldwide and effective new treatments are urgently needed. The current treatment of metastatic PDAC in fit patients is based on two chemotherapy combinations (FOLFIRINOX and gemcitabine plus nab-paclitaxel) which were validated more than 8 years ago. Although almost all treatments targeting specific molecular alterations have failed so far when administered to unselected patients, encouraging results were observed in the small subpopulations of patients with germline BRCA 1/2 mutations, and somatic gene fusions (neurotrophic tyrosine receptor kinase, Neuregulin 1, which are enriched in KRAS wild-type PDAC), KRAS G12C mutations, or microsatellite instability. While targeted tumor metabolism therapies and immunotherapy have been disappointing, they are still under investigation in combination with other drugs. Optimizing pharmacokinetics and adapting available chemotherapies based on molecular signatures are other promising avenues of research. This review evaluates the current expectations and limits of available treatments and analyses the existing trials. A permanent search for actionable vulnerabilities in PDAC tumor cells and microenvironments will probably result in a more personalized therapeutic approach, keeping in mind that supportive care must also play a major role if real clinical efficacy is to be achieved in these patients.
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Affiliation(s)
- Anthony Turpin
- Department of Medical Oncology, CNRS UMR9020,
Inserm UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to
Therapies, University Lille, CHU Lille, Lille, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Curie
Institute, Versailles Saint-Quentin University, Paris-Saclay University,
Saint-Cloud, France
| | - Elise Colle
- Department of Digestive and Medical Oncology,
Hospital Paul Brousse (AP-HP), Villejuif, University of Paris Saclay,
France
| | - Nelson Dusetti
- Cancer Research Center of Marseille, CRCM,
Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille,
France
| | - Rémy Nicolle
- Centre de Recherche sur l’Inflammation, INSERM,
U1149, CNRS, ERL 8252, Université de Paris Cité, Paris, France
| | - Jérôme Cros
- Department of Pathology, University of Paris
Cité, Hospital Beaujon (AP-HP), Clichy, France
| | - Louis de Mestier
- Department of Gastroenterology and
Pancreatology, University of Paris Cité, Hospital Beaujon (AP-HP), Clichy,
France
| | - Jean-Baptiste Bachet
- Department of Gastroenterology and Digestive
Oncology, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University,
Paris, France
| | - Pascal Hammel
- Department of Digestive and Medical Oncology,
Hôpital Paul Brousse (AP-HP), 12 Avenue Paul Vaillant-Couturier, Villejuif
94800, University of Paris Saclay, France
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20
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Hammel P, Golan T, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Sharan K, Ou X, Cui K, Locker G, Kindler H. 1298P Extended overall survival results from the POLO study of active maintenance olaparib in patients with metastatic pancreatic cancer and a germline BRCA mutation. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Torregrosa C, Pernot S, Vaflard P, Perret A, Tournigand C, Randrian V, Doat S, Neuzillet C, Moulin V, Stouvenot M, Roth G, Darbas T, Auberger B, Godet T, Jaffrelot M, Lambert A, Dubreuil O, Gluszak C, Bernard‐Tessier A, Turpin A, Palmieri L, Bouche O, Goujon G, Lecomte T, Sefrioui D, Locher C, Grados L, Gignoux P, Trager S, Nassif E, Saint A, Hammel P, Lecaille C, Bureau M, Perrier M, Botsen D, Bourgeois V, Taieb J, Auclin E. FOLFIRI plus BEvacizumab or aFLIbercept after FOLFOX‐bevacizumab failure for COlorectal cancer (BEFLICO): an AGEO multicenter study. Int J Cancer 2022; 151:1978-1988. [DOI: 10.1002/ijc.34166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Cécile Torregrosa
- Gastrointestinal Oncology Department, Hôpital Européen Georges Pompidou, AP‐HP, Université de Paris Paris France
| | - Simon Pernot
- Medical oncology Bergonié Institute Bordeaux France
| | | | - Audrey Perret
- Department of Cancer Medicine Gustave Roussy Cancer Institute Villejuif France
| | - Christophe Tournigand
- Medical Oncology, Henri Mondor Hospital, Assistance Publique des Hôpitaux de Paris Paris Est Creteil University, INSERM, IMRB F‐94010 Creteil France
| | - Violaine Randrian
- Hepatology and Gastro‐enterology Department University Hospital Center of Poitiers Poitiers France
| | - Solene Doat
- Digestive Oncology Department Pitié‐Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris Paris France
| | - Cindy Neuzillet
- Medical Oncology Department Curie Institute, Saint‐Cloud, Versailles Saint‐Quentin ‐ Paris Saclay University France
| | - Valérie Moulin
- Oncology Department Hospital of La Rochelle La Rochelle France
| | - Morgane Stouvenot
- Department of Oncology University Hospital Center of Besançon Besançon France
| | - Gael Roth
- Hepato‐gastroenterology and Digestive oncology Unit University Hospital Center of Grenoble Grenoble France
| | - Tiffany Darbas
- Oncology Department University Hospital Center of Limoges Limoges France
| | - Benjamin Auberger
- Oncology Department University Hospital Center of Brest Brest France
| | - Tiphaine Godet
- Gastroenterology and digestive oncology department University Hospital Center of Angers Angers France
| | - Marion Jaffrelot
- Digestive Oncology Department University Hospital Center of Toulouse Toulouse France
| | - Aurélien Lambert
- Medical Oncology Department, Institut de Cancérologie de Lorraine Nancy France
| | - Olivier Dubreuil
- Medical Oncology Department Diaconesses‐Croix St Simon Hospital Paris
| | - Cassandre Gluszak
- Medical Oncology department Institut de Cancérologie de l'Ouest Angers France
| | - Alice Bernard‐Tessier
- Gastroenterology and Digestive Oncology Department, Saint‐Antoine Hospital, APHP Paris France
| | - Anthony Turpin
- University of Lille, CNRS UMR9020, Inserm UMR‐S 1277 ‐ Canther ‐ Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille University Hospital, Department of Medical Oncology Lille France
| | - Lola‐Jade Palmieri
- Gastroenterology and Digestive Oncology Department Cochin Hospital, APHP. Paris France
| | - Olivier Bouche
- Oncology Department University Hospital Center of Reims Reims France
| | - Gael Goujon
- Gastroenterology and Digestive Oncology Department Bichat Hospital Paris France
| | - Thierry Lecomte
- Department of Hepato‐Gastroenterology and Digestive Oncology, Tours University Hospital and INSERM U1069 Nutrition, Croissance et Cancer University of Tours Tours France
| | - David Sefrioui
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, F 76000 Rouen France
| | - Christophe Locher
- Gastroenterology and Digestive Oncology Department Meaux Hospital Meaux France
| | - Lucien Grados
- Gastroenterology and Digestive Oncology Department University Hospital Center of Amiens Amiens France
| | - Pauline Gignoux
- Oncology Department University Hospital Center of Martinique Fort de France France
| | | | - Elise Nassif
- Oncology Department Leon Berard Institute Lyon France
| | - Angélique Saint
- Medical oncology department Antoine Lacassagne Center Nice France
| | - Pascal Hammel
- Digestive and medical oncology department University Paris‐Saclay, Hospital Paul Brousse (AP‐HP), Villejuif France
| | - Cédric Lecaille
- Gastroenterology Department Polyclinique Bordeaux Nord Aquitaine Bordeaux France
| | - Mathilde Bureau
- Digestive oncology department University Hospital Center of Nantes Nantes France
| | - Marine Perrier
- Gastroenterology and Digestive Oncology Department Boulogne‐Sur‐Mer Hospital, Boulogne‐Sur‐Mer France
| | - Damien Botsen
- Oncology Department University Hospital Center of Reims Reims France
| | - Vincent Bourgeois
- Gastroenterology and Digestive Oncology Department Boulogne‐Sur‐Mer Hospital, Boulogne‐Sur‐Mer France
| | - Julien Taieb
- Gastrointestinal Oncology Department, Hôpital Européen Georges Pompidou, AP‐HP, Université de Paris Paris France
| | - Edouard Auclin
- Gastrointestinal Oncology Department, Hôpital Européen Georges Pompidou, AP‐HP, Université de Paris Paris France
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22
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Neuzillet C, Bouché O, Tournigand C, Chibaudel B, Bouguion L, Bengrine-Lefevre L, Lopez-Trabada Ataz D, Mabro M, Metges JP, Péré-Vergé D, Conroy T, Lievre A, Andre M, Desseigne F, Goldwasser F, Henriques J, Anota A, Hammel P. Adapted physical activity in patients (Pts) with advanced pancreatic cancer (APACaP): Results from a prospective national randomized GERCOR trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4007 Background: The benefit of adapted physical activity (APA) on health-related quality of life (HRQoL) in Pts with advanced pancreatic ductal adenocarcinoma (aPDAC) treated by chemotherapy (CTx) has never been prospectively assessed. Methods: Pts with aPDAC and ECOG performance status (PS) 0–2 were randomized 1:1 to receive usual care (UC) including first-line CTx at the investigator’s choice (standard arm), or UC plus a home-based 16-week APA program (APA arm). The APA program consisted of personalized aerobic and resistance exercises, with a weekly remote supervision by an APA professional trainer, and unsupervised sessions with a family member or friend (APA partner). The primary objective was the effect on HRQoL at week 16 (W16) measured by 3 dimensions of the EORTC QLQ-C30, global health status (GHS), physical functioning (PF), and fatigue (FA), with a one-sided type I error of 0.016 for each dimension. The primary HRQoL analysis was performed in Pts with available baseline and W16 scores for the 3 targeted dimensions (mITT1). Secondary analyses of HRQoL changes by the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods included Pts with baseline and ≥1 follow-up score (mITT2). Differences > 5 points in scores were considered clinically significant. Results: A total of 313 Pts (median age: 64 years; men: 55%, ECOG PS 0-1: 93%; metastatic: 77%; FOLFIRINOX: 78%, gemcitabine-based: 13%) were included from 11/2014 to 10/2020 (standard arm: n = 157, APA arm: n = 156). In the mITT1 population (n = 172), mean differences in HRQoL at W16 adjusted from baseline were -0.98 (SD 23.87; p = 0.39), -2.08 (SD 21.34; p = 0.26), and 4.16 (SD 29.18; p = 0.18) for GHS, PF, and FA, respectively. In the mITT2 population (n = 259), APA was associated with significant improvements in 5 (GHS, PF, cognitive functioning [CF], social functioning [SF], appetite loss) and 8 (GHS, CF, emotional functioning [EF], SF, insomnia, constipation, pain, financial difficulties) dimensions of HRQoL by MMRM and TUDD, respectively (Table). Secondary endpoints, including overall survival, progression-free survival, and chemotherapy toxicity will be presented. Conclusions: APA in combination with usual care improved several dimensions of HRQoL in Pts with aPDAC receiving first-line CTx. Clinical trial information: NCT02184663. [Table: see text]
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Affiliation(s)
- Cindy Neuzillet
- Department of Medical Oncology, Institut Curie-Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint Cloud, France
| | - Olivier Bouché
- Department of Digestive Oncology, Reims University Hospital, Reims, France
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Lucile Bouguion
- Department of Hepato-Gastroenterology, Hospital Center Departmental Vendée, La Roche-Sur-Yon, France
| | | | | | | | - Jean-Philippe Metges
- CHU Brest–Institut de Cancerologie et d’Hematologie ARPEGO Network, Brest, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Astrid Lievre
- Department of Gastroenterology, Rennes University Hospital, Rennes, France
| | - Morgan Andre
- Department of Gastroenterology, Centre Hospitalier Intercommunal Mont-de-Marsan-Pays des Sources, Mont De Marsan, France
| | | | - François Goldwasser
- Department of Medical Oncology, Hopital Cochin, Université Paris Descartes, CARPEM, APHP, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life in Oncology Unit, Department of Oncology University Hospital, INSERM UMR 1098, Besançon, France
| | - Amélie Anota
- Department of Methodology and quality of life, University Hospital Besançon; Direction of Clinical Research and Innovation, Centre Léon Bérard; French National Platform Quality of Life and Cancer, Besançon, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Hospital Paul Brousse, University Paris-Saclay, Villejuif, France
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23
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Adam R, Accardo C, Houssami S, Sa Cunha A, Levi F, Hammel P, Vibert E, Azoulay D, Cherqui D, Allard MA. Optimal cytoreductive LIVER surgery for unresectable colorectal liver metastases: A prospective observational study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3570] [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
3570 Background: Patients with multiple colorectal liver metastases (CLM) involving all the hepatic segments are currently not eligible for potentially curative liver surgery. Transplantation is a promising alternative but graft shortage and stringent selection criteria limit its accessibility. Owing to the improving efficacy of chemotherapy, the impossibility to resect all the initial metastatic sites could lead to revisit the role of optimal cytoreductive liver surgery (CLS) aiming to treat by resection ± radiofrequency, all the macroscopic residual tumors after a good response to chemotherapy. Although validated for ovarian cancer and peritoneal carcinomatosis, this strategy remains unexplored in CLM. Our objective was to evaluate the outcome of this strategy in patients with definitively unresectable CLM. Methods: Within a prospective monocentric study, we enrolled for debulking surgery, between 2017 and 2021, all consecutive patients with multinodular unresectable CLM involving all segments on initial imaging and consequently ineligible for a curative surgery either after a one or two-stage hepatectomy. These patients should have a strong response to chemotherapy ( > 50 % on RECIST criteria) for at least a 3-month period and no or limited extrahepatic disease, to be included. End-points of the analysis were overall and disease-free survival at 3 years. Results: Among 26 patients considered for this strategy, optimal CLS could be achieved in 21 patients after a median interval of 10 months from CLM diagnosis. The median number of lesions was 11 (7 - 26) on initial imaging. Four patients (19%) had synchronous lung metastases. Liver-first strategy was undertaken in 19 patients (90%). Postoperative complications (Grade ≥ III) occured in 5 patients (24%). One patient died within 90-day after operation from intra-abdominal hemorrage while on anticoagulation therapy. After a median follow-up of 25 months from hepatectomy, the 3-year OS rates was 85%. Median survival was not reached at the time of the analysis. Of the 4 (19%) patients with complete pathological response on the liver specimen, 3 developed recurrence. A total of 17 patients (81%) developed recurrence after a median time of 10,5 months from hepatectomy. Among them, repeat hepatectomy could be undertaken in four patients. The survival time to surgical failure (recurrence untreatable with curative intent) was 32% and 16% at 2 and 3 years. At last follow-up, seven patients (33%) are alive and recurrence-free. Conclusions: The promising results of this prospective series suggest that CLS may be worthy in patients with diffuse CLM non curatively treatable by surgery but responding well to chemotherapy. This strategy should however be reserved to hyperselected patients, super responders, eligible for an optimal resection of all the macroscopic residual tumors, and confimed by other expert centers, to be definitively validated.
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Affiliation(s)
- Rene Adam
- AP-HP, Hôpital Paul Brousse, Univ Paris-Saclay, Villejuif, France
| | | | | | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Francis Levi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
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24
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Bouchahda M, Ulusakarya A, Thirot-Bidault A, Colle E, Attari A, Bossevot R, Ali M, Huang Q, Fritsch A, Breda G, Hammel P, Adam R, Levi F. A multicenter telemonitoring-telecare study with automatic assessment of physiological parameters and patient-reported outcomes in remote pancreatic cancer patients on mFOLFIRINOX: Interim technology report. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13617] [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
e13617 Background: There is an unmet need for improved treatment outcomes along with safer care of patients (pts) at home, at risk of severe adverse events from chemotherapy. Methods: MultiDom (NCT04263948; Ramsay Santé Research GCS) aims to reduce emergency hospitalisations of pancreatic adenocarcinoma pts on mFOLFIRINOX with a novel telemonitoring-telecare platform (Clinikali). Accelerometry and body temperature are measured q1-min using a continuously-worn telecommunicating chest surface sensor, daily body weight is self-measured with a telecommunicating balance, and 23 electronic pt-reported outcomes (ePROs) are self-rated using a tablet for 1 week before (baseline) and 6 weeks after the first course. Hidden Markov, spectrum and other algorithms automatically compute physical activity, sleep, temperature, body weight change, ePROs severity, and dichotomy index I<O of the circadian rest-activity rhythm (% activity In-bed below median activity Out-of-bed), one to four times daily. Alerts are automatically generated and sent to a coordination platform of health professionals, with trackable follow-up. Results: From 6/2021 to 2/2022, 16 of 42 planned pts (38%) from 4 centers have been included (females/males, 10/6 pts; aged 64-79 years; PS 0/1, 8/8 pts; 2 borderline/locally-advanced, and 14 metastatic (liver, 9; lymph nodes, 8; lung, 4). This technology report involves 9 pts on study for a median duration of 57 days (d) (range, 49-70d), whilst receiving 3 mFOLFIRINOX courses, with tumor control in 8 pts. Nearly 1.2x107 data were teletransmitted. At baseline, rest-activity rhythm was robust for 7 pts (I<O >97.5%) and disrupted for 2 pts (I<O <96%). Median compliance rates per pt (range) were 81% (67-92%) for rest-activity and body temperature, 96% (53-100%) for body weight, and 89% (78-100%) for self-rated e-PROMs. The median number of alerts generated for each pt (range) was 3 (0-10) for disrupted rest-activity rhythm (I<O <96%) or high temperature (2.5oC above median), and 2 (0-9) for body weight loss >5%, A median of 6 alerts per pt was generated for one or more severe ePROs (pain, 7 pts; fatigue, 6 pts; impact on activity, 5 pts; anorexia, 4 pts). Supportive treatment was mostly initiated at home, avoiding undue hospitalization. Pts rated the median global evaluation factor as 5 (4-5), i.e. the highest score, in the 23-items research participation questionnaire. Conclusions: Continuous multidimensional telemonitoring of physiology and e-PROs met excellent patient compliance, thus supporting exploration of biological mechanisms linking e-PROs to circadian rhythms and treatment activity. Study is ongoing to assess whether such telemonitoring-telecare platform may drive practice-changes in patient pathways and digitized clinical trials in the current era of precision medicine. Clinical trial information: NCT04263948.
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Affiliation(s)
| | - Ayhan Ulusakarya
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
| | | | - Elise Colle
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
| | | | - Rachel Bossevot
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
| | | | - Qi Huang
- Department of Statistics and Medical School, Warwick University, Coventry, United Kingdom
| | | | | | - Pascal Hammel
- Digestive and Medical Oncology Department, Hospital Paul Brousse, University Paris-Saclay, Villejuif, France
| | - Rene Adam
- AP-HP Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Francis Levi
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
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25
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Adam R, Badrudin D, Allard MA, Golse N, Ulusakarya A, Cherqui D, Sa Cunha A, Vibert E, Azoulay D, Ciacio O, Pittau G, Lucchese A, Hammel P, Lewin M, Giacchetti S. Is cure possible for breast cancer metastatic to the liver? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1099] [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
1099 Background: Metastatic breast cancer (MBC) is a lethal disease and is generally only amenable to systemic treatment. Although increasingly recommended on selected patients, local treatments, and particularly surgery, are seldom used in the therapeutic armamentarium for MBC and their long-term survival benefit is unknown. We hypothesized that combining surgery to systemic treatment for selected patients with breast cancer liver metastases could lead to long-term survival or even an option of cure. Methods: A retrospective study of prospectively gathered data from a surgical series of liver resections for MBC was conducted. Patients with no or limited and stable extra-hepatic disease were offered surgery after multidisciplinary discussion, if the liver metastases were responding to systemic treatment and were amenable to complete macroscopic resection. Five- and ten-year actual survivors were identified and their characteristics were explored. Results: From 1984 to 2020, 207 female patients underwent liver resections for MBC in our institution. There was no postoperative mortality. Postoperative complication rate was 23.3% and liver-specific complication rate was 19.0%. There was a total of 48 repeat hepatectomies. Median disease-free interval between initial breast cancer and liver metastasis was 36 ± 90.1 months. There was a median of 2 ± 1.8 liver metastases at diagnosis with a median size of 33.0 ± 18.3 mm and 73.1% of patients had radiological response before resection. Five- and ten-year overall survivals (OS) as well as 5- and 10-year disease-free survivals (DFS) were 39.6% and 12.7% as well as 14.2% and 6.4%, respectively. Median OS was 44.0 ± 47.2 months in the whole series. Focusing on the 5- and 10-year survivors, median OS were 89.5 ± 44.7 months and 144.0 ±42.6 months, respectively. In the 10-year survivors’ group, median DFS was 98 ±62.3 months. Observed survivals in this study underestimate true actual survivals owing to censoring of patients lost to follow-up. Conclusions: Long-term survival (≥ 5 years) as well as a curative perspective (≥ 10 years survival) are achievable for selected patients with breast cancer liver metastases by combining surgery to systemic treatment. Considering the recent improvements in the results of systemic treatments, introducing surgical resection in the treatment sequences of MBC could play an even more beneficial role.
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Affiliation(s)
- Rene Adam
- AP-HP Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Ayhan Ulusakarya
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Eric Vibert
- Cancer Institute Paul Brousse, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Oriana Ciacio
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Gabriella Pittau
- Centre Hépato-biliaire, AP-HP, Paul Brousse Hospital, Villejuif, France
| | | | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Maite Lewin
- AP-HP Hopital Paul Brousse, Service de Radiologie, Villejuif, France
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26
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Schwarz L, Bachet JB, Meurisse A, Bouché O, Assenat E, Piessen G, Terrebonne E, Hammel P, Regenet N, Turco C, Taieb J, Mabrut JY, Turrini O, Portales F, Paye F, Barbier L, Truant S, Sa Cunha A. Resectable pancreatic adenocarcinoma neo-adjuvant FOLF(IRIN)OX-based chemotherapy: A multicenter, non-comparative, randomized, phase II trial (PANACHE01-PRODIGE48 study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4134] [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
4134 Background: Despite the limited number of published RCTs, patients with resectable pancreatic adenocarcinoma (rPAC; NCCN criteria) seem to benefit from neoadjuvant (NAT) with regards to R0 resection rate, downstaging and survivals (PREOPANC-1; Preop-02/JSAP-05; NEONAX, SWOG05-15). Few prospective results are currently available concerning the completion of the full therapeutic sequence and oncological results. Methods: In the PANACHE01-PRODIGE48 prospective multicenter controlled non-comparative Phase II trial, 153 patients with rPDAC were randomized 2:2:1 to 4 cycles of NAT chemotherapy (mFOLFIRINOX; Arm1 or FOLFOX; Arm2) or upfront surgery (Ctrl_Arm) in 28 French centers from 02/2017 to 07/2020. Primary objective was to evaluate the safety and efficacy of two regimens of NAT chemotherapy. The main co-primary endpoints were 1y-OS rate after randomization and the rate of patients undergoing the full therapeutic sequence. Event-free survival (EFS) was used to evaluate the time to recurrence between groups. An event being defined as progression before surgery, unresectable or metastatic disease at surgical exploration, recurrence after surgery or death. Results: Of the 153 randomized patients, 146 were available for analysis (Arm1,n=70; Arm2,n=50; Ctrl_arm,n=26). In the Arm1 and 2, completion of the 4 planed cycles was 88.6 and 84%, respectively, with a dose reduction in 52% and 24%. The cumulative rates of grade 3/4/5 toxicity were 56.7 and 57.4%, respectively. The resection rates (RR) were 74, 68 and 81% respectively in Arm1, Arm2 and Ctrl_Arm. Respectively, 88.4, 91 and 85.7% of patients started adjuvant chemo. 1y-OS rates were respectively of 84.1, 71.8 and 80.8% in Arm1, Arm2 and Ctrl_Arm with a median follow-up in each group of 25.6, 33, 30.9 months. Following the intermediate analysis, the Arm2 was stopped for lack of efficacy (rejection of the H0 hypothesis for 1yOS). 1y-Event free survival (EFS) rates were 51.4% in Arm1, 43.1% in Arm2 and 41.7% in Ctrl_Arm, with corresponding median EFS of 12.4, 11 and 9.2 months. Conclusions: The feasibility and efficacy of the mFOLFIRINOX neoadjuvant chemotherapy is confirmed regarding completion of therapeutic sequence and oncological outcomes. These results confirm the rationale for ongoing clinical trials, PREOPANC3 and Alliance AO21806. Clinical trial information: NCT02959879.
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Affiliation(s)
| | - Jean-Baptiste Bachet
- Sorbonne University, Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Aurelia Meurisse
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, INSERM UMR 1098, Besancon, France
| | | | - Eric Assenat
- Montpellier University Hospital, Montpellier, France
| | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Eric Terrebonne
- Pôle Appareil Digestif, Endocrinologie et Nutrition CHU de Bordeaux, Bordeaux, France
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | | | - Célia Turco
- Besancon University Hospital, Besancon, France
| | - Julien Taieb
- Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
| | | | - Olivier Turrini
- Digestive surgery Department, Institut Paoli-Calmettes, Marseille, France
| | | | | | | | - Stephanie Truant
- Department of Digestive Surgery and Transplantation, Lille, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
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27
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Philip PA, Bahary N, Mahipal A, Kasi A, Rocha Lima CMSP, Alistar AT, Oberstein PE, Golan T, Sahai V, Metges JP, Lacy J, Fountzilas C, Lopez CD, Ducreux M, Hammel P, Salem ME, Bajor DL, Benson AB, Buyse ME, Van Cutsem E. Phase 3, multicenter, randomized study of CPI-613 with modified FOLFIRINOX (mFFX) versus FOLFIRINOX (FFX) as first-line therapy for patients with metastatic adenocarcinoma of the pancreas (AVENGER500). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4023] [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
4023 Background: Metastatic pancreatic cancer (mPC) remains a deadly disease with very limited treatment options. FFX is a standard first-line therapy for mPC with a median overall survival (mOS) of 11.1 months. CPI-613 is a stable intermediate of a lipoate analog that inhibits pyruvate dehydrogenase and α-ketoglutarate dehydrogenase enzymes of the tricarboxylic cycle preferentially within the mitochondria of cancer cells. In a phase I study, CPI-613+mFFX was safe and exhibited promising signal of efficacy. Methods: A global, randomized phase 3 trial was conducted across 73 sites to investigate the efficacy and safety of CPI-613 in combination with mFFX compared to standard dose FFX in treatment-naïve patients with mPC. Treatment was administered in 2-weekly cycles until progression or intolerable toxicity. In the experimental arm, CPI-613 at 500 mg/m2 was given intravenously on days 1 and 3. The doses of irinotecan, oxaliplatin, and 5-fluorouracil in the experimental arm were 65 mg/m2, 140 mg/m2, and 2,400 mg/2, respectively. Primary endpoint was OS. Secondary endpoints were progression-free survival (PFS), overall response rate (ORR), duration of response, pharmacokinetics, patient reported outcomes and safety. Results: 528 patients were randomly assigned (266 in test and 262 in control arm). There were 362 deaths, with a mOS of 11.1 months for CPI-613+mFFX vs. 11.7 months for FFX [hazard ratio (HR), 0.95; 95% CI, 0.77 to 1.18; P = 0.655]; mPFS was 7.8 months vs. 8.0 months respectively [HR, 0.99; 95% CI, 0.76 to 1.29; P = 0.94]; ORR was 39% in the test arm vs. 34% in the control arm [ORR ratio, 1.23 (95% CI, 0.86 to 1.75)]. Grade ≥ 3 treatment-emergent adverse events with ≥ 10% frequency in CPI-613 plus mFFX vs. FFX arm were diarrhea (11.2% vs. 19.6%), hypokalemia (13.1% vs. 14.9%), anemia (13.9% vs. 13.6%), neutropenia (11.2% vs. 14.0%), thrombocytopenia (11.6% vs. 13.6%) and fatigue (10.8% vs. 11.5%). Conclusions: The addition of CPI-613 to mFFX failed to show significant improvements of ORR, PFS or OS. The mFFX in the test arm that had the lowest prospectively tested doses of FFX was without compromise on PFS or OS and may be considered as a reference for future FFX administration. Clinical trial information: NCT03504423.
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Affiliation(s)
- Philip Agop Philip
- Karmanos Cancer Center, Wayne State University, and SWOG, Farmington Hills, MI
| | - Nathan Bahary
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | - Talia Golan
- The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Jill Lacy
- Yale School of Medicine, New Haven, CT
| | | | | | - Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | | | - David Lawrence Bajor
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | - Marc E. Buyse
- International Drug Development Institute, Louvain-La-Neuve, Belgium
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Edeline J, Hirano S, Bertaut A, Konishi M, Benabdelghani M, Uesaka K, Watelet J, Ohtsuka M, Hammel P, Kaneoka Y, Joly JP, Yamamoto M, Monard L, Ambo Y, Louvet C, Ando M, Malka D, Nagino M, Phelip JM, Ebata T. Individual patient data meta-analysis of adjuvant gemcitabine-based chemotherapy for biliary tract cancer: combined analysis of the BCAT and PRODIGE-12 studies. Eur J Cancer 2022; 164:80-87. [PMID: 35182925 DOI: 10.1016/j.ejca.2022.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 09/30/2021] [Revised: 12/15/2021] [Accepted: 01/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although gemcitabine-based chemotherapy is the standard of care for advanced biliary tract cancers (BTCs), adjuvant phase III studies (BCAT in Japan, PRODIGE 12 in France) failed to show benefit, possibly owing to fewer patients (n = 225 and n = 194) compared with the adjuvant capecitabine BILCAP trial (n = 447). We performed a combined analysis of both gemcitabine-based chemotherapy adjuvant studies. METHODS We performed individual patient data meta-analysis of all patients included in BCAT and PRODIGE 12. BCAT study randomised patients with extrahepatic cholangiocarcinoma to single-agent gemcitabine or observation. PRODIGE 12 randomised patients with all BTC subtypes to gemcitabine-oxaliplatin combination or observation. Combined analysis was performed using Kaplan-Meier curves and a Cox regression model stratified on the trial. RESULTS Two hundred and twelve versus 207 patients were randomised in the gemcitabine-based chemotherapy versus observation arms. Baseline characteristics were balanced between arms. The median follow-up was 5.5 years. After 258 relapse-free survival (RFS) events, there was no difference in RFS (log-rank p = 0.45; hazard ratio [HR] = 0.91 [95% confidence interval [CI] 0.71-1.16]; p = 0.46). RFS rates at five years were 40.8% (95%CI: 33.9%-47.5%) for gemcitabine-based chemotherapy versus 36.6% (95%CI: 29.8%-43.4%) for observation. After 201 deaths, there was no difference in overall survival (OS) (log-rank p = 0.83; HR = 1.03 [95%CI: 0.78-1.35]; p = 0.85). OS rates at five years were 50.5% (95%CI: 43.1%-57.4%) for gemcitabine-based chemotherapy versus 49.3% (95%CI: 41.6%-56.5%) for observation. CONCLUSION With 419 patients included, this analysis did not show significant improvement in RFS and no trend in improvement in OS. Gemcitabine-based chemotherapy should not be used as an adjuvant treatment for BTC.
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Affiliation(s)
- Julien Edeline
- Medical Oncology, Centre Eugène Marquis, av de la bataille Flandres-Dunkerque, 35042 Rennes, France.
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges-François Leclercq, Dijon, France.
| | - Masaru Konishi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Centre Hospital East, Kashiwa, Japan.
| | | | - Katsuhiko Uesaka
- Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan.
| | | | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | | | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, TokyoWomen's Medical University, Tokyo, Japan.
| | | | - Yoshiyasu Ambo
- Department of Surgery, Teine-Keijinkai Hospital, Sapporo, Japan.
| | | | - Masahiko Ando
- Centre for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
| | | | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Japan.
| | | | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Japan.
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Hammel P, El-Hariry I, Macarulla T, Garcia-Carbonero R, Metges JP, Bouché O, Portales F, Pazo Cid RA, Mineur L, Cubillo Gracian AM, Trouilloud I, Guimbaud R, Tougeron D, Reina Zoilo JJ, Feliu J, Sauri T, Fountzilas C, Kay R, Youssoufian H, Hidalgo M. Trybeca-1: A randomized, phase 3 study of eryaspase in combination with chemotherapy versus chemotherapy alone as second-line treatment in patients with advanced pancreatic adenocarcinoma (NCT03665441). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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
518 Background: Eryaspase, asparaginase encapsulated in red blood cells is an investigational product under development. The encapsulated asparaginase induces the degradation of asparagine and glutamine, crucial for cancer cell growth and survival. An earlier Phase 2b study in patients with advanced pancreatic cancer showed an improvement in overall survival (OS) and progression free survival (PFS) with eryaspase plus chemotherapy. Methods: TRYbeCA-1 was a randomized, open-label Phase 3 trial of eryaspase combined with chemotherapy in patients with advanced adenocarcinoma of the pancreas who have progressed on only one prior line of systemic anti-cancer therapy. Patients were randomized in a 1:1 ratio to gemcitabine/nab-paclitaxel or irinotecan/fluorouracil (5FU) therapy (depending on first-line received) with or without eryaspase, administered as IV infusion on Day 1 and Day 15 of each 4-week cycle. Key eligibility criteria included progression on or following first-line systemic treatment, ECOG performance status 0 or 1, stage III-IV disease, documented evidence of disease progression, available tumor tissue and adequate organ function. The primary endpoint was OS. A total of 412 events were required for 90% power to detect a treatment effect hazard ratio (HR) of 0.725 at a two-sided significance level of 5%. Results: A total of 512 patients were included. Baseline characteristics were well balanced between the treatment arms. The study did not meet the OS primary endpoint [HR: 0.92 (95% confidence interval (CI), 0.76-1.11), p-value 0.375]. The median OS for patients treated with eryaspase plus chemotherapy was 7.5 mo (95% CI, 6.5-8.3), compared to 6.7 mo (95% CI, 5.4-7.5) for chemotherapy alone. There was a trend of nominal OS benefit in 107 patients treated with eryaspase and irinotecan-5FU compared to 109 patients in control subgroup, with a median OS of 8.0 mo versus 5.7 mo, respectively [HR: 0.81 (95% CI: 0.60- 1.09)]. Treatment effect was consistent across various prognosis factors. Median PFS was 3.7 mo vs. 3.5 mo in the eryaspase and control arms, respectively [HR: 0.89 (95% CI: 0.73-1.07), p-value 0.215]. Disease control rate was 57.6% and 49.0% (p-value 0.047) in the eryaspase and control arms, respectively. The most common adverse events were in the eryaspase arm were asthenia, diarrhea, and anemia (Grade 3-4: 16.9%, 7.66% and 17.3%, respectively). Eryaspase did not appear to enhance toxicity of chemotherapy. Conclusion: This large prospective study did not meet it primary endpoint of improving OS in patients treated with eryaspase. The addition of eryaspase demonstrated nevertheless a well-tolerated profile and an encouraging survival benefit in the irinotecan/5FU subgroup, warranting further investigation. Clinical trial information: NCT03665441.
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Affiliation(s)
- Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | | | | | - Rocio Garcia-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, IIS Imas12, UCM, Madrid, Spain
| | - Jean-Philippe Metges
- CHU Brest–Institut de Cancerologie et d’Hematologie ARPEGO Network, Brest, France
| | | | | | - Roberto A. Pazo Cid
- Miguel Servet University Hospital. Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | | | | | | | | | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | | | - Jaime Feliu
- Hospital Universitario La Paz, Madrid, Spain
| | - Tamara Sauri
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Richard Kay
- School of Pharmacy and Pharmaceutical Medicine, Wales, United Kingdom
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Nicolle R, Gayet O, Bigonnet M, Roques J, Chanez B, Puleo F, Augustin J, Emile JF, Svrcek M, Arsenijevic T, Hammel P, Rebours V, Giovannini M, Grandval P, Dahan L, Moutardier V, Mitry E, Van Laethem JL, Bachet JB, Cros J, Iovanna J, Dusetti NJ. Relevance of biopsy-derived pancreatic organoids in the development of efficient transcriptomic signatures to predict adjuvant chemosensitivity in pancreatic cancer. Transl Oncol 2021; 16:101315. [PMID: 34906890 PMCID: PMC8681024 DOI: 10.1016/j.tranon.2021.101315] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023] Open
Abstract
Most patient with pancreatic cancer are treated by chemotherapy. Treatments selection are not personalized on the tumor characteristics. Signatures predicting chemotherapy efficiency are essential for personalizing treatments. An RNA signature of gemcitabine-sensitivity is developed leveraged on the dissimilarities between 2D and 3D in vitro models. Combining different in vitro models can help in defining clinically efficient transcriptomic signatures.
Pancreatic ductal adenocarcinoma (PDAC) patients are frequently treated by chemotherapy. Even if personalized therapy based on molecular analysis can be performed for some tumors, PDAC regimens selection is still mainly based on patients' performance status and expected efficacy. Therefore, the establishment of molecular predictors of chemotherapeutic efficacy could potentially improve prognosis by tailoring treatments. We have recently developed an RNA-based signature that predicts the efficacy of adjuvant gemcitabine using 38 PDAC primary cell cultures. While demonstrated its efficiency, a significant association with the classical/basal-like PDAC spectrum was observed. We hypothesized that this flaw was due to the basal-like biased phenotype of cellular models used in our strategy. To overcome this limitation, we generated a prospective cohort of 27 consecutive biopsied derived pancreatic organoids (BDPO) and include them in the signature identification strategy. As BDPO's do not have the same biased phenotype as primary cell cultures we expect they can compensate one with each other and cover a broader range of molecular phenotypes. We then obtained an improved signature predicting gemcitabine sensibility that was validated in a cohort of 300 resected PDAC patients that have or have not received adjuvant gemcitabine. We demonstrated a significant association between the improved signature and the overall and disease-free survival in patients predicted as sensitive and treated with adjuvant gemcitabine. We propose then that including BDPO along primary cell cultures represent a powerful strategy that helps to overcome primary cell cultures limitations producing unbiased RNA-based signatures predictive of adjuvant treatments in PDAC.
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Affiliation(s)
- R Nicolle
- Tumor Identity Card Program (CIT), French League Against Cancer, Paris, France
| | - O Gayet
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France
| | - M Bigonnet
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France
| | - J Roques
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France
| | - B Chanez
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Paoli-Calmettes Institut, Marseille, France
| | - F Puleo
- Laboratory of Experimental Gastroenterology (Université Libre de Bruxelles), Brussels, Belgium; Department of Gastroenterology and Digestive Oncology, Delta Hospital, Center Hospitalier Interregional Edith Cavell, Brussels, Belgium
| | - J Augustin
- Department of Pathology, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - J F Emile
- Ambroise Paré Hospital, Boulogne, AP-HP, Boulogne-Billancourt, France
| | - M Svrcek
- Department of Pathology, Saint-Antoine Hospital, Sorbonne University, UPMC University, Paris, France
| | - T Arsenijevic
- Laboratory of Experimental Gastroenterology (Université Libre de Bruxelles), Brussels, Belgium; Department of Gastroenterology and Digestive Oncology, Erasme Hospital, Brussels, Belgium
| | - P Hammel
- Department of Digestive Oncology, Paul Brousse Hospital, APHP, Villejuif, France
| | - V Rebours
- Université de Paris, Department of Pancreatology, Beaujon Hospital, APHP, Clichy, France
| | - M Giovannini
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Paoli-Calmettes Institut, Marseille, France
| | - P Grandval
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Université de Paris, Department of Pancreatology, Beaujon Hospital, APHP, Clichy, France
| | - L Dahan
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; La Timone Hospital, Marseille, France
| | - V Moutardier
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Nord Hospital, Marseille, France
| | - E Mitry
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Paoli-Calmettes Institut, Marseille, France
| | - J L Van Laethem
- Laboratory of Experimental Gastroenterology (Université Libre de Bruxelles), Brussels, Belgium; Department of Gastroenterology and Digestive Oncology, Erasme Hospital, Brussels, Belgium
| | - J B Bachet
- Department of Gastroenterology, Pitié-Salpetrière Hospital, Sorbonne University, UPMC University, Paris, France
| | - J Cros
- Université de Paris, Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - J Iovanna
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; Paoli-Calmettes Institut, Marseille, France
| | - N J Dusetti
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France.
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Hammel P, Carrier E, Carney M, Eisner M, Fleming T. A novel event-free survival endpoint in locally advanced pancreatic cancer. Ther Adv Med Oncol 2021; 13:17588359211059586. [PMID: 34868352 PMCID: PMC8640304 DOI: 10.1177/17588359211059586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The treatment paradigm for locally advanced pancreatic cancer (LAPC) is evolving rapidly. The development of neoadjuvant therapies composed of combination therapies and the evaluation of their impact on conversion to borderline resectable (BR) status, resection, and ultimately overall survival (OS) are presently being pursued. These efforts justify re-visiting study endpoints in order to better predict therapeutic effects on OS, by capturing not only the achievement of R0 resection at the end of induction therapy but also the long-term reductions in the rate of local and distal recurrence. The proposed herein event-free survival (EFS) endpoint, with its novel definition specific to LAPC, is formulated to achieve these objectives. It is an analog to disease-free survival (DFS) endpoint in the adjuvant setting applied to the neoadjuvant setting and may be a valuable surrogate endpoint for this patient population.
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Affiliation(s)
- Pascal Hammel
- Digestive and Medical Oncology Department, Hospital Paul Brousse, University Paris-Saclay, 94800 Villejuif, France
| | - Ewa Carrier
- Department of Clinical Development, FibroGen, Inc., San Francisco, CA, USA
| | - Mairead Carney
- Department of Clinical Development, FibroGen, Inc., San Francisco, CA, USA
| | - Mark Eisner
- Department of Clinical Development, FibroGen, Inc., San Francisco, CA, USA
| | - Thomas Fleming
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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32
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Laks S, van Leeuwaarde R, Patel D, Keutgen XM, Hammel P, Nilubol N, Links TP, Halfdanarson TR, Daniels AB, Tirosh A. Management recommendations for pancreatic manifestations of von Hippel-Lindau disease. Cancer 2021; 128:435-446. [PMID: 34735022 DOI: 10.1002/cncr.33978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/26/2022]
Abstract
Von Hippel-Lindau disease (VHL) is a multineoplasm inherited disease manifesting with hemangioblastoma of the central nervous system and retina, adrenal pheochromocytoma, renal cell carcinoma, pancreatic neuroendocrine tumors and cysts, and neoplasms/cysts of the ear, broad ligament, and testicles. During 2018-2020, the VHL Alliance gathered several committees of experts in the various clinical manifestations of VHL to review the literature, gather the available evidence on VHL, and develop recommendations for patient management. The current report details the results of the discussion of a group of experts in the pancreatic manifestations of VHL along with their proposed recommendations for the clinical surveillance and management of patients with VHL. The recommendations subcommittee performed a comprehensive systematic review of the literature and conducted panel discussions to reach the current recommendations. The level of evidence was defined according to the Shekelle variation of the Grading of Recommendations, Assessment, Development, and Evaluation grading system. The National Comprehensive Cancer Network Categories of Evidence and Consensus defined the committee members' interpretation of the evidence and degree of consensus. The recommendations encompass the main aspects of VHL-related pancreatic manifestations and their clinical management. They are presented in a clinical orientation, including general planning of screening and surveillance for pancreatic neuroendocrine tumors, utility of biochemical biomarkers, the optimal choice for imaging modality, indirect risk stratification, indications for tissue sampling of VHL-related pancreatic neuroendocrine tumors, and interventions. These recommendations are designed to serve as the reference for all aspects of the screening, surveillance, and management of VHL-related pancreatic manifestations.
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Affiliation(s)
- Shachar Laks
- Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dhaval Patel
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xavier M Keutgen
- Division of Endocrine Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Pascal Hammel
- Department of Digestive and Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Naris Nilubol
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Thera P Links
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amit Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuroendocrine Tumors Service, VHL Clinical Care Center, Endocrine Oncology Genomics Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel
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de Malet A, Svrcek M, Kerbaol A, Theou-Anton N, Granier S, Dokmak S, Paye F, André T, de Mestier L, Cros J, Hammel P. Ovarian metastases of pancreatic adenocarcinoma: clinical presentation, role of surgery, and potential value of the mutational profile for the differential diagnosis with primary mucinous ovarian carcinoma. Ther Adv Med Oncol 2021; 13:17588359211053412. [PMID: 34721673 PMCID: PMC8554549 DOI: 10.1177/17588359211053412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Ovarian metastases (OM) of pancreatic adenocarcinoma (PA) (OM-PA) can mimic primary ovarian mucinous carcinoma (POMC) on imaging and histology. These metastases are often symptomatic and not highly chemosensitive, so that oophorectomy may be considered. Aims: The aims of this study were to compare the characteristics of OM-PA and POMC, and discuss the role of surgery. Patients and Methods: Clinical, imaging, and histological data of patients with OM-PA and POMC (2000–2017) in three tertiary centers were reviewed. Twenty-six genes were analyzed by next generation sequencing (NGS) on both primary PA and OM-PA. Results: Twenty-two women with OM-PA (n = 13, 11 with surgical resection) or POMC (n = 9) were selected. OM-PA were smaller than POMC (p = 0.02); imaging, histological, and immunohistochemistry data did not clearly differentiate OM-PA from POMC in 12 of 22 cases (54%). Seven PA/OM-PA pairs were analyzed, and a concordant KRAS mutation was identified in all cases. In four OM-PA, concordant mutations were also found in TP53 (n = 3), SMAD4 (n = 1), MET (n = 1), and PDGFRA (n = 1) genes. The aim of oophorectomy in 11 OM-PA was for antalgic (n = 6) or curative (n = 5) intent. Pain improved in 4/6 of the former patients, but 2/6 had significant morbidity, and 2/6 died of rapid tumor progression. After oophorectomy, median progression-free and overall survivals were 6 (0–11) and 8 months (1–131), respectively. Conclusion: Analysis of mutation profiles in both primary PA and ovarian tumors, especially KRAS, can help to determine the pancreatic origin of OM-PA. Surgical resection of OM-AP in highly selected patients may improve pelvic symptoms but may also cause significant morbidity. The benefit to survival requires further studies.
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Affiliation(s)
- Alice de Malet
- Digestive and Medical Oncology, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université of Paris Saclay, Villejuif, France
| | - Magali Svrcek
- Department of Pathology, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Sorbonne, Paris, France
| | - Anne Kerbaol
- Radiology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Clichy, France
| | - Nathalie Theou-Anton
- Biochemistry and Genetics, Bichat Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Sandra Granier
- Digestive and Medical Oncology, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université of Paris Saclay, Villejuif, France
| | - Safi Dokmak
- Digestive Surgery, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Clichy, France
| | - François Paye
- Digestive Surgery, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Sorbonne, Paris, France
| | - Thierry André
- Digestive Oncology, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Sorbonne, Paris, France
| | - Louis de Mestier
- Gastroenterology-Pancreatology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Clichy, France
| | - Jérôme Cros
- Pathology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Clichy, France
| | - Pascal Hammel
- Digestive and Medical Oncology, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université of Paris Saclay, 12 avenue Paul Vaillant-Couturier, 94800 Villejuif, France
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Breton C, Meyer A, Malka D, Matias M, De Baere T, Hammel P, Sa Cunha A, Lucchese A, Fuks D, Coriat R, Gallois C, Touchefeu Y, Maillet M, Trouilloud I, Rompteaux P, Carbonnel F, Soularue E. Local treatment of pancreatic cancer metastases: A multicenter French study of the AGEO group. Clin Res Hepatol Gastroenterol 2021; 45:101607. [PMID: 33662776 DOI: 10.1016/j.clinre.2020.101607] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/14/2020] [Accepted: 12/06/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study reports the efficacy and safety of local treatment of metastases of pancreatic ductal adenocarcinoma (PDAC), with a curative intent. METHODS We retrospectively included patients with histologically proven PDAC, who underwent a local treatment for metastases between January 1, 2000 and December 31, 2017, from 11 French hospitals. Complications of local treatment were reported. Univariate Cox models were performed to identify prognosis factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS We included 52 patients treated for 68 metastases; 33 (64%) of whom had metachronous metastases. Metastatic sites treated were: 39 (57%) hepatic, 18 (27%) pulmonary and 11 (16%) others. Metastases treatments were: 45 (66%) surgery, 9 (13%) radiofrequency and 14 (21%) other procedures. The rates of severe complications and mortality were respectively 10% and 4%. The median OS and DFS after local treatment were 36.5 months and 12.7 months, respectively. Prognosis factors associated with a shorter OS were: liver metastases when compared with lung metastases (HR 4.04; 95%CI: 1.18-13.81), N2 status of primary pancreatic tumor when compared to N0-N1 (HR 9.43; 95%CI: 2.44-36.36) and synchronous metastases when compared to metachronous metastases (HR 2.34; 95%CI: 1.05-5.23). N2 status of primary pancreatic tumor was associated with a shorter DFS when compared to N0-N1 (HR 2.82; 95%CI: 1.05-7.58). CONCLUSION In this series of highly selected patients, local treatment of metastases from PDAC is associated with prolonged survival. The rate of severe complications was low. Factors associated with shorter OS were liver metastases, N2 status and synchronous metastases.
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Affiliation(s)
- Clémence Breton
- Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Antoine Meyer
- Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - David Malka
- Department of Medical Oncology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Margarida Matias
- Department of Medical Oncology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Thierry De Baere
- Department of Radiology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Pascal Hammel
- Department of Oncology, Beaujon Hospital AP-HP, Paris University, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Antonio Sa Cunha
- Department of Digestive Surgery, Hepatobiliary Center of Paul Brousse APHP, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Angelica Lucchese
- Department of Digestive Surgery, Hepatobiliary Center of Paul Brousse APHP, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - David Fuks
- Department of Digestive Surgery, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
| | - Romain Coriat
- Department of Gastro-enterology, Cochin Hospital AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Claire Gallois
- Department of Hepato-Gastroenterology and Gastrointestinal Oncology, European Georges Pompidou Hospital AP-HP, Paris University, 20 Rue Leblanc, 75015 Paris, France
| | - Yann Touchefeu
- Department of Gastroenterology, Nantes University Hospital, 5 Allée de L'île Gloriette, 44000 Nantes, France
| | - Marianne Maillet
- Department of Gastroenterology, Saint-Louis Hospital AP-HP, Paris University,1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Isabelle Trouilloud
- Department of Medical Oncology, Saint-Antoine Hospital AP-HP, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Pierre Rompteaux
- Department of Gastroenterology, Avicenne Hospital AP-HP, Sorbonne University, 125 Rue de Stalingrad, 93000 Bobigny, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Emilie Soularue
- Department of Oncology, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
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Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Bordia S, McGuinness D, Cui K, Locker G, Kindler H. 1468P POLO: Subsequent therapy after maintenance olaparib in patients with a germline BRCA mutation and metastatic pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Arnold D, Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla Mercade T, Hall M, Park J, Hochhauser D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O'Reilly E, Bordia S, McGuinness D, Cui K, Locker G, Kindler H. 1467P POLO: Long-term safety and tolerability of olaparib for patients with a germline BRCA mutation and metastatic pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Perkhofer L, Golan T, Cuyle PJ, Matysiak-Budnik T, Van Laethem JL, Macarulla T, Cauchin E, Kleger A, Beutel AK, Gout J, Stenzinger A, Van Cutsem E, Bellmunt J, Hammel P, O’Reilly EM, Seufferlein T. Targeting DNA Damage Repair Mechanisms in Pancreas Cancer. Cancers (Basel) 2021; 13:4259. [PMID: 34503069 PMCID: PMC8428219 DOI: 10.3390/cancers13174259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022] Open
Abstract
Impaired DNA damage repair (DDR) is increasingly recognised as a hallmark in pancreatic ductal adenocarcinoma (PDAC). It is estimated that around 14% of human PDACs harbour mutations in genes involved in DDR, including, amongst others, BRCA1/2, PALB2, ATM, MSH2, MSH6 and MLH1. Recently, DDR intervention by PARP inhibitor therapy has demonstrated effectiveness in germline BRCA1/2-mutated PDAC. Extending this outcome to the significant proportion of human PDACs with somatic or germline mutations in DDR genes beyond BRCA1/2 might be beneficial, but there is a lack of data, and consequently, no clear recommendations are provided in the field. Therefore, an expert panel was invited by the European Society of Digestive Oncology (ESDO) to assess the current knowledge and significance of DDR as a target in PDAC treatment. The aim of this virtual, international expert meeting was to elaborate a set of consensus recommendations on testing, diagnosis and treatment of PDAC patients with alterations in DDR pathways. Ahead of the meeting, experts completed a 27-question survey evaluating the key issues. The final recommendations herein should aid in facilitating clinical practice decisions on the management of DDR-deficient PDAC.
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Affiliation(s)
- Lukas Perkhofer
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (A.K.); (A.K.B.); (J.G.)
| | - Talia Golan
- Oncology Institute, Sheba Medical Center, Tel Aviv University, Tel Aviv 52621, Israel;
| | - Pieter-Jan Cuyle
- Digestive Oncology Department, Imelda General Hospital, 2820 Bonheiden, Belgium;
- University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium;
| | - Tamara Matysiak-Budnik
- IMAD, Department of Gastroenterology and Digestive Oncology, Hôtel Dieu, CHU de Nantes, 44000 Nantes, France; (T.M.-B.); (E.C.)
| | - Jean-Luc Van Laethem
- GI Cancer Unit, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Teresa Macarulla
- Vall d’Hebrón University Hospital and Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain;
| | - Estelle Cauchin
- IMAD, Department of Gastroenterology and Digestive Oncology, Hôtel Dieu, CHU de Nantes, 44000 Nantes, France; (T.M.-B.); (E.C.)
| | - Alexander Kleger
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (A.K.); (A.K.B.); (J.G.)
| | - Alica K. Beutel
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (A.K.); (A.K.B.); (J.G.)
| | - Johann Gout
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (A.K.); (A.K.B.); (J.G.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium;
| | - Joaquim Bellmunt
- Medical Oncology, University Hospital del Mar, 08003 Barcelona, Spain;
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | - Eileen M. O’Reilly
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
- Department of Medicine, David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Thomas Seufferlein
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (A.K.); (A.K.B.); (J.G.)
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Giraud P, Racadot S, Vernerey D, Goldstein D, Glimelius B, Van Houtte P, Gubanski M, Spry N, Van Laethem JL, Hammel P, Huguet F. Investigation of Relation of Radiation Therapy Quality With Toxicity and Survival in LAP07 Phase 3 Trial for Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:993-1002. [PMID: 33561507 DOI: 10.1016/j.ijrobp.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The LAP07 multicenter randomized study assessed whether chemoradiation therapy increases overall survival versus continuation chemotherapy in patients whose locally advanced pancreatic cancer was controlled after 4 months of induction chemotherapy. This analysis investigated whether failure to adhere to radiation therapy (RT) guidelines influenced survival and toxicity. METHODS AND MATERIALS This is a planned analysis of secondary objectives in the framework of a randomized international phase 3 trial. The protocol included detailed written RT guidelines. All participating institutions undertook an initial benchmark case to check adherence to protocol guidelines. Centers with major deviation were not allowed to include patients until they achieved a significant improvement and rigorously followed the guidelines. On-trial RT quality assurance consisted of a central review of treatment plan with dose-volume histograms for each patient. Adherence to guidelines was graded as per protocol (PP), minor deviation (MiD), or major deviation (MaD). RESULTS Fifty-seven benchmark cases were evaluated, 26% were classified as PP, 60% were MiD, and 14% were MaD. Among the 442 included patients, 133 patients were randomized in the chemoradiation therapy arm, and 117 patients were assessable for RT quality analysis. RT quality was graded as PP in 38.5% of patients, MiD in 43.6% of patients, and MaD in 17.9% of patients. The most frequent protocol violations were dose distribution heterogeneities. Median overall survival was 17 months with PP and MiD versus 13.4 months with MaD (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.99-2.71; P = .055). There was no difference in terms of progression-free survival (HR, 1.09; 95% CI, 0.66-1.8; P = .72). Patients with MaD had more nausea than patients treated PP or with MiD (P = .0045). CONCLUSIONS MaD was associated with a trend for worst survival. There was no difference in terms of progression-free survival. Because of the low rate of major deviations, their effects on the LAP07 trial results may be negligeable.
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Affiliation(s)
- Paul Giraud
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit (EA 3181) and Quality of Life and Cancer Clinical Research Platform, CHU de Besançon, Besançon, France
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Paul Van Houtte
- Department of Radiation Oncology, Institut Jules-Bordet, Brussels, Belgium
| | - Michael Gubanski
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Jean Luc Van Laethem
- Department of Gastroenterology and Gastrointestinal cancer Unit, Erasme Hospital, Université Libre Bruxelles, Brussels, Belgium
| | - Pascal Hammel
- Service de Gastroentérologie-Pancréatologie, Beaujon Hospital, AP-HP, Clichy, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France.
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Schernberg A, Vernerey D, Goldstein D, Van Laethem JL, Glimelius B, van Houtte P, Bonnetain F, Louvet C, Hammel P, Huguet F. Predictive Value of Neutrophils Count for Local Tumor Control After Chemoradiotherapy in Patients With Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:1022-1031. [PMID: 33548338 DOI: 10.1016/j.ijrobp.2021.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Baseline neutrophil count may predict overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC). METHODS AND MATERIALS The international multicenter randomized LAP07 phase 3 trial has enrolled 442 patients with LAPC. We analyzed the prognostic value of both baseline neutrophilia (neutrophil count >7 g/L) and elevated or increasing neutrophil count as (1) neutrophilia or (2) increased absolute neutrophil count after induction chemotherapy versus baseline for OS, progression-free survival, and local control (LC). A Cox proportional hazard model was used to assess elevated or increasing neutrophil count status by randomly assigned treatment interactions for each endpoint. RESULTS Among the 442 patients, 47 patients (11%) with baseline neutrophilia had worse OS (median 8.9 vs 13.3 months; P = .01). After induction chemotherapy, among the 235 patients whose blood counts were available, 90 patients (38%) had elevated or increasing neutrophil count associated with poorer OS in univariate (median 14.4 vs 17.9 months; P = .001) and multivariate analysis (P = .004). Elevated or increasing neutrophil count was also predictive of a decreased benefit of chemoradiation therapy on LC. In 126 patients without elevated or increasing neutrophil count, 1-year LC was 80% in the chemoradiation arm versus 54% in the chemotherapy arm (P < .001; interaction test P = .015). CONCLUSIONS In this study, baseline neutrophilia and increased absolute neutrophil count were associated with worse OS in this large series of patients with LAPC. In addition, the counts were an independent prognosis factor and a strong predictive LC biomarker for chemoradiation therapy benefit. An assessment of neutrophils counts can help to improve the selection of patients who might benefit from chemoradiation therapy after induction chemotherapy.
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Affiliation(s)
| | - Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France
| | - David Goldstein
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | | | - Bengt Glimelius
- Department of Oncology, University of Uppsala, Akademiska Sjukhuset, Sweden
| | | | - Franck Bonnetain
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
| | - Christophe Louvet
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Hammel
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Service d'Oncologie Digestive, Hôpital Beaujon, Clichy, France
| | - Florence Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Paris, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
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Oh DY, Park JO, Kindler HL, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall MJ, Arnold D, Reinacker-Schick A, Tortora G, Algul H, O'Reilly EM, McGuiness D, Liu YZ, Cui K, Schlienger K, Locker GY, Golan T. MO31-6 Maintenance olaparib in Asian patients with germline BRCA-mutated metastatic pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.643] [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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41
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Taieb J, Hammel P, Reni M, Palmer D, Bridgewater J, Cubillo A, Prager G, Bayle S, Hédouin-Biville F, Teng Z, Seufferlein T, Macarulla T. SO-3 Treatment sequences and prognostic factors in metastatic pancreatic ductal adenocarcinoma: Univariate and multivariate analyses of a real-world study in Europe. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pignon F, Turpin A, Hentic O, Coriat R, Salmon E, Baumgaertner I, Bertrand N, Lévy P, Rebours V, Hammel P, de Mestier L. Efficacy and tolerance of gemcitabine and nab-paclitaxel in elderly patients with advanced pancreatic ductal adenocarcinoma. Pancreatology 2021; 21:S1424-3903(21)00157-5. [PMID: 34090806 DOI: 10.1016/j.pan.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The efficacy and safety of gemcitabine and nab-paclitaxel (GnP) among elderly patients with advanced pancreatic ductal adenocarcinoma (PDAC) remains poorly understood. We aimed to evaluate the safety and efficacy of GnP in this setting. PATIENTS AND METHODS We retrospectively included all consecutive patients aged ≥65 years with histologically proven PDAC who received at least one cycle of GnP (January 2014 to May 2018) in four academic centers. The primary endpoints were toxicity and overall survival (OS). Secondary endpoints were progression-free survival (PFS) and objective response rate. We compared patients aged ≥ or <75 years. RESULTS The study included 127 patients; among them 42 (33.1%) were aged ≥ 75 years. Fifty-seven and seventy patients received GnP as the first-line and the second-line treatment or beyond, respectively. Sixty-seven patients had at least one grade 3/4 adverse event, the most frequent being neutropenia and peripheral neuropathy. No deaths were related to toxicity. OS (median, 8.0 months; 95% confidence interval (CI), 5.8-10.2) and PFS (median, 5.5 months; 95% CI, 4.8-6.2) were similar for patients aged <75 or ≥75 years in the whole cohort and among patients receiving GnP as the first-line treatment. Cephalic PDAC, liver metastases, hypoalbuminemia, and GnP received beyond the first-line were associated with a significantly shorter OS on the multivariate analysis. CONCLUSION GnP is well tolerated and effective in elderly patients with advanced PDAC, even patients aged ≥75 years. The data from daily clinical practice are consistent with the results reported with first-line treatment and highlight the relevance of GnP administration in elderly patients.
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Affiliation(s)
- Flore Pignon
- Université de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital (APHP), Clichy, France; Department of Medical Oncology, Oscar Lambret Cancer Center, F-59000 Lille, France
| | - Anthony Turpin
- Department of Oncology, Lille University Hospital; CNRS UMR9020, INSERM UMR1277, University of Lille, Institut Pasteur, Lille, France
| | - Olivia Hentic
- Université de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital (APHP), Clichy, France
| | - Romain Coriat
- Université de Paris, Department of Hepato-Gastroenterology and Digestive Oncology, Cochin University Hospital (APHP), Paris, France
| | - Emma Salmon
- Department of Hepato-Gastroenterology and Digestive Oncology, Bayonne, France
| | | | - Nicolas Bertrand
- Department of Oncology, Lille University Hospital, ULR 2694 METRICS, University of Lille, Lille, France
| | - Philippe Lévy
- Université de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital (APHP), Clichy, France
| | - Vinciane Rebours
- Université de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital (APHP), Clichy, France
| | - Pascal Hammel
- Université de Paris, Department of Digestive Oncology, Beaujon University Hospital (APHP), Clichy, France
| | - Louis de Mestier
- Université de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital (APHP), Clichy, France.
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Saillard C, Delecourt F, Schmauch B, Moindrot O, Svrcek M, Bardier-Dupas A, Emile JF, Ayadi M, De Mestier L, Hammel P, Neuzillet C, Bachet JB, Iovanna J, Nelson DJ, Paradis V, Zaslavskiy M, Kamoun A, Courtiol P, Nicolle R, Cros J. Identification of pancreatic adenocarcinoma molecular subtypes on histology slides using deep learning models. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
4141 Background: Pancreatic adenocarcinoma (PAC) is predicted to be the second cause of death by cancer in 2030 and its prognosis has seen little improvement in the last decades. PAC is a very heterogeneous tumor with preeminent stroma and multiple histological aspects. Omic studies confirmed its molecular heterogeneity, possibly one of the main factors explaining the failure of most clinical trials. Two and three transcriptomic subtypes of tumor cells and stroma respectively, were described with major prognostic and predictive implications. The tumor subtypes, Basal-like and Classical, have been shown by several groups to be predictive of the response to first line chemotherapy. As of today, these subtypes can only be defined by RNA profiling which is limited by the quantity and quality of the samples (formalin fixation and low cellularity) as well as by the analytical delay that may restrict its application in routine care. In addition, tumors may harbor a mixture of several subtypes limiting their interpretation using bulk transcriptomic approaches and thereby their clinical use. Here, we propose a multistep approach using deep learning models to predict tumor components and their molecular subtypes on routine histological preparations. Methods: 728 whole-slide digitized histological slides corresponding to 350 consecutive resected PAC from four centers with clinical and transcriptomic data were assembled and used as a discovery set. PAC from TCGA (n = 134) was used as a validation set. Tumor regions from slides of the discovery set were annotated to train a multistep deep learning model that first recognizes tumor tissue and then predicts tumor and stroma cells molecular subtypes assessed by the published PurIST algorithm. Results: The tumor detection model was very efficient (AUC = 0.98 in the TCGA validation cohort). In the discovery set, the Basal-like/Classical classification performance of the model by cross validation was 0.79 (AUC) and reached 0.86 when restricted to samples with a high-confidence RNA-defined molecular subtype.Subtypes defined by the model were independently associated with overall survival in multivariate analysis (HR = 2.56 [1.87 - 3.49], pval < 0.001), and association was higher relatively to PurIST RNA subtypes (HR = 1.60 [1.17 - 2.19] pval < 0.001). In the validation cohort, the model had an overall AUC of 0.82, and 0.89 in the subset of “subtype-pure” tumors. In addition to demonstrating the value of histology-based deep learning models for tumor subtyping in PAC, these results also show the limit of molecular-based subtyping in highly heterogeneous samples. Conclusions: This study provides the first PAC subtyping tool usable worldwide in clinical practice, finally opening the possibility of patient molecular stratification in routine care and clinical trials.
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Affiliation(s)
| | | | | | | | - Magali Svrcek
- Pathology Department, Sorbonne Université, Saint-Antoine Hospital, APHP, Paris, France
| | | | - Jean Francois Emile
- Service d’Anatomie Pathologique Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Mira Ayadi
- Ligue Nationale Contre le Cancer, Paris, France
| | - Louis De Mestier
- Department of Hepato-Gastroenterology, Beaujon University Hospital, Clichy, France
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | | | | | - Juan Iovanna
- Inserm U624 Stress Cellulaire, Marseille, France
| | | | - Valerie Paradis
- Department of Pathology, Beaujon University Hospital, Clichy, France
| | | | | | | | | | - Jerome Cros
- APHP-INSERM U1149 Universite Paris Diderot, Clichy, France
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McLellan P, Henriques J, Ksontini F, Doat S, Hammel P, Desrame J, Trouilloud I, Louvet C, Pietrasz D, Vernerey D, Bachet JB. Prognostic value of the early change in neutrophil-to-lymphocyte ratio in metastatic pancreatic adenocarcinoma. Clin Res Hepatol Gastroenterol 2021; 45:101541. [PMID: 33055007 DOI: 10.1016/j.clinre.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/30/2020] [Accepted: 08/31/2020] [Indexed: 02/04/2023]
Abstract
In metastatic pancreatic adenocarcinoma, a high neutrophil-to-lymphocyte ratio (NLR) at diagnosis is a marker of poor prognosis. The prognostic role of baseline NLR and NLR change during first-line chemotherapy were determined. We conducted a retrospective study by using data from a single-center prospective cohort and a randomized open-label, multicenter, randomized trial. Two hundred and twelve patients were analyzed. Baseline NLR>5 was an independent marker of poor prognosis for overall survival (HR=2.01, 95% CI 1.33-3.05; P=0.001) and progression-free survival (PFS; HR=1.80, 95% CI 1.23-2.65; P=0.0026). According to NLR dynamics (n=172), patients with NLR≤5 on days 1 and 15 had a significantly better prognosis than those with NLR≤5 on day 1 and NLR>5 on day 15 (HR=2.23, 95% CI 1.18-4.21; P=0.013), NLR >5 on day 1 and NLR ≤5 on day 15 (HR=3.25, 95% CI 1.86-5.68; P<0.001), and NLR>5 on days 1 and 15 (HR=3.37, 95% CI 1.93-5.90; P<0.001). Over time, bad responders (PFS <6 months) had significantly higher mean NLR than good responders (PFS>6 months; group effect: P<0.0001). Seven out of eight patients with baseline NLR>5 had circulating tumor DNA. This study confirmed the independent prognostic value of baseline NLR >5 in metastatic pancreatic cancer. The change in NLR early during chemotherapy was also a prognostic indicator in patients with NLR ≤5.
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Affiliation(s)
- Paul McLellan
- Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; Department of Hepato-Gastroenterology, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital 75013, APHP, Paris, France
| | - Julie Henriques
- Department of Methodology and Quality of Life Oncology, University Hospital, 3 Boulevard Alexandre Fleming, 25000 Besancon, France; Bourgogne Franche-Comté Université, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 8 rue du Docteur Jean-François-Xavier Girod, 25020 Besançon, France
| | - Feryel Ksontini
- Department of Oncology, Institute Salah-Azaïz, Boulevard du 9 avril 1938, 1006 Tunis, Tunisia
| | - Solène Doat
- Department of Hepato-Gastroenterology, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital 75013, APHP, Paris, France
| | - Pascal Hammel
- Department of Digestive Oncology, Hôpital Beaujon, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Jérome Desrame
- Department of Gastroenterology, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008 Lyon, France
| | - Isabelle Trouilloud
- Department of Oncology, Hôpital Saint-Antoine, 186 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Christophe Louvet
- Department of Oncology, Institut Mutualiste Montsouris, 54 avenue Jourdan, 75014 Paris, France
| | - Daniel Pietrasz
- Department of Hepato-Pancreato-Biliary Surgery, CHB, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Dewi Vernerey
- Department of Methodology and Quality of Life Oncology, University Hospital, 3 Boulevard Alexandre Fleming, 25000 Besancon, France; Bourgogne Franche-Comté Université, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 8 rue du Docteur Jean-François-Xavier Girod, 25020 Besançon, France
| | - Jean-Baptiste Bachet
- Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; Department of Hepato-Gastroenterology, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital 75013, APHP, Paris, France.
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45
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Golan T, Hammel P. Management of BRCA Mutation Carriers With Pancreatic Adenocarcinoma. J Natl Compr Canc Netw 2021; 19:469-473. [PMID: 33845459 DOI: 10.6004/jnccn.2021.7031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, with a 5-year survival rate of ≤7% across all stages. Most patients are diagnosed with advanced disease and median overall survival is limited. The limited success of conventional therapies for PDAC is at least partially attributable to its genetic heterogeneity. Extensive genomic efforts have been made to subtype PDAC. The DNA damage repair (DDR) deficiency subtype, also known as unstable genome/DSBR (DNA double-strand break repair) subtype, is one of the most clinically relevant biologic abnormalities in PDAC. Increased PDAC risk was found to be associated with inherited syndromes, which are present in approximately 10% of patients with PDAC. Recent updates to the ASCO and NCCN guidelines recommend risk assessment for all individuals with PDAC, irrespective of personal or family history or ethnicity. Germline BRCA mutations associated with DNA repair dysfunction is one of the best illustrations of actionable biologic subtypes in PDAC. This genetic alteration can indeed be targeted by PARP inhibitors (PARPi). Treatment implications for germline BRCA carriers with PDAC include the use of platinum-based therapy and the validation of PARPi administration as a maintenance strategy in platinum-sensitive patients. In the era of precision medicine, this is the first convincing example of targeting identified germline hereditary mutations in PDAC.
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Affiliation(s)
- Talia Golan
- 1Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv Israel; and
| | - Pascal Hammel
- 2Oncology Department, Hôpital Paul Brousse (AP-HP), Villejuif; and.,3Université Paris-Saclay, Cachan, France
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Hilmi M, Cros J, Puleo F, Augustin J, Emile JF, Svrcek M, Hammel P, Arsenijevic T, Van Laethem JL, Bachet JB, Nicolle R. Tumour and stroma RNA signatures predict more accurately distant recurrence than clinicopathological factors in resected pancreatic adenocarcinoma. Eur J Cancer 2021; 148:171-180. [PMID: 33743485 DOI: 10.1016/j.ejca.2021.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few patients with pancreatic adenocarcinoma (PAC) are eligible for surgery. Patients with early relapse have a poor prognosis and might be better candidates for a medical approach. Clinical and pathological parameters only partially predict recurrence and are only obtained after surgery. PAC subtypes based on gene expression were proposed, and we assessed if they could predict the risk and type of recurrence independently of clinicopathological parameters. METHODS Patients with curative-intent surgery for PAC without pretreatment were selected and divided into two independent cohorts defined as discovery (n = 381) and validation (n = 149) cohorts. Transcriptomic analyses were performed on formalin-fixed paraffin-embedded surgical samples to characterise tumour and stroma compartments using previously defined signatures. We associated molecular and clinicopathological characteristics with general, distant, and local recurrences using Cox regression analyses. RESULTS We found that tumour biology predicted distant recurrence contrary to local recurrence, which was directly related to resection margin status. Pure basal-like and stroma-activated subtypes were strongly associated with distant recurrence, independently of clinicopathological factors (hazard ratios [HRs] = 5.85, p < 0.001 and HR = 1.75, p = 0.007, respectively). By dissecting tumoural and stromal compartments, we demonstrated that the basal-like tumour component positively correlated with distant recurrence in both cohorts (HR = 1.45, p < 0.001 and HR = 1.90, p < 0.001), whereas the inactive structural stroma component was protective against distant recurrence (HR = 0.68, p < 0.001 and HR = 0.72, p < 0.001). CONCLUSIONS In addition to suggesting a different mechanism for local and distant relapse (incomplete resection and high metastatic potential, respectively), our results show the potency of molecular phenotype to predict patient outcome regarding distant recurrences.
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Affiliation(s)
- Marc Hilmi
- Programme Cartes D'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France.
| | - Jérôme Cros
- Department of Pathology, Assistance Publique Hopitaux de Paris, Beaujon Hopsital, INSERM U1149, Université de Paris, Clichy, France
| | - Francesco Puleo
- Department of Gastroenterology and Medical Oncology, Delta Hospital CHIREC, Brussels, Belgium
| | - Jeremy Augustin
- Department of Pathology, Assistance Publique Hopitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Jean-Francois Emile
- Department of Pathology, Assistance Publique Hopitaux de Paris, Ambroise Paré Hospital, Université de Versailles Saint Quentin-En-Yvelines, Boulogne-Billancourt, France
| | - Magali Svrcek
- Department of Pathology, Assistance Publique Hopitaux de Paris, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - Pascal Hammel
- Department of Pancreatology, Assistance Publique Hopitaux de Paris, Beaujon Hopsital, University Paris VII, Clichy, France
| | - Tatjana Arsenijevic
- Department of Gastroenterology and Medical Oncology, Hôpital Erasme and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Medical Oncology, Hôpital Erasme and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology, Assistance Publique Hopitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Remy Nicolle
- Programme Cartes D'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
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47
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Pujol P, Barberis M, Beer P, Friedman E, Piulats JM, Capoluongo ED, Garcia Foncillas J, Ray-Coquard I, Penault-Llorca F, Foulkes WD, Turnbull C, Hanson H, Narod S, Arun BK, Aapro MS, Mandel JL, Normanno N, Lambrechts D, Vergote I, Anahory M, Baertschi B, Baudry K, Bignon YJ, Bollet M, Corsini C, Cussenot O, De la Motte Rouge T, Duboys de Labarre M, Duchamp F, Duriez C, Fizazi K, Galibert V, Gladieff L, Gligorov J, Hammel P, Imbert-Bouteille M, Jacot W, Kogut-Kubiak T, Lamy PJ, Nambot S, Neuzillet Y, Olschwang S, Rebillard X, Rey JM, Rideau C, Spano JP, Thomas F, Treilleux I, Vandromme M, Vendrell J, Vintraud M, Zarca D, Hughes KS, Alés Martínez JE. Clinical practice guidelines for BRCA1 and BRCA2 genetic testing. Eur J Cancer 2021; 146:30-47. [PMID: 33578357 DOI: 10.1016/j.ejca.2020.12.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
BRCA1 and BRCA2 gene pathogenic variants account for most hereditary breast cancer and are increasingly used to determine eligibility for PARP inhibitor (PARPi) therapy of BRCA-related cancer. Because issues of BRCA testing in clinical practice now overlap with both preventive and therapeutic management, updated and comprehensive practice guidelines for BRCA genotyping are needed. The integrative recommendations for BRCA testing presented here aim to (1) identify individuals who may benefit from genetic counselling and risk-reducing strategies; (2) update germline and tumour-testing indications for PARPi-approved therapies; (3) provide testing recommendations for personalised management of early and metastatic breast cancer; and (4) address the issues of rapid process and tumour analysis. An international group of experts, including geneticists, medical and surgical oncologists, pathologists, ethicists and patient representatives, was commissioned by the French Society of Predictive and Personalised Medicine (SFMPP). The group followed a methodology based on specific formal guidelines development, including (1) evaluating the likelihood of BRCAm from a combined systematic review of the literature, risk assessment models and expert quotations, and (2) therapeutic values of BRCAm status for PARPi therapy in BRCA-related cancer and for management of early and advanced breast cancer. These international guidelines may help clinicians comprehensively update and standardise BRCA testing practices.
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Affiliation(s)
- Pascal Pujol
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France; CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France.
| | | | - Philp Beer
- Wellcome Trust Sanger institute, Cambridge, United Kingdom; Glasgow Precision Oncology Laboratory, United Kingdom.
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Josep M Piulats
- Unidad Funcional de Cáncer de Próstata, Servicio de Oncología Médica, Hospital Universitari de Bellvitge-Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain; Servicio de Oncología Médica, Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain.
| | - Ettore D Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università Federico II, CEINGE Biotecnologie Avanzate, Naples, 80145, Italy.
| | - Jesus Garcia Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Diaz-UAM, Madrid, Spain.
| | - Isabelle Ray-Coquard
- Oncologie Médicale, Centre Leon Bérard; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F - 69003, Lyon, France.
| | - Frédérique Penault-Llorca
- Department of Biology and Pathology, Centre Jean Perrin, Clermont Ferrand, France; UMR INSERM 1240, Université Clermont Auvergne, Clermont Ferrand, France.
| | - William D Foulkes
- McGill University, Division of Medical Genetics, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Genomics England, Queen Mary University of London, London, UK; Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Helen Hanson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
| | - Steven Narod
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada; Canada Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Banu K Arun
- Anderson Cancer Center, The University of Texas, Department of Breast Medical Oncology, Division of Cancer Medicine, USA.
| | | | - Jean-Louis Mandel
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France; Université de Strasbourg, Illkirch, France.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
| | - Diether Lambrechts
- Laboratory of Translational Genetics (VIB-KU Leuven), ON IV Herestraat 49 - box 912, 3000, Leuven Belgium.
| | - Ignace Vergote
- Department of Gynaecologic Oncology University Hospitals Leuven, Gasthuisberg Herestraat 49, 3000 Leuven, Belgium.
| | - Michèle Anahory
- Pech de Laclause, Bathmanabane & Associés Law Firm, Paris, France.
| | - Bernard Baertschi
- French National Institute for Health and Medical Research (INSERM) Ethics Committee, France University of Geneva, Geneva, Switzerland.
| | - Karen Baudry
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Yves-Jean Bignon
- Department of Oncogenetics, Centre Jean Perrin, CBRV, Clermont-Ferrand, France; INSERM-U1240-Molecular Imaging and Theranostic Strategies (IMOST), Clermont-Ferrand, France.
| | - Marc Bollet
- Institut Hartmann, 4, rue Kléber, et Institut Rafael, 3 bd Bineau, 92309 Levallois-Perret cedex, France.
| | - Carole Corsini
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Olivier Cussenot
- CeRePP, Hopital Tenon, Paris, France; Sorbonne Université, Institut Universitaire de Cancérologie, GRC n°5 ONCOTYPE-URO, Hopital Tenon, APHP, Paris, France; Department of Urology, Assistance Publique- Hôpitaux de Paris, Hopital Tenon, Paris, France.
| | - Thibault De la Motte Rouge
- Inserm, Oncogenesis, Stress and Signaling, 35000 Rennes, France; Service d'oncologie médicale, CRLCC Eugène-Marquis, 35000 Rennes, France; UMR 1242, Inserm, Univ Rennes, CLCC Eugène Marquis, Rue Bataille Flandres Dunkerque, 35042, Rennes, France.
| | | | - Florence Duchamp
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | | | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Sud, Villejuif, France.
| | - Virginie Galibert
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France.
| | | | - Pascal Hammel
- Department of Pancreatology, Hôpital Beaujon (AP-HP), Université Denis Diderot-Paris VII, Clichy, France.
| | | | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France; Translational Research Unit, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France.
| | - Tatiana Kogut-Kubiak
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Pierre-Jean Lamy
- Institut d'analyse génomique-Imagenome, Labosud, Montpellier, France.
| | - Sophie Nambot
- Centre de Génétique et Centre de Référence Maladies Rares (Anomalies du Développement de l'Interrégion Est), Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France; Inserm UMR 1231 GAD (Génétique des Anomalies du Développement), Université de Bourgogne, Dijon, France; Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD), CHU Dijon Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France.
| | - Yann Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - Sylviane Olschwang
- Aix Marseille Université, INSERM GMGF UMR 1251, France; Département de Génétique Médicale, Hôpital Européen & Groupe Ramsay Générale de Santé, Hôpital Clairval, Aix Marseille Université, Marseille, France.
| | | | - Jean-Marc Rey
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Chloé Rideau
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Jean-Philippe Spano
- Department of Medical Oncology, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, Paris, France; Inserm UMRS 1136, Sorbonne Université, Paris, France.
| | - Frédéric Thomas
- IRD, CREEC et MIVE911 avenue Agropolis, BP 64501, Montpellier 34 394, France.
| | - Isabelle Treilleux
- Department of Pathology, Centre Léon Bérard, 28 rue Laënnec, 69373, Lyon Cédex 08, France.
| | | | - Julie Vendrell
- IRCM, INSERM 1194, Department of Pathology and Oncobiology, Laboratoire de biologie des tumeurs solides, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Michèle Vintraud
- Department of Radiotherapy, Hartmann Radiotherapy Center, Levallois-Perret, France.
| | - Daniel Zarca
- The Paris Breast Centre- L'Institut Français du Sein- 15 rue Jean Nicot, 75007, Paris, France.
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jose E Alés Martínez
- Medical Oncology Department, Hospital Nuestra Señora de Sonsoles, Ávila, Ávila, Spain.
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Nicolle R, Gayet O, Duconseil P, Vanbrugghe C, Roques J, Bigonnet M, Blum Y, Elarouci N, Armenoult L, Ayadi M, de Reyniès A, Puleo F, Augustin J, Emile J, Svrcek M, Arsenijevic T, Hammel P, Giovannini M, Grandval P, Dahan L, Moutardier V, Gilabert M, Van Laethem J, Bachet J, Cros J, Iovanna J, Dusetti N. A transcriptomic signature to predict adjuvant gemcitabine sensitivity in pancreatic adenocarcinoma. Ann Oncol 2021; 32:250-260. [DOI: 10.1016/j.annonc.2020.10.601] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
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Golan T, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall MJ, Park JO, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick AC, Tortora G, Algül H, O'Reilly EM, McGuinness D, Cui K, Schlienger K, Locker GY, Kindler HL. Overall survival from the phase 3 POLO trial: Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.378] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
378 Background: POLO is the first phase 3 trial to evaluate maintenance therapy with the poly(ADP-ribose) polymerase inhibitor (PARPi) olaparib (O) in patients with metastatic pancreatic cancer (mPaC) and a germline BRCA mutation ( gBRCAm) whose disease had not progressed on first-line platinum-based chemotherapy (PBC). POLO demonstrated that patients had significantly longer progression-free survival (PFS; primary endpoint) with maintenance O than with placebo (P; hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.35–0.82; p= 0.004). Herein, we present final overall survival (OS) data. Methods: POLO was a randomized, double-blind, placebo-controlled trial (NCT02184195) conducted at 119 sites in 12 countries. Eligible patients had mPaC without disease progression for ≥16 weeks on PBC and a deleterious or suspected deleterious gBRCAm. Patients were randomized 3:2 to O (300 mg tablet twice daily) or P. OS (time from randomization until death) was a key secondary endpoint assessed using a log-rank test. A multiple-testing procedure (MTP) was used, with alpha passed to OS owing to a significant PFS result. Time from randomization to second disease progression or death (PFS2), to discontinuation of treatment (TDT), and to initiation of first (TFST) or second (TSST) subsequent therapies following treatment discontinuation or death were secondary endpoints (log-rank test, not in MTP). Primary analysis of OS after 108 deaths; data cut-off (DCO) July 21 2020. Results: Ninety-two and 62 patients were randomized to O and P, respectively; those censored had a median follow-up of 31.3 months (mo) and 23.9 mo, respectively. At DCO, n = 13 remained on O; n = 2 on P. OS was similar for the O and P groups (median 19.0 and 19.2 mo, respectively; HR 0.83 favoring O; 95% CI 0.56–1.22; p= 0.3487). OS at 36 mo was 33.9% for O and 17.8% for P. Median PFS2 was 16.9 mo for O vs 9.3 mo for P (HR, 0.66; 95% CI 0.43–1.02; p= 0.0613). TFST, TSST and TDT were longer with O than P (Table). TDT at 24 mo was 24.3% for O vs 3.3% for P; at 36 mo was 17.2% for O vs 3.3% for P. Incidence of grade ≥3 adverse events (AEs) was 49% for O (anemia most common [12.2%]); 25% for P (anemia, hyperglycemia, upper abdominal pain most common [3.3%]). Treatment was discontinued owing to AEs for 8.9% patients in the O arm vs 1.6% for P. Conclusions: Although HR for OS was in favor of maintenance O vs P among patients with a gBRCAm and mPaC whose disease had not progressed during PBC, there was no statistically significant difference. PFS2 showed a clear trend for treatment benefit beyond disease progression in favor of O, but was not alpha protected. Safety data were consistent with the primary analysis. Clinical trial information: NCT02184195. [Table: see text]
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Affiliation(s)
- Talia Golan
- The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Michele Reni
- IRCCS Ospedale, San Raffaele Scientific Institute, Milan, Italy
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Teresa Macarulla
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Hana Algül
- Klinikum rechts der Isar, Comprehensive Cancer Center Munich TUM, Technische Universität, Munich, Germany
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50
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Schwartz LH, Kindler HL, Hammel P, Reni M, Van Cutsem E, Macarulla T, Hall MJ, Park JO, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick AC, Tortora G, Algül H, O'Reilly EM, Fromageau J, Ghiorghiu DC, McGuinness D, Locker GY, Golan T. POLO: Radiologic assessment of the impact of maintenance olaparib in patients (pts) with metastatic pancreatic cancer (mPaC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
412 Background: The phase III POLO study (NCT02184195) demonstrated a benefit of maintenance olaparib over placebo in the radiologically assessed primary endpoint of progression-free survival (PFS) in pts with mPaC (median 7.4 vs 3.8 months [mo]; 12-mo rate 34% vs 15%). The impact of radiologic assessment of pancreatic lesions, which is considered challenging, was explored. Methods: Tumors were assessed using Response Evaluation Criteria in Solid Tumors version 1.1 by blinded independent central review (BICR) in pts with mPaC treated with maintenance olaparib or placebo. PFS was analyzed in subsets of pts based on various event criteria. Results: All 154 randomized pts had mPaC prior to chemotherapy, of whom 122 had disease in the pancreas at POLO baseline (BL); 34% (53/154) had pancreas-only target lesions (TL), 26% (40/154) also had ≥1 TL outside of the pancreas, and in 19% (29/154) pancreatic disease was recorded as non-TL. Sensitivity analyses were consistent with the primary PFS analysis (Table), including when all pancreas lesion assessments were discounted (median PFS 7.4 vs 4.7 mo; 12-mo rate 38% vs 22%). Of 53 pts with pancreas-only TLs at BL, 34 had disease progression (PD); in 20 pts this was not solely based on TL measurements (16 had new lesions; 4 had multiple-cause PD). Confirmed objective responses occurred during study maintenance treatment in 20% of olaparib pts (18/92) and 10% of placebo pts (6/62). In pts with pancreas-only TLs at BL there were 7 responses in the olaparib arm (1 complete response [CR], 6 partial responses [PR]) and 2 (2 PR) in the placebo arm. In pts who had ≥1 TL outside of the pancreas at BL there were 11 (1 CR, 10 PR) and 4 (4 PR) responses, respectively. Responses were generally durable irrespective of TL location. Conclusions: The significant PFS benefit with maintenance olaparib over placebo shown in the primary analysis was consistent across all sensitivity analyses and was not impacted by radiologic assessment of pancreatic TLs. Taken together, these findings suggest that contrary to historically held belief, primary pancreas TLs may be appropriate for inclusion as sites of RECIST-evaluable disease and for assessment of treatment outcome. Clinical trial information: NCT02184195. [Table: see text]
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Affiliation(s)
| | | | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Michele Reni
- IRCCS Ospedale, San Raffaele Scientific Institute, Milan, Italy
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Teresa Macarulla
- Vall d'Hebrón University Hospital and Vall d'Hebrón Institute of Oncology, Barcelona, Spain
| | | | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Hana Algül
- Klinikum rechts der Isar, Comprehensive Cancer Center Munich TUM, Technische Universität, Munich, Germany
| | | | | | | | | | | | - Talia Golan
- The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
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