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Kurtz JE, Pujade-Lauraine E, Oaknin A, Belin L, Leitner K, Cibula D, Denys H, Rosengarten O, Rodrigues M, de Gregorio N, Martinez García J, Petru E, Kocián R, Vergote I, Pautier P, Schmalfeldt B, Gaba L, Polterauer S, Mouret Reynier MA, Sehouli J, Churruca C, Selle F, Joly F, D'Hondt V, Bultot-Boissier É, Lebreton C, Lotz JP, Largillier R, Heudel PE, Heitz F. Atezolizumab Combined With Bevacizumab and Platinum-Based Therapy for Platinum-Sensitive Ovarian Cancer: Placebo-Controlled Randomized Phase III ATALANTE/ENGOT-ov29 Trial. J Clin Oncol 2023; 41:4768-4778. [PMID: 37643382 PMCID: PMC10602539 DOI: 10.1200/jco.23.00529] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/23/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE Platinum-based doublets with concurrent and maintenance bevacizumab are standard therapy for ovarian cancer (OC) relapsing after a platinum-free interval (PFI) >6 months. Immunotherapy may be synergistic with bevacizumab and chemotherapy. PATIENTS AND METHODS ATALANTE/ENGOT-ov29 (ClinicalTrials.gov identifier: NCT02891824), a placebo-controlled double-blinded randomized phase III trial, enrolled patients with recurrent epithelial OC, one to two previous chemotherapy lines, and PFI >6 months. Eligible patients were randomly assigned 2:1 to atezolizumab (1,200 mg once every 3 weeks or equivalent) or placebo for up to 24 months, combined with bevacizumab and six cycles of chemotherapy doublet, stratified by PFI, PD-L1 status, and chemotherapy regimen. Coprimary end points were investigator-assessed progression-free survival (PFS) in the intention-to-treat (ITT) and PD-L1-positive populations (alpha .025 for each population). RESULTS Between September 2016 and October 2019, 614 patients were randomly assigned: 410 to atezolizumab and 204 to placebo. Only 38% had PD-L1-positive tumors. After 3 years' median follow-up, the PFS difference between atezolizumab and placebo did not reach statistical significance in the ITT (hazard ratio [HR], 0.83; 95% CI, 0.69 to 0.99; P = .041; median 13.5 v 11.3 months, respectively) or PD-L1-positive (HR, 0.86; 95% CI, 0.63 to 1.16; P = .30; median 15.2 v 13.1 months, respectively) populations. The immature overall survival (OS) HR was 0.81 (95% CI, 0.65 to 1.01; median 35.5 v 30.6 months with atezolizumab v placebo, respectively). Global health-related quality of life did not differ between treatment arms. Grade ≥3 adverse events (AEs) occurred in 88% of atezolizumab-treated and 87% of placebo-treated patients; grade ≥3 AEs typical of immunotherapy were more common with atezolizumab (13% v 8%, respectively). CONCLUSION ATALANTE/ENGOT-ov29 did not meet its coprimary PFS objectives in the ITT or PD-L1-positive populations. OS follow-up continues. Further research on biopsy samples is warranted to decipher the immunologic landscape of late-relapsing OC.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- Department of Medical and Surgical Oncology & Hematology, ICANS, Strasbourg, France
| | - Eric Pujade-Lauraine
- Association de Recherche sur les CAncers dont GYnécologiques (ARCAGY)-GINECO, Paris, France
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lisa Belin
- Biostatistics and Public Health Department, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpětriére – Charles Foix, Paris, France
| | - Katharina Leitner
- Gynecology and Obstetrics Department, Medical University of Innsbruck, Innsbruck, Austria
| | - David Cibula
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - Ora Rosengarten
- Oncology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Manuel Rodrigues
- Department of Medical Oncology and INSERM U830, Institut Curie, PSL Research University, Paris, France
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynaecology, University Hospital Ulm, Ulm, Germany
- SLK Klinikum Heilbronn, Heilbronn, Germany
| | - Jeronimo Martinez García
- Medical Oncology Department, Hospital Universitario Virgen Arrixaca (El Palmar) and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Roman Kocián
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ignace Vergote
- Department of Gynecology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Barbara Schmalfeldt
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Gaba
- Department of Medical Oncology, Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clínic de Barcelona, Institut D'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Cristina Churruca
- Department of Medical Oncology, Hospital Universitario Donostia, Donostia, Spain
| | - Frédéric Selle
- Oncology Department, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Florence Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Véronique D'Hondt
- Medical Oncology Department, Institut Régional du Cancer Montpellier (ICM), Montpellier, France
| | - Émilie Bultot-Boissier
- Oncology Department, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Jean-Pierre Lotz
- Medical Oncology Service, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rémy Largillier
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France
| | | | - Florian Heitz
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
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Bailleux C, Arnaud A, Frenel JS, Chabaud S, Bachelot T, You B, Stefani L, Tixidre CG, Simon H, Beal-Ardisson D, Jacquin JP, Del Piano F, Lortholary A, Cornea C, Greilsamer C, Largillier R, Brocard F, Legouffe E, Atlassi M, Hardy-Bessard AC, Heudel PE. CHEOPS trial: a GINECO group randomized phase II assessing addition of a non-steroidal aromatase inhibitor to oral vinorelbine in pre-treated metastatic breast cancer patients. Breast Cancer 2023; 30:315-328. [PMID: 36602669 PMCID: PMC9950168 DOI: 10.1007/s12282-022-01426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objective of the CHEOPS trial was to assess the benefit of adding aromatase inhibitor (AI) to metronomic chemotherapy, oral vinorelbine, 50 mg, three times a week for pre-treated, HR + /HER2- metastatic breast cancer patients. METHODS In this multicentric phase II study, patients had to have progressed on AI and one or two lines of chemotherapy. They were randomized between oral vinorelbine (Arm A) and oral vinorelbine with non-steroidal AI (Arm B). RESULTS 121 patients were included, 61 patients in Arm A and 60 patients in Arm B. The median age was 68 years. 109 patients had visceral metastases. They all had previously received an AI. The study had been prematurely stopped following the third death due to febrile neutropenia. Median PFS trend was found to be different with 2.3 months and 3.7 months in Arm A and Arm B, respectively (HR 0.73, 95%CI 0.50-1.06, p value = 0.0929). No statistical difference was shown in OS and better tumor response. 56 serious adverse events corresponding to 25 patients (21%) were reported (respectively, 12 (20%) versus 13 (22%) for arms A and B) (NS). CONCLUSION The addition of AI to oral vinorelbine over oral vinorelbine alone in aromatase inhibitor-resistant metastatic breast cancer was associated with a non-significant improvement of PFS. Several unexpected serious adverse events were reported. Metronomic oral vinorelbine schedule, at 50 mg three times a week, requires close biological monitoring. The question of hormonal treatment and chemotherapy combination remains open.
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Affiliation(s)
- Caroline Bailleux
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
| | - Antoine Arnaud
- Institut du Cancer Avignon-Provence, 250 Chemin de Baigne-Pieds, CS 800005, 84918, Avignon, France
| | - Jean-Sébastien Frenel
- Institut de Cancérologie de L'Ouest, Centre René Gauducheau, Boulevard Jacques Monod, 44805, Saint Herblain, France
| | - Sylvie Chabaud
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Benoît You
- Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Laëtitia Stefani
- Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, BP 90074, 74374, Pringy, France
| | - Claire Garnier Tixidre
- Centre Hospitalier Mutualiste de Grenoble, 8 Rue Docteur Calmette, 38028, Grenoble, France
| | - Hélène Simon
- Hôpital Morvan, CHU de Brest, 5 Avenue Foch, 29200, Brest, France
| | | | - Jean-Philippe Jacquin
- Institut de Cancérologie de La Loire Lucien Neuwirth, 108 Bis Avenue Albert Raimond, 42271, Saint Priest en Jarez, France
| | | | - Alain Lortholary
- Hôpital Privé du Confluent, 2-4 Rue Eric Tabarly, BP 20215, 44202, Nantes, France
| | - Claudiu Cornea
- Centre Hospitalier Jean-Bernard, 114 Avenue Desandrouins, BP 479, 59322, Valenciennes, France
| | - Charlotte Greilsamer
- Centre Hospitalier Départemental Vendée Les Oudairies, Boulevard Stéphane Moreau, 85925, La Roche Sur Yon, France
| | - Rémy Largillier
- Centre Azuréen de Cancérologie, 1 Place du Docteur Jean-Luc Broquerie, 06250, Mougins, France
| | - Fabien Brocard
- ORACLE-Centre d'Oncologie de Gentilly, 2 Rue Marie Marvingt, 54000, Gentilly, France
| | - Eric Legouffe
- Institut de Cancérologie du Gard Centre ONCOGARD, Rue du Professeur Henri Pujol, 30900, Nimes, France
| | - Mustapha Atlassi
- Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France
| | | | - Pierre-Etienne Heudel
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
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Trédan O, Provansal M, Abdeddaim C, Lardy-Cleaud A, Hardy-Bessard AC, Kalbacher E, Floquet A, Venat-Bouvet L, Lortholary A, Pop O, Frenel JS, Cancel M, Largillier R, Louvet C, You B, Zannetti A, Anota A, Treilleux I, Pissaloux D, Houlier A, Savoye AM, Mouret-Reynier MA, Meunier J, Levaché CB, Brocard F, Ray-Coquard I. Regorafenib or Tamoxifen for platinum-sensitive recurrent ovarian cancer with rising CA125 and no evidence of clinical or RECIST progression: A GINECO randomized phase II trial (REGOVAR). Gynecol Oncol 2021; 164:18-26. [PMID: 34696892 DOI: 10.1016/j.ygyno.2021.09.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of regorafenib versus tamoxifen in platinum-sensitive ovarian cancer biological recurrence, defined by CA-125 increase without radiological (RECIST criteria) or symptomatic evidence of progression. PATIENTS AND METHODS 116 patients with platinum-sensitive ovarian cancer presenting an isolated increase of CA-125 were planned to be randomized. Regorafenib was administered orally at 160 or 120 mg daily, 3 weeks on/1 week off or tamoxifen at 40 mg daily, until disease progression or development of unacceptable toxicity. The primary endpoint was Progression-Free Survival, assessed by progression according to RECIST 1.1 or death (by any cause). Secondary endpoints included Overall Survival, Best Response and CA-125 response rate. RESULTS 68 patients were randomized. Median age was 67 years (range: 30-87). Primary site of cancer was ovarian for most patients (92.6%). Tumors were predominantly serous / (89.7%), high grade (83.6%) and initial FIGO staging was III for 69.6% of the patients. Most (79.4%) patients were included after the first line of platinum-based treatment. After a median follow-up of 32 months, there was no difference of progression-free survival (PFS) between regorafenib and tamoxifen groups (p = 0.72), with median PFS of 5.6 months (CI 90%: 3.84-7.52) for the tamoxifen arm and 4.6 months (CI 90%: 3.65-7.33) for the regorafenib arm. There was also no difference in term of overall survival, best response or CA-125 response, delay to next therapy. Regorafenib presented a less favorable safety profile than tamoxifen, with grade 3/4 events occurring for 90.9% of the patients compared to 54.3% for tamoxifen. The most frequent were cutaneous, digestive, and biological events. Notably, hand-foot syndrome occurred in 36.4% of these patients. CONCLUSION Regorafenib presented an unfavorable toxicity profile compared to tamoxifen, with no superior efficacy in this population of patients.
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Affiliation(s)
- Olivier Trédan
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - Magali Provansal
- Département d'Oncologie Médicale, Institut Paoli Calmettes, Marseille, France
| | - Cyril Abdeddaim
- Département d'Oncologie Médicale, Centre Oscar Lambret, Lille, France
| | | | - Anne-Claire Hardy-Bessard
- Département d'Oncologie Médicale, Centre Armoricain de Radiothérapie, d'Imagerie Médicale et d'Oncologie (CARIO)-Hôpital Privé des Côtes d'Armor (HPCA), Plérin, France
| | - Elsa Kalbacher
- Département d'Oncologie Médicale CHU de Besançon, Besançon, France
| | - Anne Floquet
- Département d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | | | - Alain Lortholary
- Département d'Oncologie Médicale, Institut de Cancérologie Catherine de Sienne, Hôpital Privé du Confluent, Nantes, France
| | - Oana Pop
- Département d'Oncologie Médicale, Centre Hospitalier Annecy-Genevois, Pringy, France
| | - Jean-Sébastien Frenel
- Département d'Oncologie Médicale, ICO Centre René Gauducheau, Saint-Herblain, France
| | - Mathilde Cancel
- Département d'Oncologie Médicale, CHU Bretonneau Centre, Tours, France
| | - Rémy Largillier
- Département d'Oncologie Médicale, Centre Azuréen de Cancérologie, Mougins, France
| | - Christophe Louvet
- Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Benoît You
- Département d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Lyon, France
| | - Alain Zannetti
- Département d'Oncologie Médicale, Centre Hospitalier de Cholet, Cholet, France
| | | | | | - Daniel Pissaloux
- Département d'Anatomopathologie, Centre Léon Bérard, Lyon, France
| | - Aurélie Houlier
- Département d'Anatomopathologie, Centre Léon Bérard, Lyon, France
| | - Aude-Marie Savoye
- Département d'Oncologie Médicale, Institut Jean Godinot, Reims, France
| | | | - Jérôme Meunier
- C Département d'Oncologie Médicale, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Fabien Brocard
- Département d'Oncologie Médicale, ORACLE - Centre d'Oncologie de Gentilly, Nancy, France
| | - Isabelle Ray-Coquard
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France; University Claude Bernard, GINECO, Lyon, France
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Berton D, Floquet A, Lescaut W, Baron G, Kaminsky MC, Toussaint P, Largillier R, Savoye AM, Alexandre J, Delbaldo C, Malaurie E, Barletta H, Bosacki C, Garnier-Tixidre C, Follana P, Laharie-Mineur H, Briac Levache C, Valenza B, Dechartres A, Mollon-Grange D, Selle F. Real-World Experience of Bevacizumab as First-Line Treatment for Ovarian Cancer: The GINECO ENCOURAGE Cohort of 468 French Patients. Front Pharmacol 2021; 12:711813. [PMID: 34616296 PMCID: PMC8489574 DOI: 10.3389/fphar.2021.711813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Bevacizumab-containing therapy is considered a standard-of-care front-line option for stage IIIB–IV ovarian cancer based on results of randomized phase 3 trials. The multicenter non-interventional ENCOURAGE prospective cohort study assessed treatment administration and outcomes in the French real-world setting. Patients and Methods: Eligible patients were aged ≥ 18 years with planned bevacizumab-containing therapy for newly diagnosed ovarian cancer. The primary objective was to assess the safety profile of front-line bevacizumab in routine clinical practice; secondary objectives were to describe patient characteristics, indications/contraindications for bevacizumab, treatment regimens and co-medications, follow-up and monitoring, progression-free survival, and treatment at recurrence. In this non-interventional study, treatment was administered as chosen by the investigator and participation in the trial had no influence on the management of the disease. Results: Of 1,290 patients screened between April 2013 and February 2015, 468 were eligible. Most patients (86%) received bevacizumab 15 mg/kg every 3 weeks or equivalent, typically with carboplatin (99%) and paclitaxel (98%). The median duration of bevacizumab was 12.2 (range 0–28, interquartile range 6.9–14.9) months; 8% of patients discontinued bevacizumab because of toxicity. The most common adverse events were hypertension (38% of patients), fatigue (35%), and bleeding (32%). There were no treatment-related deaths. Most physicians (90%) reported blood pressure measurement immediately before each bevacizumab infusion and almost all (97%) reported monitoring for proteinuria before each bevacizumab infusion. Median progression-free survival was 17.4 (95% CI, 16.4–19.1) months. The 3-year overall survival rate was 62% (95% CI, 58–67%). The most commonly administered chemotherapies at recurrence were carboplatin and pegylated liposomal doxorubicin. Discussion: Clinical outcomes and tolerability with bevacizumab in this real-life setting are consistent with randomized trial results, notwithstanding differences in the treated patient population and treatment schedule. Clinical Trial Registration:ClinicalTrials.gov, Identifier NCT01832415.
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Affiliation(s)
| | | | | | - Gabriel Baron
- Assistance Publique - Hôpitaux de Paris Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France
| | | | | | | | | | | | | | | | | | - Claire Bosacki
- Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | | | | | | | | | - Bruno Valenza
- Centre Hospitalier Intercommunal de Fréjus, Saint-Raphaël, France
| | - Agnès Dechartres
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | | | - Frédéric Selle
- Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
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Berton-Rigaud D, Floquet A, Mollon-Grange D, Dechartres A, Lescaut W, Kaminsky-Forrett MC, Tredan O, Largillier R, Savoye A, Alexandre J, Delbaldo C, Malaurie E, Barletta H, Bosacki C, Tixidre CG, Follana P, Laharie-Mineur H, Levaché CB, Pujade-Lauraine E, Selle F. Use of bevacizumab (Bev) in real life for first-line (fl) treatment of ovarian cancer (OC)/ The GINECO ENCOURAGE cohort of 500 French patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Saint A, Viotti J, Borchiellini D, Hoch B, Raimondi V, Hebert C, Largillier R, Evesque L, Follana P, Ferrero JM, Delaby C, Schiappa R, Chamorey E, Barriere J. Iron deficiency during first-line chemotherapy in metastatic cancers: a prospective epidemiological study. Support Care Cancer 2019; 28:1639-1647. [DOI: 10.1007/s00520-019-04938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
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7
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Barriere J, Ferrero JM, Hoch B, Largillier R, Hebert C, Borchiellini D, Follana P, Mari V, Evesque L, Saada-Bouzid E, Schiappa R, Raimondi V, Chamorey E, Viotti J. Iron deficiency anaemia in oncology: an epidemiological prospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.016] [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: 11/14/2022] Open
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8
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Etienne-Grimaldi MC, Boyer JC, Beroud C, Mbatchi L, van Kuilenburg A, Bobin-Dubigeon C, Thomas F, Chatelut E, Merlin JL, Pinguet F, Ferrand C, Meijer J, Evrard A, Llorca L, Romieu G, Follana P, Bachelot T, Chaigneau L, Pivot X, Dieras V, Largillier R, Mousseau M, Goncalves A, Roché H, Bonneterre J, Servent V, Dohollou N, Château Y, Chamorey E, Desvignes JP, Salgado D, Ferrero JM, Milano G. New advances in DPYD genotype and risk of severe toxicity under capecitabine. PLoS One 2017; 12:e0175998. [PMID: 28481884 PMCID: PMC5421769 DOI: 10.1371/journal.pone.0175998] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/04/2017] [Indexed: 12/29/2022] Open
Abstract
Background Deficiency in dihydropyrimidine dehydrogenase (DPD) enzyme is the main cause of severe and lethal fluoropyrimidine-related toxicity. Various approaches have been developed for DPD-deficiency screening, including DPYD genotyping and phenotyping. The goal of this prospective observational study was to perform exhaustive exome DPYD sequencing and to examine relationships between DPYD variants and toxicity in advanced breast cancer patients receiving capecitabine. Methods Two-hundred forty-three patients were analysed (88.5% capecitabine monotherapy). Grade 3 and grade 4 capecitabine-related digestive and/or neurologic and/or hemato-toxicities were observed in 10.3% and 2.1% of patients, respectively. DPYD exome, along with flanking intronic regions 3’UTR and 5’UTR, were sequenced on MiSeq Illumina. DPD phenotype was assessed by pre-treatment plasma uracil (U) and dihydrouracil (UH2) measurement. Results Among the 48 SNPs identified, 19 were located in coding regions, including 3 novel variations, each observed in a single patient (among which, F100L and A26T, both pathogenic in silico). Combined analysis of deleterious variants *2A, I560S (*13) and D949V showed significant association with grade 3–4 toxicity (sensitivity 16.7%, positive predictive value (PPV) 71.4%, relative risk (RR) 6.7, p<0.001) but not with grade 4 toxicity. Considering additional deleterious coding variants D342G, S492L, R592W and F100L increased the sensitivity to 26.7% for grade 3–4 toxicity (PPV 72.7%, RR 7.6, p<0.001), and was significantly associated with grade 4 toxicity (sensitivity 60%, PPV 27.3%, RR 31.4, p = 0.001), suggesting the clinical relevance of extended targeted DPYD genotyping. As compared to extended genotype, combining genotyping (7 variants) and phenotyping (U>16 ng/ml) did not substantially increase the sensitivity, while impairing PPV and RR. Conclusions Exploring an extended set of deleterious DPYD variants improves the performance of DPYD genotyping for predicting both grade 3–4 and grade 4 toxicities (digestive and/or neurologic and/or hematotoxicities) related to capecitabine, as compared to conventional genotyping restricted to consensual variants *2A, *13 and D949V.
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Affiliation(s)
| | | | - Christophe Beroud
- Aix-Marseille University, INSERM UMR S910, GMGF, Marseille, France
- APHM Hôpital Timone, Laboratoire de Génétique Moléculaire, Marseille, France
| | - Litaty Mbatchi
- Faculté de Pharmacie de Montpellier, Montpellier, France
| | - André van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam,The Netherlands
| | | | - Fabienne Thomas
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Etienne Chatelut
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean-Louis Merlin
- Institut de Cancérologie de Lorraine, UMR CNRS 7039 CRAN, Université de Lorraine, Nancy, France
| | | | | | - Judith Meijer
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam,The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | - Henri Roché
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | | | | | | | | | | | - David Salgado
- Aix-Marseille University, INSERM UMR S910, GMGF, Marseille, France
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Berton-Rigaud D, Selle F, Floquet A, Mollon D, Lescaut W, Kaminsky MC, Ray-Coquard I, Largillier R, Savoye AM, Barletta H, Pautier P, Orfeuvre H, Baron M, Marti A, Mouysset JL, Paoli JB, Cailleux PE, Cornea C, Pujade-Lauraine E. Use of bevacizumab (Bev) in real life for first-line (fl) treatment of ovarian cancer (OC). Part1: the ENCOURAGE cohort of 1158 patients (pts) by GINECO. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.42] [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: 11/14/2022] Open
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Ferrero JM, Hardy-Bessard AC, Capitain O, Lortholary A, Salles B, Follana P, Herve R, Deblock M, Dauba J, Atlassi M, Largillier R. Weekly paclitaxel, capecitabine, and bevacizumab with maintenance capecitabine and bevacizumab as first-line therapy for triple-negative, metastatic, or locally advanced breast cancer: Results from the GINECO A-TaXel phase 2 study. Cancer 2016; 122:3119-3126. [DOI: 10.1002/cncr.30170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/02/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Jean-Marc Ferrero
- Department of Medical Oncology, Antoine-Lacassagne Centre; Nice France
| | | | - Olivier Capitain
- Department of Medical Oncology, Paul Papin Western Oncology Institute; Angers France
| | | | - Bruno Salles
- Department of Medical Oncology, William Morey Hospital; Chalon-sur-Saone France
| | - Philippe Follana
- Department of Medical Oncology, Antoine-Lacassagne Centre; Nice France
| | | | - Mathilde Deblock
- Department of Medical Oncology, Lorraine Cancer Institute; Vandoeuvre-les-Nancy France
| | - Jérôme Dauba
- Department of Medical Oncology, Mont de Marsan Hospital; Mont de Marsan France
| | - Mustapha Atlassi
- Department of Medical Oncology, Le Mans Hospital; Le Mans France
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11
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Gligorov J, Pivot XB, Jacot W, Naman HL, Spaeth D, Misset JL, Largillier R, Sautiere JL, de Roquancourt A, Pomel C, Rouanet P, Rouzier R, Penault-Llorca FM. Prospective Clinical Utility Study of the Use of the 21-Gene Assay in Adjuvant Clinical Decision Making in Women With Estrogen Receptor-Positive Early Invasive Breast Cancer: Results From the SWITCH Study. Oncologist 2015; 20:873-9. [PMID: 26112003 DOI: 10.1634/theoncologist.2014-0467] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/24/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The 21-gene Oncotype DX Recurrence Score assay is a validated assay to help decide the appropriate treatment for estrogen receptor-positive (ER+), early-stage breast cancer (EBC) in the adjuvant setting. The choice of adjuvant treatments might vary considerably in different countries according to various treatment guidelines. This prospective multicenter study is the first to assess the impact of the Oncotype DX assay in the French clinical setting. METHODS A total of 100 patients with ER+, human epidermal growth factor receptor 2-negative EBC, and node-negative (pN0) disease or micrometastases in up to 3 lymph nodes (pN1mi) were enrolled. Treatment recommendations, physicians' confidence before and after knowing the Recurrence Score value, and physicians' perception of the assay were recorded. RESULTS Of the 100 patients, 95 were evaluable (83 pN0, 12 pN1mi). Treatment recommendations changed in 37% of patients, predominantly from chemoendocrine to endocrine treatment alone. The proportion of patients recommended chemotherapy decreased from 52% pretest to 25% post-test. Of patients originally recommended chemotherapy, 61% were recommended endocrine treatment alone after receiving the Recurrence Score result. For both pN0 and pN1mi patients, post-test recommendations appeared to follow the Recurrence Score result for low and high values. Physicians' confidence improved significantly. CONCLUSION These are the first prospective data on the impact of the Oncotype DX assay on adjuvant treatment decisions in France. Using the assay was associated with a significant change in treatment decisions and an overall reduction in chemotherapy use. These data are consistent with those presented from European and non-European studies.
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Affiliation(s)
- Joseph Gligorov
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Xavier B Pivot
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - William Jacot
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Hervé L Naman
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Dominique Spaeth
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Jean-Louis Misset
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Rémy Largillier
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Jean-Loup Sautiere
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Anne de Roquancourt
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Christophe Pomel
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Philippe Rouanet
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Roman Rouzier
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
| | - Frederique M Penault-Llorca
- APHP Tenon, IUC-UPMC, Sorbonne Université, Alliance Pour la Recherche en Cancérologie, Paris, France; University Hospital Jean Minjoz, UMR1098, SFR IBCT, Besançon, France; Institut du Cancer Montpellier, Université Montpellier 1, Montpellier, France; Centre Azuréen de Cancérologie, Mougins, France; Centre d'Oncologie de Gentilly, Nancy, France; APHP-St. Louis, Université Paris Diderot, Paris, France; Centre Jean-Perrin, Université d'Auvergne, Clermont-Ferrand, France; Research Unit EA 7285, University of Versailles St-Quentin, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, Saint-Cloud, France
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Berton-Rigaud D, Selle F, Ray-Coquard I, Floquet A, Largillier R, Hardy-Bessard A, Jaubert D, Roemer-Becuwe C, Venat-Bouvet L, Lesoin A, Guardiola E, Alexandre J, Provansal M, Blot E, Achour N, Pujade-Lauraine E. Encourage: the Use in Routine Practice of Bevacizumab in First-Line Therapy for Patients with Ovarian Cancer– a Gineco Prospective Cohort Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.66] [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: 11/14/2022] Open
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Follana P, Barrière J, Chamorey E, Largillier R, Dadone B, Mari V, Hannoun-Levi J, Marcy M, Flipo B, Ferrero JM. Prognostic Factors in 401 Elderly Women with Metastatic Breast Cancer. Oncology 2014; 86:143-51. [DOI: 10.1159/000357781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/01/2013] [Indexed: 11/19/2022]
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Milano G, Ferrero JM, Thomas F, Bobin-Dubigeon C, Merlin JL, Pinguet F, Ferrand C, Boyer JC, Romieu G, Bachelot T, Pivot X, Dieras V, Largillier R, Mousseau M, Goncalves A, Roche H, Bonneterre J, De Clercq B, Etienne-Grimaldi MC. Abstract P3-15-04: A French prospective pilot study to identify dihydropyrimidine dehydrogenase (DPD) deficiency in breast cancer patients receiving capecitabine. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-15-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Health Authorities point out that DPD deficiency confers a significant risk of major toxicity for patients receiving capecitabine. Identification of at-risk patients is thus of major concern. This multicentric prospective study of the French GPCO group (Groupe de Pharmacologie Clinique Oncologique, Unicancer) evaluated the sensitivity, specificity and predictive values of DPD phenotyping and genotyping to predict severe cap-related toxixity in metastatic breast cancer patients.
Methods: 303 patients were included between February 2009 and February 2011 (15 institutions). Eighty-eight% received capecitabine as monotherapy, 28% were treated as first line (mean dose at 1st cycle 1957 mg/m2/d). Pre-treatment uracil (U, physiological DPD substrate) plasma concentration was measured in 286 patients (HPLC assay). DPD genotyping (IVS14+1G>A, 2846A>T, 1679T>G, 464T>A) was performed on 281 patients. Severe toxicity (G3-4 CTCAE v3 criteria) was measured over cycles 1-2.
Results: Grade 3-4 toxicity (diarrhea, vomiting, hematoxicity, hand-foot syndrome) has been observed in 19.6% of patients (one toxic death). A marked trend for higher U concentrations has been noted in patients developing severe toxicity vs those who didn't (median 12.7 ng/ml (Q1-Q3 9-17) vs median 10.2 ng/ml (range 8-13), respectively, p = 0.014). However, ROC curve has showed that this difference was too small for use as a reliable toxicity predictor. The patient with toxic death had an elevated U concentration at 17 ng/ml. Among the 7 patients with a DPD mutation (3 pts IVS14+1, 3 pts 2846A>T, one 1679T>G, all heterozygous), 5 developed severe toxicity (including the toxic death, 2846A>T), one did not, and the last one was not documented. Relative risk for developing severe toxicity was 4.60 in mutated patients vs wild-type patients (95%CI 2.95-7.16, p = 0.001); positive and negative predictive values were 83.3% and 81.9%, respectively; specificity was 99.5% and sensitivity was 9.8%.
Conclusions: Breast cancer patients harbouring a DPD variant allele are at risk to develop severe, up to lethal, capecitabine-related toxicity. Pre-treatment U measurement remains to be more firmly established as a reliable predictor of capecitabine toxicity. These observations are of major interest for breast cancer patients candidate for capecitabine therapy.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-15-04.
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Affiliation(s)
- G Milano
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - J-M Ferrero
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - F Thomas
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - C Bobin-Dubigeon
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - J-L Merlin
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - F Pinguet
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - C Ferrand
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - J-C Boyer
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - G Romieu
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - T Bachelot
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - X Pivot
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - V Dieras
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - R Largillier
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - M Mousseau
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - A Goncalves
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - H Roche
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - J Bonneterre
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - B De Clercq
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
| | - M-C Etienne-Grimaldi
- Centre Antoine-Lacassagne, Nice, France; Centre Clauduis-Regaud, Toulouse, France; Institut de Cancérologie du de l'Ouest, Nantes-Angers, France; Centre Alexis-Vautrin, Nancy, France; Centre Paul Lamarque, Montpellier, France; CHU de Besançon, Besançon, France; CHU de Nîmes, Nîmes, France; Centre Léon Berard, Lyon, France; Institut Curie, Paris, France; Centre Azuréen de Cancérologie, Mougins, France; CHU de Grenoble, Grenoble, France; Institut Paoli Calmettes, Marseille, France; Centre Oscar Lambret, Lille, France
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Ferrero JM, Hardy-Bessard AC, Capitain O, Lortholary A, Salles B, Follana P, Herve R, Deblock M, Dauba J, Atlassi M, Largillier R. Abstract P3-13-07: A-TaXel: Multicenter phase II combination of bevacizumab (A) with weekly paclitaxel (Ta) and capecitabine (Xel) in first line treatment for patients with triple negative metastatic or locally advanced breast cancer (TNMBC), a GINECO study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Weekly paclitaxel and capecitabine intermittent regimen is a safe and effective combination in first line treatment of MBC including triple negative cancer (Lortholary et al, Breast Cancer Res Treat 2012). In TNMBC, the combination of A with first line Ta or Xel has been shown to improve response rate (RR) and progression-free survival (PFS) (Miller K et al., N Engl J Med 2007, Robert J et al., J Clin Oncol 2011). This phase II study is to evaluate the efficacy and safety of A-TaXel combination in TNMBC.
Methods: Patients (pts) with measurable TNMBC were treated in first line until progression with q28 cycles of Ta (80 mg/m2 D1, 8, 15) + Xel (800 mg/m2 bid D1-5, 8-12, 15-19) + A (10 mg/kg D1, 14). Primary end point was best overall RR; secondary were safety, PFS, response duration and overall survival (OS).
Results: From 04/2010 to 03/2012, 64 pts were accrued including 2 ineligible pts. Patients characteristics were: median age (56.7 yrs), ECOG PS 0 (55%), histological grade III (61%), previous adjuvant chemotherapy (74%), visceral disease (65%), > 1 metastatic sites (74%).
Patients received a median of 6 cycles (1-6), mean 5.1. Grade 3-4 neutropenia, anemia and thrombopenia were 23%, 4% and 16% respectively with febrile neutropenia in 5% of pts. G-CSF support was observed in 7% of cycles. Most frequent non hematologic toxicities were alopecia (gr2 40%), hand-foot syndrome (gr2 27%, gr3 13%), nail toxicity (gr2 40%), hypertension (gr3 35%), neuropathy (gr2 26%, gr3 6%), mucositis (gr2 16%, gr3-4 9%), fatigue (gr3 18%, gr4 2%), nausea (gr2 15%, gr3 2%) and thrombosis (gr2 3%, gr3-4 5%). Treatment interruption due to toxicity was 22%, DPD deficiency in one patient, hospitalization 23%.
RR was 77%, CR 19%, PR 58%, stable disease 14% and progressive disease 9%. Median response duration was 5.6 months. Median PFS was 7.9 months (6.7-9) and OS 19.2 months (17.3-21.1).
Conclusion: A-TaXel is an effective regimen with high RR and manageable toxicity.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-07.
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Affiliation(s)
- J-M Ferrero
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - A-C Hardy-Bessard
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - O Capitain
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - A Lortholary
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - B Salles
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - P Follana
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - R Herve
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - M Deblock
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - J Dauba
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - M Atlassi
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
| | - R Largillier
- Centre Antoine Lacassagne, Nice, France, Metropolitan; Clinique Armoricaine de Radiologie, Saint-Brieuc, France; ICO Paul Papin, Angers, France; Centre Catherine de Sienne, Nantes, France; Centre Hospitalier William Morey, Chalon-sur-Saône, France; Hôpital Privé Clairval, Marseille, France; ICL Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France; Centre Hospitalier du Mans, Le Mans, France; Centre Azuréen de Cancérologie, Mougins, France
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Pautier P, Floquet A, Gladieff L, Bompas E, Ray-Coquard I, Piperno-Neumann S, Selle F, Guillemet C, Weber B, Largillier R, Bertucci F, Opinel P, Duffaud F, Reynaud-Bougnoux A, Delcambre C, Isambert N, Kerbrat P, Netter-Pinon G, Pinto N, Duvillard P, Haie-Meder C, Lhommé C, Rey A. A randomized clinical trial of adjuvant chemotherapy with doxorubicin, ifosfamide, and cisplatin followed by radiotherapy versus radiotherapy alone in patients with localized uterine sarcomas (SARCGYN study). A study of the French Sarcoma Group. Ann Oncol 2012; 24:1099-104. [PMID: 23139262 DOI: 10.1093/annonc/mds545] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is no proven benefit of adjuvant treatment of uterine sarcoma (US). SARCGYN phase III study compared adjuvant polychemotherapy followed by pelvic radiotherapy (RT) (arm A) versus RT alone (arm B) conducted to detect an increase ≥ 20% of 3-year PFS. METHODS Patients with FIGO stage ≤ III US, physiological age ≤ 65 years; chemotherapy: four cycles of doxorubicin 50 mg/m² d1, ifosfamide 3 g/m²/day d1-2, cisplatin 75 mg/m² d3, (API) + G-CSF q 3 weeks. Study was stopped because of lack of recruitment. RESULTS Eighty-one patients were included: 39 in arm A and 42 in arm B; 52 stage I, 16 stage II, 13 stage III; 53 leiomyosarcomas, 9 undifferenciated sarcomas, 19 carcinosarcomas. Gr 3-4 toxicity during API (/37 patients): thrombopenia (76%), febrile neutropenia (22%) with two toxic deaths; renal gr 3 (1 patient). After a median follow-up of 4.3 years, 41/81 patients recurred, 15 in arm A, 26 in arm B. The 3 years DFS is 55% in arm A, 41% in arm B (P = 0.048). The 3-year overall survival (OS) is 81% in arm A and 69% in arm B (P = 0.41). CONCLUSION API adjuvant CT statistically increases the 3 year-DFS of patients with US.
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Affiliation(s)
- P Pautier
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, Cedex, France.
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Gonçalves A, Gilabert M, François E, Dahan L, Perrier H, Lamy R, Re D, Largillier R, Gasmi M, Tchiknavorian X, Esterni B, Genre D, Moureau-Zabotto L, Giovannini M, Seitz JF, Delpero JR, Turrini O, Viens P, Raoul JL. BAYPAN study: a double-blind phase III randomized trial comparing gemcitabine plus sorafenib and gemcitabine plus placebo in patients with advanced pancreatic cancer. Ann Oncol 2012; 23:2799-2805. [PMID: 22771827 DOI: 10.1093/annonc/mds135] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sorafenib is an oral anticancer agent targeting Ras-dependent signaling and angiogenic pathways. A phase I trial demonstrated that the combination of gemcitabine and sorafenib was well tolerated and had activity in advanced pancreatic cancer (APC) patients. The BAYPAN study was a multicentric, placebo-controlled, double-blind, randomized phase III trial comparing gemcitabine/sorafenib and gemcitabine/placebo in the treatment of APC. PATIENTS AND METHODS The patient eligibility criteria were locally advanced or metastatic pancreatic adenocarcinoma, no prior therapy for advanced disease and a performance status of zero to two. The primary end point was progression-free survival (PFS). The patients received gemcitabine 1000 mg/m(2) i.v., weekly seven times followed by 1 rest week, then weekly three times every 4 weeks plus sorafenib 200 mg or placebo, two tablets p.o., twice daily continuously. RESULTS Between December 2006 and September 2009, 104 patients were enrolled on the study (52 pts in each arm) and 102 patients were treated. The median and the 6-month PFS were 5.7 months and 48% for gemcitabine/placebo and 3.8 months and 33% for gemcitabine/sorafenib (P = 0.902, stratified log-rank test), respectively. The median overall survivals were 9.2 and 8 months, respectively (P = 0.231, log-rank test). The overall response rates were similar (19 and 23%, respectively). CONCLUSION The addition of sorafenib to gemcitabine does not improve PFS in APC patients.
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Affiliation(s)
- A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille.
| | - M Gilabert
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - E François
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice
| | - L Dahan
- Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille; Department of Digestive Oncology, Hôpital de le Timone, Assistance Publique-Hôpitaux de Marseille, Marseille
| | - H Perrier
- Digestive Oncology Unit, Hôpital Saint-Joseph, Marseille
| | - R Lamy
- Department of Oncology, Centre Hospitalier Bretagne Sud (Lorient), Lorient
| | - D Re
- Medicine Unit, Centre Hospitalier Antibes Juan-les-Pins, Antibes
| | - R Largillier
- Department of Oncology, Centre azuréen de cancérologie, Mougins
| | - M Gasmi
- Department of Gastro-enterology, Hôpital Nord APHM, Marseille
| | - X Tchiknavorian
- Department of Medical Oncology, Centre Hospitalier Toulon, Toulon, France
| | - B Esterni
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Clinical Investigation Center 9502, Marseille
| | - D Genre
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Clinical Investigation Center 9502, Marseille
| | | | - M Giovannini
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - J-F Seitz
- Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille; Department of Digestive Oncology, Hôpital de le Timone, Assistance Publique-Hôpitaux de Marseille, Marseille
| | - J-R Delpero
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille
| | - O Turrini
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille
| | - P Viens
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille
| | - J-L Raoul
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258
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Sarradon-Eck A, Pellegrini I, Largillier R, Duran S, Tallet A, Tarpin C, Julian-Reynier C. Self-management Strategies Adopted by Breast Cancer Survivors to Improve their Adherence to Tamoxifen. Breast J 2012; 18:389-91. [DOI: 10.1111/j.1524-4741.2012.01258.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lortholary A, Largillier R, Weber B, Gladieff L, Alexandre J, Durando X, Slama B, Dauba J, Paraiso D, Pujade-Lauraine E. Weekly paclitaxel as a single agent or in combination with carboplatin or weekly topotecan in patients with resistant ovarian cancer: the CARTAXHY randomized phase II trial from Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens (GINECO). Ann Oncol 2012; 23:346-52. [DOI: 10.1093/annonc/mdr149] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ferrero JM, Largillier R, Michel C, Amiot V, Milano G, Hébert C, Mari V, Courdi A, Figl A, Follana P, Barrière J, Chamorey E. A phase I study of UFT-oral vinorelbine in metastatic breast cancer. Oncology 2011; 81:73-8. [PMID: 21968516 DOI: 10.1159/000330770] [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] [Received: 03/14/2011] [Accepted: 06/28/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite current treatment options, metastatic breast cancer (MBC) remains essentially incurable, requiring research on new drugs or combinations to improve survival and quality of life. PATIENTS AND METHODS This phase I study was designed to define the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended dose of all-oral tegafur-uracil (UFT)/folinic acid combined with vinorelbine as chemotherapy for MBC. Starting doses were 40 mg/m(2)/week of oral vinorelbine administered continuously and 250 mg/m(2)/day of UFT plus 90 mg/day of folinic acid from day 1 to day 28, followed by a 1-week rest period. RESULTS Ten patients were included. Eight were evaluable for toxicity and antitumor response. The second dose level was shown to be the MTD. At this dose, 2 out of 5 patients receiving oral vinorelbine at 40 mg/m(2)/week and UFT at 300 mg/m(2)/day developed DLT consisting of grade 3 asthenia and grade 3 nausea despite standard prophylaxis. Other toxicities were grade 1 diarrhea and anemia. There were no treatment-related deaths. CONCLUSIONS The recommended dose for this combination seems to be the first dose level. A stable response was observed for 6 patients (average 33 weeks). This combination appears to be well-tolerated and offers an alternative to intravenous chemotherapy.
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Affiliation(s)
- J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
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Lortholary A, Hardy-Bessard AC, Bachelot T, de Rauglaudre G, Alexandre J, Bourgeois H, Jaubert D, Paraiso D, Largillier R. A GINECO randomized phase II trial of two capecitabine and weekly paclitaxel schedules in metastatic breast cancer. Breast Cancer Res Treat 2011; 131:127-35. [PMID: 21947680 DOI: 10.1007/s10549-011-1776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/08/2011] [Indexed: 11/28/2022]
Abstract
To determine whether capecitabine schedule adaptation improves the tolerability of capecitabine-paclitaxel combination therapy for metastatic breast cancer (MBC), patients with anthracycline-pretreated HER2-negative MBC were randomized to either arm A (21-day cycles: capecitabine 1,000 mg/m(2) twice daily, days 1-14; paclitaxel 60 mg/m(2), days 1, 8, and 15) or arm B (28-day cycles: capecitabine 1,000 mg/m(2) twice daily, days 1-5, 8-12, and 15-19; paclitaxel 80 mg/m(2), days 1, 8, and 15). The primary endpoint was the incidence of dose reductions or delays >1 week for grade 3/4 toxicity. Secondary endpoints were efficacy and safety. All 130 randomized patients were evaluable for safety. Dose reduction or delay for grade 3/4 toxicity occurred in 39% of patients in arm A and 34% in arm B during cycles 1-6. In arm A, there were significantly more toxicity-related dose reductions (cycles 1-6: 82 vs. 67%, respectively; P = 0.05) and discontinuations (29 vs. 8%, respectively). Grade 3 diarrhea occurred in 12 and 0%, respectively, and grade 3 hand-foot syndrome in 12 versus 9%, respectively (grade 4 not applicable). There were no detectable differences in efficacy. Weekday capecitabine dosing with weekly paclitaxel may improve tolerability without a detrimental effect on efficacy, and merits further evaluation in patients suited to combination chemotherapy.
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Affiliation(s)
- Alain Lortholary
- Centre Catherine de Sienne, 2 Rue Eric Tabarly, BP 20215, 44202 Nantes Cedex 2, France.
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Barrière J, Mari V, Follana P, Largillier R, Chamorey E, Lescaut W, Flipo B, Ettore F, Raoust I, Peyrottes I, Figl A, Marcy M, Ihrai T, Courdi A, Ferrero J. Long-term responders to trastuzumab among patients with HER2-positive metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Goncalves A, Viret F, François E, Dahan L, Perrier H, Lamy R, Re D, Largillier R, Gasmi M, Tchiknavorian X, Turrini O, Moureau-Zabotto L, Delpero J, Viens P. BAYPAN study: A double-blind, phase III randomized trial of gemcitabine plus sorafenib versus gemcitabine plus placebo in patients with advanced pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Magné N, Melis A, Chargari C, Castadot P, Guichard JB, Barani D, Nourissat A, Largillier R, Jacquin JP, Chauvin F, Merrouche Y. Recommendations for a lifestyle which could prevent breast cancer and its relapse: physical activity and dietetic aspects. Crit Rev Oncol Hematol 2011; 80:450-9. [PMID: 21334920 DOI: 10.1016/j.critrevonc.2011.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 01/11/2011] [Accepted: 01/27/2011] [Indexed: 12/31/2022] Open
Abstract
External factors such as eating habits and physical activity have an important impact on breast cancer risk. This paper reviews the literature on the relationship between breast cancer and lifestyle. It aims to produce recommendations regarding physical activity and dietary intake for clinical practice. Although strong clinical evidence of the impact of lifestyle modifications is still lacking, practising healthy eating should be encouraged for the prevention of cancer, its occurrence or relapse. Physical activity is recommended to avoid excessive weight gain. For example, the beneficial effects on the risk of breast cancer could be achieved by walking half an hour per day. Three to five hours per week of moderate physical exercise therefore should be recommended for optimising the reduction of the risk of cancer. For most women, moderate to intense activity, such as heavy housework, brisk walking, or dancing, could provide an effective level of activity to keep reduce the risk of breast cancer.
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Affiliation(s)
- Nicolas Magné
- Département de Radiothérapie, Institut de Cancérologie de la Loire, 108 bis. Avenue Albert Raimond, St Priest en Jarez, France.
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Guiu S, Liegard M, Favier L, van Praagh I, Largillier R, Weber B, Coeffic D, Moreau L, Priou F, Campone M, Gligorov J, Vanlemmens L, Trillet-Lenoir V, Arnould L, Coudert B. Long-term follow-up of HER2-overexpressing stage II or III breast cancer treated by anthracycline-free neoadjuvant chemotherapy. Ann Oncol 2011; 22:321-8. [DOI: 10.1093/annonc/mdq397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Doyen J, Italiano A, Largillier R, Ferrero JM, Fontana X, Thyss A. Aromatase inhibition in male breast cancer patients: biological and clinical implications. Ann Oncol 2010; 21:1243-1245. [DOI: 10.1093/annonc/mdp450] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marcy P, Chamorey E, Figl A, Frenay M, Peyrade F, Largillier R, Machiavello J, Ferrero J, Francois E, Thariat J. Venous thrombosis associated with central venous catheter in cancer patients with surgical chest port (S) or venography- guided arm port insertion (R): A randomized controlled study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chatelut E, Schmitt A, Penel N, Campone M, Largillier R, Soulié P, Fabbro M, Houede N, Medioni J, Bougnoux P. Factors of interindividual hematopoietic toxicity of carboplatin. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2568] [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: 11/20/2022] Open
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Pellegrini I, Sarradon-Eck A, Soussan PB, Lacour AC, Largillier R, Tallet A, Tarpin C, Julian-Reynier C. Women's perceptions and experience of adjuvant tamoxifen therapy account for their adherence: breast cancer patients' point of view. Psychooncology 2010; 19:472-9. [PMID: 19507263 DOI: 10.1002/pon.1593] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Largillier R, Savignoni A, Gligorov J, Chollet P, Guilhaume MN, Spielmann M, Luporsi E, Asselain B, Coudert B, Namer M. Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years: a GET(N)A Working Group analysis. Cancer 2009; 115:5155-65. [PMID: 19691088 DOI: 10.1002/cncr.24608] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Usual practices recommend waiting at least 2 years between diagnosis of early breast cancer (EBC) and pregnancy. Few data highlighted a harmful effect of an early pregnancy for low-risk patients. The authors analyzed retrospectively data from women younger than 35 years who became pregnant before or after treatment of EBC. METHODS Between 1990 and 1999, 908 consecutive EBC patients were analyzed. The primary endpoint was to compare overall survival (OS) between pregnant and nonpregnant patients. The secondary endpoint was to establish a score index laying down the risk of distant recurrence. RESULTS Within the year before the diagnosis, 105 (11.6%) patients became pregnant and 118 (13%) were pregnant after treatment. In a multivariate model, a pregnancy before the diagnosis was not predictive of death but of local relapse. A pregnancy subsequent to breast cancer therapy resulted in a 77% decrease of death (P < .001). In good-prognosis score index patients, the annual risk of relapse remained low. In patients having the higher score, recurrences occurred mainly during the first years after the treatment. Beyond 80 months, the annual risk of relapse seemed to be similar to those of lower-risk subgroups. CONCLUSIONS In women aged younger than 35 years, a pregnancy occurring before or after the diagnosis of breast cancer was not an independent prognostic factor of death. In the subset of patients having a high risk of relapse, it may be preferable to postpone a pregnancy beyond 5 years after the breast cancer therapy.
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Affiliation(s)
- Rémy Largillier
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France.
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de la Fouchardière C, Largillier R, Goubely Y, Hardy-Bessard AC, Slama B, Cretin J, Orfeuvre H, Paraiso D, Bachelot T, Pujade-Lauraine E. Docetaxel and pegylated liposomal doxorubicin combination as first-line therapy for metastatic breast cancer patients: results of the phase II GINECO trial CAPYTTOLE. Ann Oncol 2009; 20:1959-63. [PMID: 19556321 DOI: 10.1093/annonc/mdp231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This phase II study evaluated the clinical benefit of pegylated liposomal doxorubicin (PLD) and docetaxel (Taxotere) as first-line therapy for metastatic breast cancer (MBC). PATIENTS AND METHODS MBC patients were enrolled to receive six cycles of PLD 35 mg/m2 (day 1) and docetaxel 40 mg/m2 (days 1 and 15), every 28 days (group A). Because of unacceptable toxic effects, doses were modified to PLD 30 mg/m2 (day 1) and docetaxel 75 mg/m2 (day 2), every 3 weeks (group B). The primary end point was clinical benefit. RESULTS Sixty-seven patients were included (group A, 53; group B, 14). In both groups, the median number of cycles delivered was 4 and the overall dose intensity was 82% for docetaxel and 71% for PLD. In group A, main toxic effects were hematologic, palmar-plantar erythrodysesthesia (PPE), and stomatitis. In group B, higher rates of grade 3-4 PPE, febrile neutropenia, and hematologic toxic effects were reported. The rate of clinical benefit was 47%. Among patients with a measurable disease, 49% achieved a partial response, 27% had a stable disease, and 13% progressed, according to RECIST criteria. CONCLUSION The combination of PLD and docetaxel delivered at planned doses in this study yields unacceptable toxicity and should not be used routinely in patients with MBC.
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Pellegrini I, Sarradon-Eck A, Soussan PB, Lacour AC, Largillier R, Tallet A, Tarpin C, Julian-Reynier C. Women's perceptions and experience of adjuvant tamoxifen therapy account for their adherence: breast cancer patients' point of view. Psychooncology 2009. [PMID: 19507263 DOI: 10.1002/pon.1593.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study on primary breast cancer patients undergoing adjuvant tamoxifen treatment was to determine how their perceptions of the treatment and their experience of side-effects contributed to their adherence to the treatment. METHODS A consecutive series of primary breast cancer patients eligible for tamoxifen therapy were studied qualitatively by conducting semi-structured in-depth interviews at two French cancer centres. RESULTS The women aged 35-65 (N=34) were struggling with several issues involving their understanding and experience of the treatment, which have not been documented so far. These issues included confusion about the 'hormonal' nature and activity of tamoxifen and the etiology of the changes in their menopausal status, as well as the symbolic associations formed by patients about the paradox of taking a treatment that has aging effects but saves lives. CONCLUSIONS This study shows the great physical burden often associated with tamoxifen treatment and brings to light women's own complex representations of the treatment and their interpretation of the side-effects. Better communication between health-care providers and patients should ultimately help to prevent refusal or discontinuation of tamoxifen treatment.
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Marcy P, Chamorey E, Macchiavello J, Largillier R, Peyrade F, Ferrero J, Hanoun-Levi J, Poudenx M, François E, Frenay M. Distal or proximal venous port device insertion: Results of a prospective randomized trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20605] [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
e20605 Background: Open, nonblinded, prospective, randomized, controlled trial comparing two techniques of venous port device insertion: percutaneous distal (phlebography-guided arm port- study technique- 2) vs proximal surgical (cephalic vein cutdown- control technique- 1) placement -To determine whether technique 1 is superior to technique 2. Methods: 230 eligible patients beginning a course of i.v. chemotherapy via a port device catheter with an expected duration of treatment of 3 months or longer were randomized (written informed consent). Eligibility criteria included adult patients with solid tissue malignancy (neuro oncology, gynecology, lung, abdominal, head§neck) beginning a course of I.V.chemotherapy, normal hemostatic parameters, no organ failure, a life expectancy >3months, WHO status<3. Exclusion criteria included current anticoagulant therapy, previous ipsilateral venous catheter/pacewires/surgical axillary node dissection/radiodermatitis, local tumor growth/sepsis, symptomatic brain metastasis, psychosis. The silicone rubber 7F catheter was connected to a 11mm port reservoir, and implanted under local anesthesia using either technique 1 or 2 after randomization. Outcome measurements included technical feasibility/procedure duration, port complications, quality of life (EORTC) questionnaires. Results: Median study duration was 12.2 vs 11.9 months (p: 0.9), median chemotherapy cycles were 6.0 in both groups. Patients groups differed significantly in venous access side (left access in group 2) and sex ratio (p=0.028). In group 2, technical success rate was higher (99 vs 91%, p<0.02), procedure was shorter: 18.0min (10.0–90.0) vs 21min (15.0- 45.0)(p<0.008), but global complication rate was higher (p<0.05). Device complication related explantation rate was 11.9 vs 2.8% (p=0.022). Conclusions: Both techniques are safe and effective. Despite a higher technical success rate and a shorter procedure duration, arm port insertion has a lower complication-free duration. Distal (arm port) technique should be recommended in young female cancer patients (neckline cosmesis/discretion), head and neck cancer patients, obese patients (upright position) and in patients presenting with respiratory insufficiency or at high risk for pneumothorax. No significant financial relationships to disclose.
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Affiliation(s)
- P. Marcy
- Antoine Lacassagne, Nice, France
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Lortholary A, Hardy-Bessard AC, Bachelot T, Dalivoust P, de Rauglaudre G, Alexandre J, Bourgeois H, Jaubert D, Paraiso D, Largillier R. Weekly paclitaxel and capecitabine in HER2-negative metastatic breast cancer (MBC): A multicenter GINECO randomized phase II comparing two paclitaxel-capecitabine schedules. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1114 Background: Paclitaxel (Ta) and capecitabine (Xel) are synergistic in vitro. Compared to a continuous weekly Tax combined with a classical 14 days (d)/21 Xel administration (Elza-Brown et al., ASCO 2000), we have explored the combination of Xel 5d/week (wk) and weekly Ta 3 wk out 4 in the objective to increase the efficacy/toxicity ratio of the TaXel combination. Methods: Patients (pts) in first or second-line of MBC, previously treated with anthracyclins + docetaxel were randomized either to A: Ta (60 mg/m2/w) + Xel (2000 mg/m2/d x 14 d/21) or to B: Ta (80 mg/m2/w) + Xel (2000 mg/m2/d x 5 d/wk) 3wk out 4. Results: From January 2006 to January 2008, 130 pts were accrued (A 66, B 64). Pts characteristics were well balanced between the two arms including median age (58 yrs), histologic type and grade, hormone receptor-positive tumor (80%), previous treatment, visceral disease (72%), number of sites (>1; 63%), ECOG PS (0; 42%, 1; 58%). Pts received a median of 6 cycles (1–23) with a received/planned mean dose of 89.3% for Ta in both arms and of 74 and 76% for Xel respectively in arm A and B. Haematological toxicity (Tox) was low in both arms with neutropenia Gr 3 in only 8% of cycles, G-CSF support in 2% of cycles, and infection G3 in 5 pts. Alopecia G2 was less frequent in arm A (29 vs 60%). Other Tox were similar in both arms: [G2/3 (%) cutaneous (35/17), pain (36/9), fatigue (26/13), neuropathy (20/3), diarrhea (15/6), mucositis (8/2), vomiting (9/1)] but treatment interruption due to Tox was more frequent in A (A 19, B 7 pts) (p = 0.02). Response rate was 52% (B) versus 44% (A). A progression-free survival advantage was seen for B over A (366 vs 272 days, p = 0,15) including in the triple negative pt subset (n = 26 pts) (197 vs 150 days, p = 0.07). Conclusions: The intermittent regimen (3 wk out 4) of weekly paclitaxel and capecitabine 5 d/week is a well accepted, safe and effective TaXel schedule and might be a chemotherapy regimen of choice in MBC including triple negative patients. No significant financial relationships to disclose.
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Gladieff L, Lortholary A, Largillier R, Weber B, Alexandre J, Durando X, Slama B, Dauba J, Paraiso D, Pujade-Lauraine E. Weekly paclitaxel (wP) as single agent or in combination with weekly topotecan (wT) or carboplatin (C) in patients with resistant ovarian cancer (ROC): The phase II CARTAXHY randomized trial from GINECO. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5557 Background: For ROC patients (pts) with early progression during or after (< 6 months) platinum and 3 weekly P, use of single non-platinum agent including wP is standard (Kristensen G, et al. J Clin Oncol 26: 2008 abstr 5508). Few randomized trials have explored combination therapy in this setting. Methods: Pts with ROC after a first or second line including a platinum and a taxane were randomized to receive wP (80 mg/m2/week) alone or in combination with wT (3mg/m2/week) or C (AUC 5 every 4 weeks). The primary end-point was the comparison of progression-free survival (PFS) between single non-platinum agent and combination therapy (wP+wT or wP+C). Secondary objectives included safety, QoL, response rate (RR) and overall survival. Results: From April 2004 to August 2008, 165 pts were accrued (wP 57, wP+wT 57, wP+C 51). Median number of cycles and P dose-intensity (mg/m2/week) was 4.6 and 70, 4.2 and 63 in monotherapy and combination therapy arms respectively. Non-hematological toxicity was not different between the arms, except an excess of hypersensitivity reactions in the wP+C arm. Grade 3–4 neutropenia (48 vs 13% of pts), and anemia (24 vs 6%) were more frequent in combination therapy than in single agent arm and similar with wT or C combination. Febrile neutropenia was experienced by 5 pts treated with combination therapy. Discontinuation from drug treatment was more frequent with combination therapy (24% of pts) than with monotherapy (4%), mainly due to hematotoxicity. RR was 34, 38 and 39% for wP, wP+wT and wP+C respectively. Median PFS of pts treated with single agent (112 days) was not significantly different from those treated with combination therapy (149 days) (p = 0,62) and was similar in wP+wT (152 days) or wP+C (146 days) arms. Treatment with single non-platinum agent or combination therapy was not found an independent parameter when added to a Cox model including prognostic variables. Conclusions: Combination therapy (CT) in platinum resistant ovarian cancer was found more toxic than weekly paclitaxel and the PFS advantage from CT was not statistically significant. No significant financial relationships to disclose.
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Doyen J, Italiano A, Largillier R, Ferrero J, Fontana X, Thyss A. Aromatase inhibition in male breast cancer patients: Biological and clinical implications. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1130 Background: Because male breast cancer (MBC) is rare, treatment recommendations are derived from results of trials in female patients (pts). Although, several studies have shown the superiority of third-generation aromatase inhibitors (AI) over tamoxifen in menopausal women with advanced breast cancer, the role of such molecules remains unknown in male pts. We report here the largest experience about the efficacy of AI in MBC pts with advanced disease and their impact on estradiol (E) levels. Methods: MBC pts were selected from the breast cancer database of the Centre Antoine-Lacassagne (Nice, France) as follows: Metastatic disease with at least one measurable or assessable non-measurable lesion, estrogen receptor (ER) and/or or progesterone receptor (PR) positive, availability of complete clinical and histological data, evidence of progressive disease at initiation of AI, receipt of at least one month of treatment with non steroidal (anastrozole, letrozole) or steroidal (exemestane) AI. Sex hormone levels were retrospectively assessed on serum samples from our institutional serum bank. Results: 15 pts entered the study. Median age was 68 (range 39–85). 7 pts received previous lines of hormonal therapy (median = 1) and 3 pts a previous line of chemotherapy before the introduction of AI. The best response was complete response in 2 pts (13%), partial response in 4 pts (27%), stable disease (SD) in 2 pts (13%) and progressive disease (PD) in 7 pts (47%). The median duration of objective response (OR) was 11.6 months (95% confidence interval [CI] 7.6–15.5). At the time of analysis, 8 pts (53%) had died and 7 (47%) were still alive. The median PFS and OS were 4.4 months (95% CI 0.1–8.6) and 33 months (95% CI 18.4–47.6) respectively. The 1-year PFS and OS rates were 20% (95% CI 9.7–30.3) and 84.6% (95% CI 74.6–94.6), respectively. 9 out of 11 pts with available samples had E levels less than the lower limit of the assay during AI treatment. Among the 9 pts with E level decrease, four had OR, one had SD, and four had PD. 1 pt had E levels higher than the upper limit of the assay during AI treatment. This pt showed disease progression. Further data on FSH and testosterone levels will be presented at the meeting. Conclusions: AI are active in MBC pts. This activity is correlated with a significant reduction in E levels. No significant financial relationships to disclose.
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Affiliation(s)
- J. Doyen
- Centre Antoine Lacassagne, Nice, France
| | | | | | | | | | - A. Thyss
- Centre Antoine Lacassagne, Nice, France
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Favier L, Liegard M, Guiu S, van Praagh I, Largillier R, Weber B, Coeffic D, Vasseur B, Coudert B. Long-term follow-up and factors of survival of HER-2 positive breast cancer patients treated either by neoadjuvant trastuzumab docetaxel (TAXHER-S01 study) or by neoadjuvant trastuzumab docetaxel carboplatin (GETN[A]1 study). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11507] [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
e11507 Background: Almost 20% of breast cancers over express Her2, which is associated with a more aggressive phenotype and with a decreased survival. Nevertheless, trastuzumab (T) has been a revolutionary step in the adjuvant and in the metastatic treatments of Her2 positive breast cancers. Here, we focus on neoadjuvant T and try to determine the factors correlating with disease free survival and with overall survival in Her2 positive breast cancer treated with T based neoadjuvant chemotherapy. Methods: Data from two published T based neoadjuvant phases II were used: the TAX-HER trial which studied the use of 6 courses of 3 weekly docetaxel with weekly neoadjuvant T (scheme TH) (Coudert et. al. Annals of Oncology 2006) and the GET(N)A-1 trial which studied the use of 6 courses of 3 weekly docetaxel and carboplatin along with weekly neoadjuvant T (scheme TCH) followed by 3 weekly adjuvant T (Coudert et. al. JCO 2007). Moreover, additional patients from our institution and treated by neoadjuvant TH and adjuvant T were included. Survival curves were estimated using Kaplan-Meier methods and compared by log-rank test. Results: Data was available for 128 patients. 62 patients (48.4%) received neoadjuvant TH from whom 39 did not receive adjuvant T. 66 (51.6%) received neoadjuvant TCH and adjuvant T. Tumors characteristics were as followed: 65 (50.7%) SBR 1–2, 54 (42.19%) SBR 3, 49 (38.28%) hormonal receptors (RH) negative and 72 (56.25%) RH positive. The rate of pathological complete response (pCR) (Chevalier 1/2) was 39.6%. Overall survival (OS) for the entire cohort was 74,8 months. Relapse was defined as local, regional, metastatic relapse or death. Survival without relapse (SR) was 74.8 months. No difference was noted in OS and in SR according to the type of chemotherapy, TH or TCH. pCR did significantly influence SR (p = 0. 03) and survival without local recurrence (SLR) (p = 0.04) but neither OS nor survival without metastatic relapse (SMR). Multivariate analysis demonstrated that OS was correlated with node response (as defined by sataloff grade NA or NB) (p=0.0275) and the use of hormonal therapy in RH positive tumors (p=0.0724). [Table: see text]
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Affiliation(s)
- L. Favier
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - M. Liegard
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - S. Guiu
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - I. van Praagh
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - R. Largillier
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - B. Weber
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - D. Coeffic
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - B. Vasseur
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
| | - B. Coudert
- Centre George-François Leclerc, Dijon, France; Centre Jean Perrin and INSERM U 71, Clermont Ferrand, France; Centre Antoine Lacassagne, Nice, France; Centre Alexis Vautrin, Nancy, France; Clinique du Mail, Grenoble, France; Laboratoires ROCHE, Neuilly, France; TAXHER-S01 & GETN(A) Groups
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Mancini J, Genève J, Dalenc F, Genre D, Monnier A, Kerbrat P, Largillier R, Serin D, Rios M, Roché H, Jimenez M, Tarpin C, Julian Reynier C. Attitudes envers les essais randomisés en cancérologie selon le vécu préalable. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.137] [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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Schmitt A, Gladieff L, Lansiaux A, Bobin-Dubigeon C, Etienne-Grimaldi MC, Boisdron-Celle M, Serre-Debauvais F, Pinguet F, Floquet A, Billaud E, Le Guellec C, Penel N, Campone M, Largillier R, Capitain O, Fabbro M, Houede N, Medioni J, Bougnoux P, Lochon I, Chatelut E. A Universal Formula Based on Cystatin C to Perform Individual Dosing of Carboplatin in Normal Weight, Underweight, and Obese Patients. Clin Cancer Res 2009; 15:3633-9. [DOI: 10.1158/1078-0432.ccr-09-0017] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Chamorey E, Barrière J, Ferrero J, Largillier R. Reply to Adjuvant chemotherapy and prognosis in patients with breast cancer. Ann Oncol 2009; 20:193-194. [DOI: 10.1093/annonc/mdn633] [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: 11/12/2022] Open
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41
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Chamorey E, Barrière J, Ferrero J, Largillier R. Reply to Is initially metastatic breast carcinoma different from recurrent metastatic breast carcinoma? Ann Oncol 2009; 20:189-190. [DOI: 10.1093/annonc/mdn605] [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: 11/14/2022] Open
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Largillier R, Ferrero JM, Doyen J, Barriere J, Namer M, Mari V, Courdi A, Hannoun-Levi JM, Ettore F, Birtwisle-Peyrottes I, Balu-Maestro C, Marcy PY, Raoust I, Lallement M, Chamorey E. Prognostic factors in 1,038 women with metastatic breast cancer. Ann Oncol 2008; 19:2012-9. [PMID: 18641006 DOI: 10.1093/annonc/mdn424] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Treatment of metastatic breast cancer (MBC) remains palliative. Patients with MBC represent a heterogeneous group whose prognosis and outcome may be dependent on host factors. The purpose of the present study was dual: first, to draw up a list of factors easily available in everyday clinical practice requiring no sophisticated or costly methods and second, to provide results from a large cohort of women who underwent diagnostic and treatment at a single institution. PATIENTS AND METHODS From 1975 to 2005, a total of 1,038 women with MBC during their follow-up were included in this retrospective analysis. Patients were subsequently assigned to five groups according to the period of metastatic diagnosis. RESULTS It is shown that age at initial diagnosis, hormonal receptor status and site of metastasis are the most relevant prognostic factors for predicting survival from the time of metastastic occurrence. It is also shown that a metastasis-free interval is an easily and immediately available multifactorial prognostic index reflecting the multiparametric variability of the disease. CONCLUSION These fundamental observations may assist physicians in evaluating the survival potential of patients and in directing them toward the appropriate therapeutic decision.
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Affiliation(s)
- R Largillier
- Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice, France
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Kurtz E, Besson D, Deslandres M, Lavau-Denes S, Largillier R, Roemer-Becuwe C, Weber B, Chinet-Charrot P, Paraiso D, Pujade-Lauraine E. Cetuximab (Ce) + topotecan (Tc) + cisplatin (Cp) for the treatment (Tt) of advanced cervix cancer (ACC): A phase II GINECO trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mancini J, Genève J, Dalenc F, Genre D, Monnier A, Kerbrat P, Largillier R, Serin D, Rios M, Roché H, Jimenez M, Tarpin C, Julian-Reynier C. Décision de participer à un essai clinique en cancérologie: influence du vécu sur les attitudes. ONCOLOGIE 2008. [DOI: 10.1007/s10269-007-0827-6] [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]
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Beauclair S, Formento P, Fischel JL, Lescaut W, Largillier R, Chamorey E, Hofman P, Ferrero JM, Pagès G, Milano G. Role of the HER2 [Ile655Val] genetic polymorphism in tumorogenesis and in the risk of trastuzumab-related cardiotoxicity. Ann Oncol 2007; 18:1335-41. [PMID: 17693647 DOI: 10.1093/annonc/mdm181] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To examine the impact of a frequent her2 gene polymorphism (Ile655Val) on tumor growth and on the pharmacodynamics of treatment by trastuzumab. PATIENTS AND METHODS Experimental study: The growth characteristics of cells expressing the Ile or Val isoform were examined in vitro and after injection into nude mice. The effect of trastuzumab was determined in both experimental models. Clinical study: 61 patients with advanced breast cancers and treated by trastuzumab were genotyped for HER2 by PCR-RFLP. The influence of HER2 genotype on the trastuzumab treatment was examined. RESULTS Experimental study: HER2-expressing cells acquired the characteristics of tumor cells. The Val isoform-expressing cells showed the highest growth capacity and developed aggressive tumors sensitive to trastuzumab. Clinical study: There was no link between tumor response or survival and HER2 genotype. All cases of treatment-related cardiotoxicity were found in the Ile/Val group and there was no cardiac toxicity in the Val/Val and Ile/Ile patients. CONCLUSIONS This study establishes a clear-cut difference between the two HER2 isoforms regarding their tumorogenic potential with an advantage for the Val/HER2 isoform. In breast cancer patients treated with trastuzumab, the presence of a Val allele may constitute a risk factor for cardiac toxicity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/adverse effects
- Base Sequence
- Blotting, Western
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Cell Transformation, Neoplastic/genetics
- Female
- Heart/drug effects
- Heart Diseases/chemically induced
- Humans
- Immunohistochemistry
- Mice
- Mice, Nude
- Middle Aged
- Molecular Sequence Data
- Mutagenesis, Site-Directed
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/pathology
- Polymerase Chain Reaction
- Polymorphism, Genetic
- Polymorphism, Restriction Fragment Length
- Protein Isoforms/genetics
- Receptor, ErbB-2/genetics
- Transfection
- Trastuzumab
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Affiliation(s)
- S Beauclair
- Oncopharmacology unit (EA 3836), Centre Antoine Lacassagne, Nice, France
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Mancini J, Genève J, Dalenc F, Genre D, Monnier A, Kerbrat P, Largillier R, Serin D, Rios M, Roché H, Jimenez M, Tarpin C, Julian Reynier C. Decision-making and breast cancer clinical trialsHow experience challenges attitudes. Contemp Clin Trials 2007; 28:684-94. [PMID: 17434812 DOI: 10.1016/j.cct.2007.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 10/25/2006] [Revised: 02/28/2007] [Accepted: 03/04/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to measure women's preferences about decision-making and their impact to participate or not to a hypothetical randomised controlled trial (RCT). METHODS We surveyed prospectively breast cancer patients invited to participate in a clinical RCT (group 1a=201 acceptances, group 1b=66 refusals) or not invited (group 2=188). All women had the same treatment. RESULTS Decision-making preferences of patients who had refused clinical RCT entry were more patient's centred (72.3%) compared to those of patients who accepted (35.0%, P<0.001). Altruism was not a significant determinant of patients' participation. Randomisation was considered acceptable in 52.0% (group 1a) compared to 16.9% and 21.1% for group 1b or group 2, respectively (P<0.001). It was the main predictor of willingness to participate in a hypothetical RCT (adjusted odds ratio (OR(adj)) 4.6; 95% confidence interval [2.7-7.7]; P<0.001) with the patient group allocation (OR(adj) group 1a=5.0 [2.9-8.7]; group 1b=0.2 [0.0-0.8]; group 2=1 [referent]; P<0.001). After multivariate adjustment, willingness to participate was also significantly related with medical decision-making preferences (OR(adj) 2.2 [1.0-4.9]; P=0.045), with the feeling of being unable to refuse a doctor's proposal (OR(adj) 1.8 [1.1-3.2]; P=0.031), and with satisfaction with doctors' communication (OR(adj) 3.1 [1.5-7.8]; P<0.001). CONCLUSIONS Patients' acceptance to participate in a RCT is preferred to be doctor's decision, whereas refusal is a personal one. When proposing a RCT, doctors must deal with patients' a priori negative feelings about randomisation. They should thoroughly discuss the reasons for and importance of randomisation as well as the other aspects of participating in the trial in order to give patients all of the information they need to make an informed decision.
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Affiliation(s)
- Julien Mancini
- INSERM, UMR379, Epidemiology and Social Sciences Unit, Paoli-Calmettes Institute, Marseille, F-13273, France
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Courdi A, Largillier R, Ferrero JM, Lallement M, Raoust I, Ettore F, Peyrottes I, Chamorey E, Balu-Maestro C, Chapellier C. Early versus late local recurrences after conservative treatment of breast carcinoma: differences in primary tumor characteristics and patient outcome. Oncology 2007; 71:361-8. [PMID: 17785993 DOI: 10.1159/000107771] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 03/30/2007] [Accepted: 05/26/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate whether some aspects of patient or tumor characteristics influence the timing of local recurrence (LR) in breast cancer treated conservatively, and to assess the impact of the timing of LR on patient outcome. METHODS A retrospective analysis was conducted on patients treated with conservative breast surgery followed by radiotherapy for breast carcinoma who developed LR. Out of 2,008 cases treated in our Institute between 1977 and 2002, 180 ipsilateral LR were observed. Of these, 46 LR were observed within 36 months after treatment, called early local recurrence (ELR), 44 developed between 37 and 60 months, called medium local recurrence (MLR), and 90 occurred after 60 months, called late local recurrence (LLR). Patient and tumor characteristics were analyzed in the 2 groups and compared. RESULTS Primary tumors >20 mm were more frequently found in patients with ELR (31%) than in patients with LLR (17%, p = 0.047). Grade 3 tumors were more often encountered in patients with ELR than in patients with LLR (27 versus 7%, p = 0.0002). Patients with ELR more frequently had tumors with negative estrogen receptors than patients with LLR (37% versus 6%, p < 0.0001). There was no statistically significant difference in the axillary lymph node (LN) status between patients with ELR and those with LLR (35 and 23% of positive LN, respectively, p = 0.24). Tumor size, grade, LN status, hormone receptors and the timing of LR affected the specific survival (SS) from initial surgery. On multivariate analysis, only LN status and the timing of LR retained an independent prognostic value, with an odds ratio of 6.7 for ELR. After LR, the SS was also influenced by all of the above factors, and on multivariate analysis, LN status, hormone receptors and the timing of LR were independent predictors with an odds ratio of SS of 2.50 in case of ELR (p = 0.006). The 5-year SS after LR for ELR, MLR and LLR were 55.8, 74.8 and 79.5%, respectively. CONCLUSIONS Unfavorable tumor characteristics such as big size, high grade, lack of hormone receptors, but not LN status, were associated with ELR. These findings suggest that patients with such aggressive tumor characteristics who do not recur early will have a lower risk of LLR than patients with more favorable factors.
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Affiliation(s)
- A Courdi
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France.
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Julian-Reynier C, Genève J, Dalenc F, Genre D, Monnier A, Kerbrat P, Largillier R, Serin D, Rios M, Roché H, Jimenez M, Tarpin C, Maraninchi D. Assessment of Care by Breast Cancer Patients Participating or Not Participating in a Randomized Controlled Trial: A Report With the Patients' Committee for Clinical Trials of the Ligue Nationale Contre le Cancer. J Clin Oncol 2007; 25:3038-44. [PMID: 17536083 DOI: 10.1200/jco.2006.08.9367] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cancer patients participating in randomized controlled trials (RCTs) have not been found to have better clinical outcomes than other patients. Our objective was to assess the impact of RCTs on patients' satisfaction with care. Patients and Methods A prospective study was carried out in a cohort of women with breast cancer (N = 455) divided into those invited to participate in an RCT (201 acceptances, 66 refusals) and a comparable control group not invited to participate (n = 188). All the patients underwent the same treatment (fluorouracil, epirubicin, and cyclophosphamide 100 mg/m2 for six cycles). One and 7 months after the beginning of chemotherapy, self-administered satisfaction scores were used to compare the women's assessment of their care (Comprehensive Assessment of Satisfaction with Care validated scale). Results At the beginning of chemotherapy, women to whom RCT had been proposed rated the doctors' availability (average ± standard deviation [SD]: RCT acceptance group, 3.60 ± 0.78; RCT refusal group, 3.68 ± 0.87; control group, 3.41 ± 0.82; P ≤ .02) and the doctors' communication (average ± SD: RCT acceptance group, 3.56 ± 0.88; RCT refusal group, 3.67 ± 0.88; control group, 3.39 ± 0.84; P ≤ .05) higher than those to whom the trial was not proposed. After the treatment, participants in the RCT felt that their doctor was more supportive (average ± SD: RCT acceptance group, 3.04 ± 0.92; control group, 2.77 ± 0.85; P = .005) and more informative about their illness and treatment (average ± SD: RCT acceptance group, 3.34 ± 0.88; control group, 3.08 ± 0.92; P = .006) than those in the control group. The general level of satisfaction was also higher in the RCT acceptance group. Conclusion Women participating in an RCT have a more positive picture of their doctors' care than others, probably because of the structural effects of the informed consent and data collection processes.
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Affiliation(s)
- Claire Julian-Reynier
- Institut National de la Santé et de la Recherche Médicale, U379, Epidemiology and Social Sciences Unit, Marseille, France.
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Lhomme C, Petit T, Largillier R, Mayer F, Floquet A, Rey A, Jimenez M, Haie-Meder C. Concomitant weekly carboplatin (CB) and paclitaxel (P) with pelvic radiotherapy (RT) for the treatment of advanced cervical cancer (ACC): A FNCLCC gynecologic group phase I trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5542 Background: Standard primary treatment for locally ACC is RT with concomitant chemotherapy (CT). CB and P are radiosensitizers with in vitro synergistic action. Methods: Patients (pts) with FIGO stage IIB-IVA negative paraaortic lymph nodes cervical cancer were treated with 6 weekly cycles of CT during pelvic RT (45 Gy) and brachytherapy (BT) according to Table 1 . Each dose escalation step followed a 30-day period of observation on cohorts of 3 to 6 pts depending on dose limiting toxicity (DLT): toxic death; garde (G) 4 neutropenia > 1 week; G 4 toxicity (other hematologic or non-hematologic); any toxicity requiring = 1 week delay in RT, or > 2 dose reductions of CT, or G 3/4 hematologic toxicity > 3 weeks after treatment’s end; unendurable G 3 non hematologic toxicity. Results: 23 pts were included by 5 centers in 5 dose levels (L). Stage distribution: IIB (10), III (11), IVA (2); 20 epidermoid and 3 adenocarcinoma; ECOG: 0 (16), 1 (7). 22 pts received the 6 planned cycles. Median dose of irradiation was 45 Gy (43.2–50) with no toxicity related interruption. 17 pts underwent BT, 2 had hysterectomy and 1 received complementary external irradiation 12 Gy. CT dose reduction was necessary in 4 pts (cycle 5 or 6) and cycles postponed for 10 pts (cycle. 5 or 6). One pt experienced paclitaxel allergy at L1. G 3 anemia and/or neutropenia were reported in 11 pts and G 4 neutropenia = 1 week in 2 pts. Radiodermatitis occurred in 5 pts, asthenia in 3 and nausea in 1. One DLT was observed: unendurable G 3 asthenia + G 3 neutropenia and leucopenia at L3. Clinical and radiological complete response was obtained in 13 pts, 5 PRs and 2 SDs in 20 evaluable pts. Conclusions: Acceptable toxicity and optimal irradiation were possible at L4 in 7 pts. These doses are recommended for future phase II studies of concomitant CT/RT in ACC. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- C. Lhomme
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - T. Petit
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - R. Largillier
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - F. Mayer
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - A. Floquet
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - A. Rey
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - M. Jimenez
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
| | - C. Haie-Meder
- Institut Gustave Roussy, Villejuif Cedex, France; Centre Paul Strauss, Strasbourg, France; Centre Antoine Lacassagne, Nice, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonié, Bordeaux, France; FNCLCC, Paris, France
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Largillier R, Valenza B, Ferrero JM, Novo C, Creisson A, Lesbats G, Mari V, Hebert C, Chamorey E. Haematological Evaluation of Weekly Therapy with Topotecan for the Treatment of Recurrent Ovarian Cancer Resistant to Platinum-Based Therapy. Oncology 2007; 73:177-84. [DOI: 10.1159/000127384] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 09/12/2007] [Indexed: 11/19/2022]
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