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Isabelle RC, Tredan O, Garin G, Ménétrier-Caux C, Chabaud S, Bachelot T, Cropet C, Heudel PE, Rebattu P, Dupont P, Verronese E, Cadore AC, Fouillat V, Derbel O, Bonnin N, Croughs T, Morre M, Pasqual N, Manuel M, Clapisson G, Caux C, Pérol D, Blay JY. Abstract CT333: Elypse-7: A randomized, placebo-controlled, Phase 2a evaluating the impact of IL-7 immunotherapy on CD4 count, risks of severe haematological toxicity and tumor progression in metastatic breast cancer patients. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-ct333] [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: Total and CD4 lymphopenia is observed in 25% of advanced cancers patients and is a predictive factor of chemotherapy (CT)-induced death, febrile neutropenia, thrombocytopenia, anemia, as well as an independent prognostic factor for survival and tumor progression. CYT107 is a glycosylated recombinant human IL-7 (CYTHERIS, France) emerging as a promising immuno-restorative agent well tolerated in Phase 1 trials. To date, it is unknown whether IL-7 can correct lymphopenia during CT and whether this could translate into clinical benefit in advanced cancer patients.
Methods: A placebo-controlled, monocentric, Phase 2a (NCT01368107) was conducted in lymphopenic metastatic breast cancer (MBC) patients to be treated by capecitabine (2500mg/m2/d, pers os, 21-day cycle from D21 after randomization). Using a 2x2 factorial design, patients were randomly allocated to 4 arms to receive 1) before the 1st cycle of CT : r-hIL-7 (CYT107:10µg/kg, subcutaneously, weekly at D0, D7, D14, groups 2 & 4) or placebo (groups 1 & 3), then 2) during the 3rd cycle of CT: r-hIL-7 (weekly at D57, D64, D71, groups 3 & 4) or placebo (groups 1 & 2). The primary endpoint, CD4 count evolution, was evaluated before (D0 to D21) and during CT (D57 to D78). Secondary endpoints include risks of severe hematological AE, safety and progression free survival (PFS). An ancillary study has evaluated the quantitative and functional changes in circulating immune cells (see abstract Ménétrier-Caux).
Results: From Nov. 2011 to Jun. 2013, 20 patients (median age [range]: 60 [39-76 y.]; median CD4 count on D0: 242 [22-522 cells/µL]) with MBC (mainly with bone and liver metastasis) were enrolled. Before CT (n=20), r-hIL-7 treatment induced a significant increase of CD4 count (median relative evolution: +148.1% [41.8-763.9 cells/µL] in r-hIL-7 groups vs +9.9% [-50.3-102.2 cells/µL] in placebo [Wilcoxon, p=0.002]). During CT (n=11), r-hIL-7 treatment also increased CD4 count (+58.6%[-15.2-281.5 cells/µL] in r-hIL-7 groups vs -2.4% [-27.6-112.5 cells/µL] in placebo [p=0.121]). Overall, r-hIL-7 was well tolerated with reactions related to injection as the main specific AE, no binding or neutralizing antibodies, and no r-hIL-7-related ≥ Grade 3 AE except 1 fatal SAE for which one a relationship to r-hIL-7 cannot be ruled out. Interestingly, r-hIL-7 treatment during CT reduced the incidence of Grade 3 hematological AE compared to placebo (0 vs 5 events, respectively). PFS data will be available by Feb. 2014.
Conclusion: In this exploratory trial, r-hIL-7 treatment was safe at biologically active dose, able to correct CD4 lymphopenia and associated with lower incidence of severe hematological toxicity during CT. These early results are encouraging and warrant further investigations of IL-7 clinical applications in the oncology field.
Citation Format: Ray-Coquard Isabelle, Olivier Tredan, Gwenaele Garin, Christine Ménétrier-Caux, Sylvie Chabaud, Thomas Bachelot, Claire Cropet, Pierre-Etienne Heudel, Paul Rebattu, Patricia Dupont, Estelle Verronese, Anne-claire Cadore, Valérie Fouillat, Olfa Derbel, Nathalie Bonnin, Thérèse Croughs, Michel Morre, Nicolas Pasqual, Manuari Manuel, Gilles Clapisson, Christophe Caux, David Pérol, Jean-Yves Blay. Elypse-7: A randomized, placebo-controlled, Phase 2a evaluating the impact of IL-7 immunotherapy on CD4 count, risks of severe haematological toxicity and tumor progression in metastatic breast cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT333. doi:10.1158/1538-7445.AM2014-CT333
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Affiliation(s)
| | - Olivier Tredan
- 1Medical Oncology Dpt, Leon Berard Cancer Center, Lyon, France
| | - Gwenaele Garin
- 2DRCI, Biostatistic Unit, Leon Berard Cancer Center, Lyon, France
| | - Christine Ménétrier-Caux
- 3Innovation in Immuno-monitoring and Immunotherapy Platform (P3I),INSERM U1052, CNRS UMR 5286, Université Lyon 1, ISPB, Leon Berard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- 2DRCI, Biostatistic Unit, Leon Berard Cancer Center, Lyon, France
| | - Thomas Bachelot
- 1Medical Oncology Dpt, Leon Berard Cancer Center, Lyon, France
| | - Claire Cropet
- 2DRCI, Biostatistic Unit, Leon Berard Cancer Center, Lyon, France
| | | | - Paul Rebattu
- 1Medical Oncology Dpt, Leon Berard Cancer Center, Lyon, France
| | - Patricia Dupont
- 4DRCI, Clinical study office, Leon Berard Cancer Center, Lyon, France
| | - Estelle Verronese
- 5Innovation in Immuno-monitoring and Immunotherapy Platform (P3I), Leon Berard Cancer Center, Lyon, France
| | | | - Valérie Fouillat
- 2DRCI, Biostatistic Unit, Leon Berard Cancer Center, Lyon, France
| | - Olfa Derbel
- 1Medical Oncology Dpt, Leon Berard Cancer Center, Lyon, France
| | - Nathalie Bonnin
- 1Medical Oncology Dpt, Leon Berard Cancer Center, Lyon, France
| | | | | | | | | | - Gilles Clapisson
- 5Innovation in Immuno-monitoring and Immunotherapy Platform (P3I), Leon Berard Cancer Center, Lyon, France
| | - Christophe Caux
- 8Innovation in Immuno-monitoring and Immunotherapy Platform (P3I), INSERM U1052, CNRS UMR 5286, Université Lyon 1, ISPB, Leon Berard Cancer Center, Lyon, France
| | - David Pérol
- 2DRCI, Biostatistic Unit, Leon Berard Cancer Center, Lyon, France
| | - Jean-Yves Blay
- 9Medical Oncology Dpt, INSERM U1052, CNRS UMR 5286, Université Lyon 1, ISPB, Leon Berard Cancer Center, Lyon, France
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Mignotte H, Perol D, Fontanière B, Nachury LP, Blanc-Jouvand A, Fouillat V, Chauvin F, Lasset C. [Cervical cancer screening for high risk women: is it possible? Results of a cervical cancer screening program in three suburban districts of Lyon]. Bull Cancer 1999; 86:573-9. [PMID: 10417430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Between november 1993 and october 1996, a cervical screening program was proposed for women 25-65-year-old who tend to have little or no medical supervision, in three suburban districts of Lyon. The data and results of the two last Pap-smears have been collected together with details of gynecological follow-up. Both general practitioners and gynaecologists were actively involved. A total of 3,792 women (12.3% of the target) were registered, with a larger proportion of women over 60 (17.7%). According to the "Consensus of Lille", only 403 women (34.4%) had adequate screening (over 50 y: 25.8%, 35-49 y: 39.4%, 25-35 y: 36.5%) and 2,489 women had inappropriate gynaecological follow-up: no smear for 185 women (4.9%) and inadequate schedule of follow-up visits for 476 others (12.5%). Missing data (date or results of Pap smear) were noted for 1,828 patients (48.2%). The screening procedure for women over 50 years was carried out mainly by general practitioner. Of 3,127 registered smears, 62 positive results were found (2.1%). Of these women, 9 were lost to follow-up and 4 did not have appropriate tests. Others results were: 27 negative further investigations, 9 CIN1, 7 CIN2, 3 CIN3, 1 in situ carcinoma and 2 invasive carcinoma. Despite low participation, this pilot study indicates that a procedure can be established to integrate high risk women in cervical cancer screening programme. Active participation of general practitioners is essential.
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Affiliation(s)
- H Mignotte
- Association pour le dépistage du cancer du col utérin, BP 107, 69672 Bron Cedex
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Mathieu P, Frappaz D, Chauvin F, Combaret V, Vercherat M, Brunat-Mentigny M, David L, Esteve J, Favrot M, Fouillat V, Greffe J, Lasset C, Renaud P, Philip T. A 5-year (1990-1994) neuroblastoma screening feasibility study in France. Methodology and preliminary observations. Early Hum Dev 1996; 46:177-96. [PMID: 9019414 DOI: 10.1016/0378-3782(96)01763-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Following the pioneering Japanese experience, several European and North American groups implemented pilot studies on screening infants for neuroblastoma, considering the possibility of demonstrating a decrease in mortality rate. In France, a 5-year (1990-1994) feasibility study on neuroblastoma screening at the age of 4 months was initiated in the Rhône district (1.5 M inhabitants, 26,000 births per year). METHODS Vanillylmandelic (VMA) and homovanillic (HVA) acids were measured by HPLC, and creatinine (Cr) by the Jaffé's kinetic method on Technicon RA-XT. VMA and HVA were expressed as microgram/mg of Cr. The method was assessed with both a daily intra-laboratory control and a sample of urine obtained from a national quality control organism. RESULTS AND DISCUSSION The overall participation rate for the 5-year period was 82.2%. Out of 105,293 infants tested from 128,126 births, 12 NB cases were discovered with screening (screened cases) and 1 case was discovered with a late performed test (at 13 months of age). Six neuroblastomas were found clinically before the age of 4 m. Two cases were missed because the parents did not perform the test. Three children with normal tests at screening were false-negative cases: two of them were found secreting at diagnosis, while one remained non-secretory at diagnosis and later on. Otherwise, thirty-five false-positive tests were found. Biochemical observations are discussed. It is too early to reach clinical conclusions from this screening program on neuroblastomas as it is presently being followed up.
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Affiliation(s)
- P Mathieu
- Service de Biologie Générale et de Neurobiologie, Centre hospitalier du Vinatier, Bron-Lyon, France
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