25 research outputs found
Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study
Les adĂ©nocarcinomes de lâintestin grĂȘle (AIG) sont des tumeurs
rares et de mauvais pronostic à un stade avancé. Les données
publiĂ©es concernant lâefficacitĂ© de la chimiothĂ©rapie palliative sont
peu nombreuses. Le but de notre Ă©tude Ă©tait dâĂ©valuer lâefficacitĂ©
et la tolérance de différents protocoles « modernes » de chimiothérapie
et de comparer lâefficacitĂ© des chimiothĂ©rapies Ă base de
sels de platine dans le traitement de premiÚre ligne des AIG avancés.
Cette étude rétrospective multicentrique a inclus 93 patients
(sexe masculin : 53 % ; ùge médian : 56 ans ; site primitif duodénal
: 53 %) avec un AIG avancé (métastatique : 86 %) traités par
LV5FU2 (n = 10), FOLFOX (n = 48), FOLFIRI (n = 19) ou LV5FU2-
cisplatine (n = 16). Le taux de toxicité grade 3-4 était significativement
plus fréquent dans le groupe de patients traités par
LV5FU2-cisplatine (75 %) comparativement aux autres groupes
de patients (p = 0,001). Les médianes de survie sans progression
(SSP) Ă©taient de 7,7 ; 6,9 ; 6,0 et 4,8 mois (p = 0,16) et les
médianes de survie globale (SG) étaient de 13,5 ; 17,8 ; 10,6 et
9,3 mois (p = 0,25) pour les quatre groupes de patients traités par
LV5FU2, FOLFOX, FOLFIRI et LV5FU2-cisplatine, respectivement.
En analyse multivariĂ©e, lâindice de performance OMS Ă 2
(p < 0,0001) ainsi que des taux Ă©levĂ©s dâACE (p = 0,02) et de CA
19-9 (p = 0,03) avant traitement étaient les seuls facteurs indépendants
significativement associés à un mauvais pronostic.
Dans le sous-groupe de patients traités par sels de platine, ceux
qui ont reçu une chimiothérapie par FOLFOX avaient de meilleures
SSP et SG que les patients traités par LV5FU2-cisplatine. En analyse
multivariée, le traitement par FOLFOX était un facteur significatif
et indépendant de survie prolongée en termes de
SSP (p < 0,0001) et SG (p = 0,02). Ainsi, cette Ă©tude, la plus
grande rapportĂ©e Ă ce jour, suggĂšre dâune part que lâindice de
performance OMS et les taux dâACE et CA 19-9 avant traitement
sont des facteurs pronostiques indĂ©pendants de survie et, dâautre
part que la chimiothérapie par FOLFOX est le traitement de choix
en premiÚre ligne des AIG avancés
Caractérisation du syndrome de sprue réfractaire
PARIS5-BU MĂ©d.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF
Use of Proton Pump Inhibitors and Risk of Pancreatic Cancer: A Nationwide Case-Control Study Based on the French National Health Data System (SNDS)
International audienceBackground: Only a few studies investigated the association between proton pump inhibitors (PPIs) use and pancreatic cancer, with inconsistent results. Moreover, these studies had a number of methodological limitations. Our objective was to assess this association in a nationwide case-control study.Methods: We used the French National Health Data System (SNDS), covering 99% of the French population since 2006. Incident cases of pancreatic cancer, identified between 2014 and 2018, were matched with up to 4 controls on year of birth, sex, frequency of hospitalization within 8 years prior to index date, and department of residence. Associations between PPIs and pancreatic cancer were estimated using conditional logistic regression models adjusted for sociodemographic characteristics, risk factors of pancreatic cancer (including diabetes mellitus, tobacco-related diseases, and morbid obesity), and other comorbidities.Results: 23,321 cases of pancreatic cancer (mean age 69.8 years, 51.7% males) and 75,937 matched controls were included. Overall, 77.8% of cases and 75.5% of controls were PPI ever users. Ever (vs. never) PPI use was associated with an increased risk of pancreatic cancer (adjusted OR [aOR]=1.05, 95% CI: 1.01-1.09). A dose-response relationship was observed (1-30 cumulative defined daily dose [cDDD]: aOR=0.92, 95%CI: 0.87-0.97; 31-180 cDDD: aOR=1.05, 95%CI: 1.00-1.11; 181-1080 cDDD: aOR=1.18, 95%CI: 1.12-1.24; >1080 cDDD: aOR=1.17, 95%CI: 1.10-1.23).Conclusions: Based on these findings, a slight increase in the risk of pancreatic cancer associated with high cumulative doses of PPIs cannot be excluded.Impact: Given the overuse of PPIs, efforts should be continued to limit treatments to appropriate indications and durations
Evolution Ă long terme des falaises des âVaches Noiresâ et occurrence des glissements (Calvados, Basse-Normandie, France)
National audienc
Long term evolution of âLes Vaches Noiresâ cliffs and spatio-temporal occurrence of landslides (Calvados, Basse-Normandie, France). First preliminary results.
International audienc
Long term evolution of âLes Vaches Noiresâ cliffs and spatio-temporal occurrence of landslides (Calvados, Basse-Normandie, France). First preliminary results.
International audienc
Erreurs mĂ©dicamenteuses en Auvergne RhĂŽne-Alpes : Ă©tude pilote descriptive collaborative entre structures rĂ©gionales de vigilance et dâappui (SRVA)
FOLFIRINEC: a randomized phase II trial of mFOLFIRINOX vs platinum-etoposide for metastatic neuroendocrine carcinoma of gastroenteropancreatic or unknown origin
International audienceBackgroundPoorly differentiated neuroendocrine carcinomas (NEC) are rare diseases with a poor prognosis. Platinum-etoposide (PE) has been the recommended first-line treatment for decades. FOLFIRINEC (NCT04325425) is a national multicenter randomized phase II study which aims to challenge this standard regimen.MethodsThe primary objective is to compare the median progression-free survival (PFS) under mFOLFIRINOX versus PE. The secondary objectives are to evaluate the objective response rates (ORR), median overall survival (OS), safety and quality of life. The associated real-time translational study will establish a molecular profile for each patient enrolled.Main inclusion criteria areNEC of gastroenteropancreatic (GEP) or unknown origin, metastatic and RECIST 1.1 evaluable disease, tumor sample available and no contraindication to chemotherapy. Patients will be randomized 1:1 between PE every 21 days for 6â8 cycles and mFOLFIRINOX every 14 days for up to 12 cycles and stratified according to center, performance status, Ki67 and pathological subtype.This trial will randomize 218 patients (24 months of follow-up) to have 80% power to detect an improvement of the median PFS from 5 months under PE to 7.5 months under mFOLFIRINOX (HR of 0.67, α =5%, two-sided). An intermediate analysis is planned at 50% of events