Results of combined treatment of anaplastic thyroid carcinoma (ATC)

<p>Abstract</p> <p>Background</p> <p>Anaplastic thyroid carcinoma (ATC) is among the most aggressive human malignancies. It is associated with a high rate of local recurrence and with poor prognosis.</p> <p>Methods</p> <p>We retrospectively reviewed 44 consecutive patients treated between 1996 and 2010 at Leon Berard Cancer Centre, Lyon, France. The combined treatment strategy derived from the one developed at the Institut Gustave Roussy included total thyroidectomy and cervical lymph-node dissection, when feasible, combined with 2 cycles of doxorubicin (60 mg/m2) and cisplatin (100 mg/m2) Q3W, hyperfractionated (1.2 Gy twice daily) radiation to the neck and upper mediastinum (46-50 Gy), and then four cycles of doxorubicin-cisplatin.</p> <p>Results</p> <p>Thirty-five patients received the three-phase combined treatment. Complete response after treatment was achieved in 14/44 patients (31.8%). Eight patients had a partial response (18.2%). Twenty-two (50%) had progressive disease. All patients with metastases at diagnosis died shortly afterwards. Thirteen patients are still alive. The median survival of the entire population was 8 months.</p> <p>Conclusion</p> <p>Despite the ultimately dismal prognosis of ATC, multimodality treatment significantly improves local control and appears to afford long-term survival in some patients. There is active ongoing research, and results obtained with new targeted systemic treatment appear encouraging.</p

MRI-Based Radiomics Input for Prediction of 2-Year Disease Recurrence in Anal Squamous Cell Carcinoma

International audiencePurpose: Chemo-radiotherapy (CRT) is the standard treatment for non-metastatic anal squamous cell carcinomas (ASCC). Despite excellent results for T1-2 stages, relapses still occur in around 35% of locally advanced tumors. Recent strategies focus on treatment intensification, but could benefit from a better patient selection. Our goal was to assess the prognostic value of pre-therapeutic MRI radiomics on 2-year disease control (DC). Methods: We retrospectively selected patients with non-metastatic ASCC treated at the CHU Bordeaux and in the French FFCD0904 multicentric trial. Radiomic features were extracted from T2-weighted pre-therapeutic MRI delineated sequences. After random division between training and testing sets on a 2:1 ratio, univariate and multivariate analysis were performed on the training cohort to select optimal features. The correlation with 2-year DC was assessed using logistic regression models, with AUC and accuracy as performance gauges, and the prediction of disease-free survival using Cox regression and Kaplan-Meier analysis. Results: A total of 82 patients were randomized in the training (n = 54) and testing sets (n = 28). At 2 years, 24 patients (29%) presented relapse. In the training set, two clinical (tumor size and CRT length) and two radiomic features (FirstOrder_Entropy and GLCM_JointEnergy) were associated with disease control in univariate analysis and included in the model. The clinical model was outperformed by the mixed (clinical and radiomic) model in both the training (AUC 0.758 versus 0.825, accuracy of 75.9% versus 87%) and testing (AUC 0.714 versus 0.898, accuracy of 78.6% versus 85.7%) sets, which led to distinctive high and low risk of disease relapse groups (HR 8.60, p = 0.005). Conclusion: A mixed model with two clinical and two radiomic features was predictive of 2-year disease control after CRT and could contribute to identify high risk patients amenable to treatment intensification with view of personalized medicine

Stromal Protein-Mediated Immune Regulation in Digestive Cancers

The stromal tumor microenvironment (TME) consists of immune cells, vascular and neural structures, cancer-associated fibroblasts (CAFs), as well as extracellular matrix (ECM), and favors immune escape mechanisms promoting the initiation and progression of digestive cancers. Numerous ECM proteins released by stromal and tumor cells are crucial in providing physical rigidity to the TME, though they are also key regulators of the immune response against cancer cells by interacting directly with immune cells or engaging with immune regulatory molecules. Here, we discuss current knowledge of stromal proteins in digestive cancers including pancreatic cancer, colorectal cancer, and gastric cancer, focusing on their functions in inhibiting tumor immunity and enabling drug resistance. Moreover, we will discuss the implication of stromal proteins as therapeutic targets to unleash efficient immunotherapy-based treatments

Thrombocytopenia due to hypersplenism in oncological disease: Partial splenic embolization during palliative treatment

International audienc

Cancers colorectaux avec mutation V600E de BRAF : où en sommes-nous ?

National audienceLa mutation BRAFV600E, observée chez 8 % des cancers colorectaux (CCR), confère un phénotype particulier et un mauvais pronostic aux CCR, que ce soit au stade localisé ou métastatique. Les CCR BRAF mutés sont préférentiellement des cancers du côlon droit, peu différenciés, à composante mucineuse, touchant une population plus âgée et plus souvent féminine et sont associés à une évolution métastatique ganglionnaire et péritonéale plus fréquente. La mutation de BRAFV600E est associée à une instabilité des microsatellites (MSI) d’origine sporadique dans 20 à 40 % des cas. En situation localisée, elle n’implique aucune modification du traitement adjuvant. En situation métastatique, il faut systématiquement faire la recherche d’un phénotype MSI, compte tenu de sa fréquente association avec la présence d’une mutation de BRAF, afin de proposer une immunothérapie démontrée très efficace dans ce cas. Pour les CCRm non-MSI, une trichimiothérapie associée au bevacizumab est à privilégier chez les patients en bon état général mais l’association à un anti-EGFR peut se discuter, notamment, quand l’objectif est la réponse tumorale. Parallèlement, la chirurgie doit être systématiquement discutée en cas de métastase(s) hépatique(s) résécable(s) car la présence d’une mutation de BRAFV600E n’est pas un facteur de risque de récidive et qu’une survie prolongée peut être observée. En deuxième ou troisième ligne, le triplet encorafenib, binimetinib et cetuximab, ainsi que le doublet encorafenib et cetuximab sont supérieurs à l’association irinotécan plus cetuximab en termes de réponse et de survie (étude BEACON) et représentent un nouveau standard thérapeutique. Leur utilisation en première ligne est à l’étude

Efficacy of Sunitinib in Advanced Medullary Thyroid Carcinoma: Intermediate Results of Phase II THYSU

The article reports on the efficacy of sunitinib for thyroid carcinoma from a phase II trial