Trabectedin (ET-743/Yondelis) for treating soft tissue sarcomas and ovarian cancer

peer reviewedSoft tissue sarcomas account for 1% of all malignant tumours. Until a few years ago, doxorubicine and ifosfamide were the only active chemotherapy drugs in the metastatic setting. Recently, a new drug has proven its efficacy after failure of standard treatments: the trabectedin; its activity is based on interference with ADN repair mechanisms. Trabectedin has just been also validated and reimbursed in patients with ovarian cancer, in partially sensitive recurrence. In this paper, we will review the mechanism of action and the clinical results of trabectedin

Ovarian cancer metastasis to the pectoral muscle

peer reviewedWe report the case of a patient with a sero-papillary ovarian cancer and a pectoral muscle metastasis. Muscular metastases are more common than previously suspected; any physician could encounter this type of case in his daily practice. This paper summarizes the literature on the subject

Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads

peer reviewedCancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people’s mental and physical health in “normal” aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals’ attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients’ mental and physical health

Natural Antisense Transcripts: Molecular Mechanisms and Implications in Breast Cancers.

Natural antisense transcripts are RNA sequences that can be transcribed from both DNA strands at the same locus but in the opposite direction from the gene transcript. Because strand-specific high-throughput sequencing of the antisense transcriptome has only been available for less than a decade, many natural antisense transcripts were first described as long non-coding RNAs. Although the precise biological roles of natural antisense transcripts are not known yet, an increasing number of studies report their implication in gene expression regulation. Their expression levels are altered in many physiological and pathological conditions, including breast cancers. Among the potential clinical utilities of the natural antisense transcripts, the non-coding|coding transcript pairs are of high interest for treatment. Indeed, these pairs can be targeted by antisense oligonucleotides to specifically tune the expression of the coding-gene. Here, we describe the current knowledge about natural antisense transcripts, their varying molecular mechanisms as gene expression regulators, and their potential as prognostic or predictive biomarkers in breast cancers

Circulating tumor cells: detection, characterization and clinical impact

peer reviewedThe metastatic process generates circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) in bone marrow and other organs which can remain as occult metastases. Various methods and systems have been developed to allow the isolation and identification of those cells but major technical limitations still exist. Research on CTCs is a nevertheless tremendously growing field of cancer research because of their potential clinical applications. CTCs indeed convey predictive information for the development of metastasis and recurrence, and prognostic information regarding patient survival. CTCs enumeration could also be used to monitor the effectiveness of adjuvant treatments. Moreover, enhancing our basic understanding of the metastatic process, CTCs, and DTCs in particular, are thought to contain subpopulations of cells with stem cells properties that would be responsible for relapses

Everolimus Plus Exemestane Versus Everolimus or Capecitabine Monotherapy in Breast Cancer : BOLERO-6

The data from this trial will provide insight into the safety and efficacy of the combination of EVE and EXE versus EVE or capecitabine monotherapy in women with ER+, HER2- ABC progressing on/after prior LET or ANA.Peer reviewe

Radiation recall dermatitis after oral cyclophosphamide

peer reviewedRadiation recall dermatitis is an inflammatory skin reaction occurring in a previously irradiated field following the delivery of a promoting agent. It has been described after a number of antineoplastic agents such as gemcitabine, taxanes, anthracyclines. We report the case of a 50-year-old man with metastatic prostate cancer who developed two consecutive radiation recall dermatitis episodes triggered by oral cyclophosphamide. They occurred 4 to 5 weeks after palliative radiotherapy on bone metastasis. Spontaneous resolution was observed within 6 weeks after discontinuation of cyclophosphamide and with local supportive care. To our knowledge this is the first reported case of radiation recall dermatitis after oral cyclophosphamide

Breast cancer: role of imaging procedures to detect metastases at initial staging and during routine follow-up the first 3 years after diagnosis

peer reviewedIn our region, repeated tumor staging by radiological procedures aiming to detect relapses and/or metastases from breast cancer is frequently performed. However, these procedures are not recommended by current international guidelines. We retrospectively analyzed the charts from 818 patients with a new diagnosis of breast cancer seen at CHU Liege between 2005 and 2009. We assessed the role of staging procedures at initial diagnosis and during follow-up the first 3 years after the diagnosis of breast cancer. Twenty-six patients presented with metastatic disease at diagnosis and 55 patients developed loco-regional relapses or metastases during follow-up. For asymptomatic patients, imaging procedures only detected tumor metastases or relapse without elevated tumor markers in 9 patients at initial diagnosis and 10 patients during follow-up. The diagnosis of an asymptomatic relapse and/or metastases had no positive impact on progression-free or overall survival. The anatomic extension identified patients at high risk for presenting distant metastases already at the time of initial diagnosis and the biological aggressiveness evaluated by Ki-67 was an important prognostic factor for early relapse. In view of these results, we do not recommend staging and searching for metastatic disease in asymptomatic patients presenting early stage breast cancer with low expression of the Ki-67 at the time of initial diagnosis. We also do not recommend repeated staging and searching for metastases by imaging in asymptomatic patients during routine follow-up. Staging should only be performed if a relapse is suspected during follow-up.Dans nos régions, des bilans par imagerie sont régulièrement réalisés lors du diagnostic et dans le cadre du suivi d’un cancer du sein. Cependant, cette pratique est contraire aux recommandations internationales. Nous avons évalué l’intérêt d’un bilan d’extension au diagnostic et lors du suivi, jusqu’à 3 ans après le diagnostic, de 818 patients atteints de cancer du sein pris en charge au CHU de Liège entre 2005 et 2009. Vingt-six patients présentaient des métastases au diagnostic et 55 rechutes locorégionales ou systémiques ont été observées. Pour les patients asymptomatiques, l’imagerie seule a identifié la dissémination à distance et/ou la rechute locorégionale chez 9 patients au diagnostic et 10 patients dans le cadre du suivi. La découverte d’une rechute et/ou d’une dissémination métastatique asymptomatique n’a pas eu d’impact favorable sur la survie sans progression ou la survie globale. L’extension anatomique au diagnostic identifie les patients à risque de présenter une maladie directement métastatique tandis que l’agressivité biologique, évaluée par le Ki-67, est un facteur de risque important pour la rechute précoce. Suite aux résultats obtenus, nous déconseillons de réaliser un bilan d’extension à la recherche de métastases au moment du diagnostic pour les cancers du sein asymptomatiques à un stade précoce avec un Ki-67 peu élevé. Nous déconseillons également la réalisation régulière d’un bilan d’extension par imagerie à la recherche de métastases chez les patients asymptomatiques. Un bilan est à réaliser dans le cadre du suivi uniquement si une rechute est suspectée

Trastuzumab Deruxtecan in HER2-Positive Metastatic Breast Cancer Patients with Brain Metastases: A DESTINY-Breast01 Subgroup Analysis

Trastuzumab deruxtecán; Cáncer de mama metastásico; Metástasis cerebralesTrastuzumab deruxtecan; Metastatic breast cancer; Brain metastasesTrastuzumab deruxtecan; Càncer de mama metastàtic; Metàstasis cerebralsDESTINY-Breast01 (NCT03248492) evaluated trastuzumab deruxtecan (T-DXd; DS-8201) in patients with heavily pretreated HER2-positive metastatic breast cancer (mBC). We present a subgroup of 24 patients with a history of treated brain metastases (BM), a population with limited treatment options. In patients with BMs, the confirmed objective response rate (cORR) was 58.3% [95% confidence interval (CI), 36.6%–77.9%], and the median progression-free survival (mPFS) was 18.1 months (95% CI, 6.7–18.1 months). In patients without BMs (n = 160), cORR was 61.3% and mPFS was 16.4 months. Eight patients (47.1%) experienced a best overall intracranial response of partial response or complete response. Seven patients (41.2%) had a best percentage change in brain lesion diameter from baseline consistent with stable disease. Two patients (8.3%) with BMs and two (1.3%) without BMs experienced progression in the brain. The safety profile of T-DXd was consistent with previous studies. The durable clinical activity of T-DXd in this population warrants further investigation. Significance: Advances in treating HER2-positive metastatic breast cancer have greatly improved patient outcomes, but intracranial progression remains an important risk for which few therapeutic options are currently available. T-DXd demonstrated durable efficacy in patients with stable, treated BMs.AstraZeneca (AstraZeneca PLC) i American Regent (American Regent, Inc.)

Radiotherapy in breast cancer: current standards of treatment, prediction of local recurrence and open questions

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