Alterations in Homologous Recombination-Related Genes and Distinct Platinum Response in Metastatic Triple-Negative Breast Cancers: A Subgroup Analysis of the ProfiLER-01 Trial

International audienc

Evolution de la prise en charge thérapeutique du cancer colo-rectal métastatique (de la belladone à la pharmacogénomique : exemple de l'essai COLOGEN)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Evolution vers une médecine personnalisée de la prise en charge thérapeutique du cancer du sein

Le cancer du sein est classiquement réparti selon des critères anatomo-pathologiques en trois sous-types majeurs: hormona-dépendant, Human Epidermal Growth Factor Receptor-2 positif et triple négatif. Le développement récent des technologies à haut débit a permis de mieux appréhender l'hétérogénéité du cancer du sein en révélant l'existence d'une multitude d'entités moléculaires au sein de ces trois sous-types. Malgré l'enthousiasme généré autour des thérapies ciblées, l'efficacité clinique de ces molécules demeure encore limitée. Une des approches actuelles pour surmonter ce problème est de mieux sélectionner les patientes pouvant bénéficier d'une thérapie ciblée donnée en se basant sur les données moléculaires de chaque patiente. Cette personnalisation de la prise en charge des patientes va très prochainement modifier en profondeur la façon de développer et d'évaluer les nouvelles molécules. L'émergence de la médecine personnalisée constitue donc un véritable défi nécessitant une coordination multi-disciplinaire englobant des compétences scientifiques, pharmaceutiques et médicales multiples pour sa mise en place en pratique cliniqueLYON1-BU Santé (693882101) / SudocSudocFranceF

Small cell cancer of the bladder: The Leon-Berard cancer centre experience

Background: Small cell bladder carcinoma is an uncommon tumor. In this retrospective study we report our experience dealing with this disease at the Leon-Berard Cancer Centre. Materials and Methods: We retrospectively analyzed various characteristics of small cell bladder carcinoma: patient demographics, histological diagnosis, disease stage, treatment effects and outcome, in 14 non-metastatic small cell bladder carcinoma patients treated at our institution between 1995 and 2006. Results: The mean age at diagnosis was 60 years (range, 45-77). All patients were male. Seventy-five per cent were smokers. All had locally advanced disease. Ten patients (71.4%) were treated by cystoprostatectomy and bilateral pelvic lymph node resection, one by cystoprostatectomy alone. Two patients received neoadjuvant chemotherapy and four received adjuvant chemotherapy. One patient was treated by radiotherapy with concomitant cisplatin after transurethral resection of bladder tumor (TURBT). One patient refused surgery and was treated by chemotherapy alone. One patient was lost to follow-up after TURBT. After 49-month median follow-up, 12 patients had relapsed. Disease-free survival was 5.7 months. The most frequent sites of relapse were the retroperitoneal lymph node (seven patients) and the liver (three patients). Nine patients died of metastasis. Median overall survival was 29.5 months. Survival probability at two years was 58%. Median overall survival was 34 months in the mixed small carcinoma group, as compared with 9.5 months in the pure small cell carcinoma group (P=0.01). Mean overall survival was 27.2 months for all patients and 38.6 months for patients treated with cystectomy and adjuvant chemotherapy. Conclusion: To date, the optimal treatment for locally advanced small cell bladder carcinoma is not clear. Cystectomy with neoadjuvant or adjuvant chemotherapy appears as a viable option

Transmission of breast cancer polygenic risk based on single nucleotide polymorphisms

International audience"The goal of the present study was to further refine how polygenic risk scores may be used in a large population and to quantify the transmission of risk score through generations.

A qualitative study of teleconsultation practices among French oncologists in a post-COVID-19 period

Background The Covid-19 pandemic has prompted healthcare professionals to adapt and implement new tools to ensure continuity of patient care. Teleconsultation became the only option for some practitioners who had never used it previously and boosted its use for others who already used it. Several studies have reviewed the use of teleconsultation in oncology during the epidemic, but few have addressed its continued use and how practitioners view it in a post-epidemic period. The aim of this survey was to conduct a qualitative exploration of how oncologists use teleconsultation in their daily practice in a post-COVID 19 period. Materials and Methods For this qualitative study, semi-structured interviews were conducted with oncologists in France who utilized teleconsultation in the field of oncology during the COVID-19 period. The interview guide included questions on the interests and limitations of using teleconsultation in oncology, on reluctance to use it among oncologists, and invited participants to formulate proposals for more optimal use. Results Fourteen oncologists participated in the survey. Currently, 12% of the consultations of the surveyed practitioners are conducted via teleconsultation. Seven themes were identified in the analysis of the interviews: (a) The oncologist and teleconsultation; (b) Clinical motivations for using teleconsultation; (c) Comparison between teleconsultation and in-person consultation; (d) Advantages and disadvantages of teleconsultation; (e) Technical modalities of teleconsultation; (f) Role of Covid and confinement in the use of teleconsultation; (h) Epistemic judgments about teleconsultation. Optimal teleconsultation occurs when seamlessly incorporated into patient care, offering reduced patient inconvenience, and providing economic and environmental benefits. Although there's a lack of unified agreement in research literature regarding time efficiency, teleconsultation facilitates more customized patient monitoring and addresses the challenge of “medical deserts” nationally. Considering patient preferences is crucial when contemplating the use of teleconsultation. Predominantly, technical issues stand as the principal barriers to teleconsultation implementation. Conclusion Even after the end of the health crisis, teleconsultation is still used in clinical practice. Recommendations for effective use are suggested

Adjuvant therapeutic strategy decision support for an elderly population with localized breast cancer: A monocentric cohort retrospective study

International audienceGuidelines for the management of elderly patients with early breast cancer are scarce. Additional adjuvant systemic treatment to surgery for early breast cancer in elderly populations is challenged by increasing comorbidities with age. In non-metastatic settings, treatment decisions are often made under considerable uncertainty; this commonly leads to undertreatment and, consequently, poorer outcomes. This study aimed to develop a decision support tool that can help to identify candidate adjuvant post-surgery treatment schemes for elderly breast cancer patients based on tumor and patient characteristics. Our approach was to generate predictions of patient outcomes for different courses of action; these predictions can, in turn, be used to inform clinical decisions for new patients. We used a cohort of elderly patients (� 70 years) who underwent surgery with curative intent for early breast cancer to train the models. We tested seven classification algorithms using 5-fold cross-validation, with 80% of the data being randomly selected for training and the remaining 20% for testing. We assessed model performance using accuracy, precision, recall, F1-score, and AUC score. We used an autoencoder to perform dimensionality reduction prior to classification. We observed consistently better performance using logistic regression and linear discriminant analysis models when compared to the other models we tested. Classification performance generally improved when an autoencoder was used, except for when we predicted the need for adjuvant treatment. We obtained overall best results using a logistic regression model without autoencoding to predict the need for adjuvant treatment (F1-score = 0.869)

Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women

International audienceBackground: Glucocorticoids could theoretically decrease breast cancer risk through their anti-inflammatory effects or increase risk through immunosuppression. However, epidemiological evidence is limited regarding the associations between glucocorticoid use and breast cancer risk. Methods: We investigated the association between systemic glucocorticoid use and breast cancer incidence in the E3N cohort, which includes 98,995 women with information on various characteristics collected from repeated questionnaires complemented with drug reimbursement data available from 2004. Women with at least two reimbursements of systemic glucocorticoids in any previous 3-month period since January 1, 2004, were defined as exposed. We considered exposure as a time-varying parameter, and we used multivariable Cox regression models to estimate hazard ratios (HRs) of breast cancer. We performed a competing risk analysis using a cause-specific hazard approach to study the heterogeneity by tumour subtype/stage/grade. Results: Among 62,512 postmenopausal women (median age at inclusion of 63 years old), 2864 developed breast cancer during a median follow-up of 9 years (between years 2004 and 2014). Compared with non-exposure, glucocorticoid exposure was not associated with overall breast cancer risk [HR = 0.94 (0.85-1.05)]; however, it was associated with a higher risk of in situ breast cancer and a lower risk of invasive breast cancer [HR insitu = 1.34 (1.01-1.78); HR invasive = 0.86 (0.76-0.97); P homogeneity = 0.01]. Regarding the risk of invasive breast cancer, glucocorticoid exposure was inversely associated with oestrogen receptor (ER)-positive breast cancer [HR ER+ = 0.82 (0.72-0.94); HR ER− = 1.21 (0.88-1.66); P homogeneity = 0.03]; it was also inversely associated with the risk of stage 1 or stage 2 tumours but positively associated with the risk of stage 3/4 breast cancers [HR stage1 = 0.87 (0.75-1.01); HR stage2 = 0.67 (0.52-0.86); HR stage3/4 = 1.49 (1.02-2.20); P homogeneity = 0.01]. Conclusion: This study suggests that the association between systemic glucocorticoid use and breast cancer risk may differ by tumour subtype and stage

Multicontrast MRI-based radiomics for the prediction of pathological complete response to neoadjuvant chemotherapy in patients with early triple negative breast cancer

International audienceIntroduction :To assess pre-therapeutic MRI-based radiomic analysis to predict the pathological complete response to neoadjuvant chemotherapy (NAC) in women with early triple negative breast cancer (TN).Materials and methods :This monocentric retrospective study included 75 TN female patients with MRI (T1-weighted, T2-weighted, diffusion-weighted and dynamic contrast enhancement images) performed before NAC. For each patient, the tumor(s) and the parenchyma were independently segmented and analyzed with radiomic analysis to extract shape, size, and texture features. Several sets of features were realized based on the 4 different sequence images. Performances of 4 classifiers (random forest, multilayer perceptron, support vector machine (SVM) with linear or quadratic kernel) were compared based on pathological complete response (defined on the excised tissues), on 100 draws with 75% as training set and 25% as test.Results : The combination of features extracted from different MR images improved the classifier performance (more precisely, the features from T1W, T2W and DWI). The SVM with quadratic kernel showed the best performance with a mean AUC of 0.83, a sensitivity of 0.85 and a specificity of 0.75 in the test set.Conclusion :MRI-based radiomics may be relevant to predict NAC response in TN cancer. Our results promote the use of multi-contrast MRI sources for radiomics, providing enrich source of information to enhance model generalization