Oncological patients' reactions to COVID-19 pandemic: A single institution prospective study.

peer reviewedBACKGROUND: The spread of the COVID-19 pandemic has led to a rapid reorganization in all human and hospital activities, with impact on cancer patients. AIM: An analysis of cancer patients fears, and awareness of COVID-19 has been done in this study. METHODS AND RESULTS: We analyzed cancer patients' reactions to the pandemic and their perception of oncological care reorganization, through a 12-item survey, proposed at the peak of pandemic and 3 months later. Overall, 237 patients were included in the study. During the peak of pandemic 34.6% of patients were more worried about COVID-19 than cancer versus 26.4% in the post-acute phase (p = .013). Although 49.8% of patients in the acute phase and 42.3% in the post-acute phase considered their risk of death if infected ≥50%, and more than 70% of patients thought to be at higher risk of complications, the majority of them did not consider the possibility to stop or delay their treatment. Patients were more interested in following news about COVID-19 than cancer and they complied with all preventive measures in more than 90% of the cases. CONCLUSIONS: Although cancer patients worried about COVID-19 and evaluated the risk of complication or death due to COVID-19 as extremely high, they were still asking for the best oncological treatment

Safety, Efficacy, and Patient Acceptability of Everolimus in the Treatment of Breast Cancer.

Everolimus combined with exemestane is an important treatment option for patients suffering from estrogen receptor-positive, human epidermal growth factor receptor 2-negative, advanced breast cancer (ABC) who have been previously treated with a nonsteroidal aromatase inhibitor (NSAI). After presentation of phase III registration trial BOLERO-2, several phase IIIb trials have been started to evaluate this regimen in a more real-world setting. Here, we review the efficacy and safety data published or presented at selected international meetings. These studies confirmed the outcome observed in the BOLERO-2 trial. Patient acceptance rate is also discussed by focusing on the permanent everolimus discontinuation rate in these trials. Factors influencing the safety profile are also reported, including the impact of age. The optimal sequence of combined therapy approaches associating targeted and endocrine therapy (ET) has yet to be determined as new treatment options such as cyclin-dependent kinase inhibitors become available. However, everolimus-exemestane remains an important treatment option with a major impact on progression-free survival (PFS) and an acceptable safety profile

Triple-negative breast cancer : treatment challenges and solutions

Triple-negative breast cancers (TNBCs) are defined by the absence of estrogen and progesterone receptors and the absence of HER2 overexpression. These cancers represent a heterogeneous breast cancer subtype with a poor prognosis. Few systemic treatment options exist besides the use of chemotherapy (CT). The heterogeneity of the disease has limited the successful development of targeted therapy in unselected patient populations. Currently, there are no approved targeted therapies for TNBC. However, intense research is ongoing to identify specific targets and develop additional and better systemic treatment options. Standard adjuvant and neoadjuvant regimens include anthracyclines, cyclophosphamide, and taxanes. Platinum-based CT has been proposed as another CT option of interest in TNBC. We review the role of this therapy in general, and particularly in patients carrying BRCA germ-line mutations. Available data concerning the role of platinum-based CT in TNBC were acquired primarily in the neoadjuvant setting. The routine use of platinum-based CT is not yet recommended by available guidelines. Many studies have reported the molecular characterization of TNBCs. Several actionable targets have been identified. Novel therapeutic strategies are currently being tested in clinical trials based on promising results observed in preclinical studies. These targets include androgen receptor, EGFR, PARP, FGFR, and the angiogenic pathway. We review the recent data on experimental drugs in this field. We also discuss the recent data concerning immunologic checkpoint inhibitors

Appendiceal neuroendrocrine neoplasms: incidentaloma or something we should worry about?

PURPOSE OF REVIEW: To synthesize the current knowledge and guidelines on the management of appendiceal neuroendocrine neoplasms (ANENs). RECENT FINDINGS: Most recent guidelines are essentially based on heterogeneous retrospective series. With the advent of a more precise classification of neuroendocrine neoplasms, this heterogeneity is rightly criticized and many 'grey areas' are now debated in expert literature. The only way to solve these issues is through the conduct of large prospective multicentre studies, but this seems somewhat utopian, given the rarity of this disease. SUMMARY: ANENs are rare tumours with a favourable prognosis, and mainly diagnosed in young patients. They are predominantly localized, and diagnosed incidentally on appendectomy. This procedure is curative for the vast majority of patients but ANENs can relapse even a significant time after the first diagnosis. Identifying the risks for recurrence is challenging, with some factors thought to be predictive of nodal involvement. The presence of one or more of these factors justifies an oncological radicalization of the surgical procedure (right hemicolectomy with lymphadenectomy). However, the beneficial impact of this surgical procedure on survival is still unproven

Resistance to therapy in estrogen receptor positive and human epidermal growth factor 2 positive breast cancers: progress with latest therapeutic strategies

In this article, we focus on the subtype of estrogen receptor (ER)-positive, human epidermal growth factor 2 (HER2)-positive breast cancer (BC). Preclinical and clinical data indicate a complex molecular bidirectional crosstalk between the ER and HER2 pathways. This crosstalk probably constitutes one of the key mechanisms of drug resistance in this subclass of BC. Delaying or even reversing drug resistance seems possible by targeting pathways implicated in this crosstalk. High-risk patients currently receive anti-HER2 therapy, chemotherapy and endocrine therapy in the adjuvant setting. In metastatic cases, most patients receive a combination of anti-HER2 therapy and chemotherapy. Only selected patients presenting more indolent disease are candidates for combinations of anti-HER2 therapy and endocrine therapy. However, relative improvements in progression-free survival by chemotherapy-based regimens are usually lower in ER-positive patients than the ER-negative and HER2-positive subgroup. Consequently, new approaches aiming to overcome endocrine therapy resistance by adding targeted therapies to endocrine therapy based regimens are currently explored. In addition, dual blockade of HER2 or the combination of trastuzumab and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOP) inhibitors targeting the downstream pathway are strategies to overcome resistance to trastuzumab. This may lead in the near future to the less frequent use of chemotherapy-based treatment options in ER-positive, HER2-positive BC

CAR-T cells therapy in solid tumors : where are we now ?.

editorial reviewedChimeric antigen receptor T cells (also known as CAR-T cells) have already made their way into the therapeutic arsenal of specific hematological cancers, significantly improving the prognosis of patients. The prospect of such an innovative and effective treatment in solid tumors is very attractive. For this reason, several clinical studies have been initiated. Unfortunately, the antigenic heterogeneity and microenvironmental hostility of these solid tumors currently limit the effectiveness of CAR-T cells. New strategies are being sought to counteract these therapeutic obstacles.Les lymphocytes T porteurs d’un récepteur antigénique chimérique, appelés CAR-T cells, ont déjà fait leur chemin dans l’arsenal thérapeutique de certains cancers hématologiques, améliorant significativement le pronostic des patients. La perspective d’un tel traitement, aussi innovant qu’efficace, dans les tumeurs solides est très attrayante. C’est la raison pour laquelle plusieurs études cliniques ont vu le jour. Malheureusement, l’hétérogénéité antigénique et l’hostilité micro-environnementale de ces tumeurs solides limitent actuellement l’efficacité des CAR-T cells. De nouvelles stratégies sont recherchées pour contrer ces obstacles thérapeutiques

Late relapses of breast cancer after adjuvant chemotherapy

peer reviewe

Management of appendiceal malignant tumors: a single centre experience

peer reviewedAIM: To report the experience of a tertiary center in the management of appendiceal tumor. METHODS: We retrospectively reviewed our experience from 2010 to 2021, including 102 appendiceal tumors amongst 3,432 appendicectomies. Demographic data, clinical presentation, histopathology, operative reports, treatment and outcome were retrieved from the medical charts. RESULTS: Among the 102 tumors, 41 appendiceal neuroendocrine tumors (NET) (40%), 29 low grade mucinous neoplasm (28%) and 36 adenocarcinoma (35%) were identified. Goblet cells were described in 7% of NET and in 22% of adenocarcinoma. 18 cases of pseudomyxoma peritonei were included. The most frequent clinical presentation was acute appendicitis with tumor diagnosis on appendiceal resection specimen, but in 28% of cases, the diagnosis of appendiceal tumor was suspected before surgery using medical imaging. Surgery was performed by laparoscopy in 60% of cases, and postoperative course was almost always without or with minor complication (Clavien 0 to 2 in 91% of cases). Three patients with incidental appendiceal tumor died postoperatively (<30 days). Regarding NET patients, revision surgery (6) with right hemicolectomy (n=5) was performed according to the oncology board. None of them suffered from recurrency. Concerning adenocarcinoma, 45% required revision surgery and HIPEC was performed in 34%. Adjuvant therapy, exclusively by FOLFOX, was performed in 34% of adenocarcinoma. Despite aggressive management, 22% suffered from recurrency during the follow-up. The 1-year and 5-y survival rates were 91% and 45%, respectively in the adenocarcinoma series. CONCLUSION: Appendiceal tumors are not rare and they often presented as acute appendicitis. Appendiceal NET are less invasive and simple follow-up is recommended in the majority of the cases, except for locally advanced cases (T3-T4) where surgical revision is needed. Appendiceal adenocarcinoma is a particularly recurrent tumor despite aggressive multidisciplinary management