77 research outputs found
[Prognosis of colorectal cancer and socio-economic inequalities].
It is well established that socio-economic status is a major prognostic factor for many cancers, including colorectal cancer. The aims of this review are (i) to report epidemiological data showing how socio-economic status influences colorectal cancer survival, (ii) to attempt to describe the mechanisms underlying these survival inequalities, and (iii) to assess their impact on survival of colorectal cancer
Epidemiology of gastric cancers and the role of Helicobacter pylori
Le risque de cancer de lâestomac est associĂ© Ă la prĂ©sence
dâune gastrite chronique atrophique avec achlorhydrie, gĂ©nĂ©ralement
associée à une infection par une bactérie commensale,
lâHelicobacter pylori (H. pylori). Ce facteur de risque est au
centre de lâĂ©tude du rĂŽle du milieu environnant et des habitudes
alimentaires
Rectal cancer with synchronous unresectable metastases: arguments for therapeutic choice
Environ 4 000 patients sont pris en charge chaque année en
France pour un cancer du rectum avec des métastases synchrones
jugées non résécables en réunion de concertation pluridisciplinaire
(RCP). Il nâexiste pas de consensus sur la stratĂ©gie
thérapeutique à proposer et parmi les trois options possibles, les
critÚres de choix restent relativement imprécis.
â La chirurgie premiĂšre est certes le meilleur traitement pour
contrĂŽler les symptĂŽmes rectaux mais elle nâa pas dĂ©montrĂ©
quâelle augmentait la survie et la rĂ©sĂ©cabilitĂ© secondaire des
métastases par rapport aux autres options et comporte un
risque de résection incomplÚte, de complications pouvant
retarder ou empĂȘcher la chimiothĂ©rapie, de progression accĂ©lĂ©rĂ©e
de la maladie métastatique et de mortalité comprise
entre 1 et 5 %.
â La radio-chimiothĂ©rapie premiĂšre suivie dâune chirurgie permet
le contrÎle des symptÎmes rectaux mais retarde la chimiothérapie
pour les métastases qui dominent le pronostic ; elle
expose aux mĂȘmes risques de complications que la chirurgie
premiĂšre.
â La chimiothĂ©rapie premiĂšre nous paraĂźt intĂ©ressante en
absence de complications locales sévÚres (occlusion, hémorragie)
; elle est potentiellement efficace sur les mĂ©tastases Ă
distance qui conditionnent le pronostic et sur la tumeur primitive
qui répond souvent de maniÚre similaire ; elle ne fige pas
la stratĂ©gie et offre la possibilitĂ© de lâadapter Ă chaque Ă©valuation
selon la réponse, la tolérance et les possibilités de résection
(tumeur primitive et métastases).
Dans tous les cas, il est fondamental de discuter ces dossiers au
cas par cas en RCP pour adapter la stratégie thérapeutique aux
caractĂ©ristiques du patient, de la tumeur primitive et de lâextension
mĂ©tastatique, ainsi quâĂ la rĂ©ponse obtenue aux traitements
proposés successivement.Rectal cancers with synchronous unresectable metastases are
diagnosed in about 4 000 patients. There is yet no consensus on
the therapeutic strategy for these cases which must be discussed
during multidisciplinary meeting. Three options are available
and arguments of choice remain relatively weak.
â First-line resection of the primary rectal tumour is indeed
the best treatment to control rectal symptoms but it does
not seem to improve survival and secondary resectability
of metastases when compared to other options; moreover
incomplete resection or complications may delay chemotherapy, accelerate the metastastic process and mortality
rate ranges from 1 to 5%.
â First-line radio-chemotherapy followed by surgery allows for
controlling rectal symptoms but delays chemotherapy for
metastases dominating the prognosis; it exposes the patients
to the same morbidity and mortality as first-line surgery.
â First-line chemotherapy is the third valid option in the absence
of major rectal symptoms (occlusion, haemorrhage); chemotherapy
is potentially efficient on distant metastases bearing a
high prognosis impact and on the primary rectal tumour, which
often has a similar response. First-line chemotherapy allows
for adapting the therapeutic strategy after each evaluation
according to the tumour response, side effects and possibility
of resection (primary rectal tumour and metastases).
In all cases, medical records of such patients should be discussed
during a multidisciplinary meeting to adapt the therapeutic
strategy to the patientâs characteristics, primary rectal tumor,
metastases staging and evolution
Moxetumomab pasudotox in heavily pre-treated patients with relapsed/refractory hairy cell leukemia (HCL): long-term follow-up from the pivotal trial
Background
Moxetumomab pasudotox is a recombinant CD22-targeting immunotoxin. Here, we present the long-term follow-up analysis of the pivotal, multicenter, open-label trial (NCT01829711) of moxetumomab pasudotox in patients with relapsed/refractory (R/R) hairy cell leukemia (HCL).
Methods
Eligible patients had receivedââ„â2 prior systemic therapies, includingââ„â2 purine nucleoside analogs (PNAs), orââ„â1 PNA followed by rituximab or a BRAF inhibitor. Patients received 40 ”g/kg moxetumomab pasudotox intravenously on Days 1, 3, and 5 of each 28-day cycle for up to six cycles. Disease response and minimal residual disease (MRD) status were determined by blinded independent central review. The primary endpoint was durable complete response (CR), defined as achieving CR with hematologic remission (HR, blood counts for CR) lastingâ>â180 days.
Results
Eighty adult patients were treated with moxetumomab pasudotox and 63% completed six cycles. Patients had received a median of three lines of prior systemic therapy; 49% were PNA-refractory, and 38% were unfit for PNA retreatment. At a median follow-up of 24.6 months, the durable CR rate (CR with HRâ>â180 days) was 36% (29 patients; 95% confidence interval: 26â48%); CR with HRââ„â360 days was 33%, and overall CR was 41%. Twenty-seven complete responders (82%) were MRD-negative (34% of all patients). CR lastingââ„â60 months was 61%, and the median progression-free survival without the loss of HR was 71.7 months. Hemolytic uremic and capillary leak syndromes were each reported inââ€â10% of patients, andââ€â5% had grade 3â4 events; these events were generally reversible. No treatment-related deaths were reported.
Conclusions
Moxetumomab pasudotox resulted in a high rate of durable responses and MRD negativity in heavily pre-treated patients with HCL, with a manageable safety profile. Thus, it represents a new and viable treatment option for patients with R/R HCL, who currently lack adequate therapy.publishedVersio
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
Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids
This is an expert consensus from the European Neuroendocrine Tumor Society recommending best practice for the management of pulmonary neuroendocrine tumors including typical and atypical carcinoids. It emphasizes the latest discussion on nomenclature, advances and utility of new diagnostic techniques as well as the limited evidence and difficulties in determining the optimal therapeutic strateg
Bevacizumab plus FOLFIRI or FOLFOX in chemotherapy-refractory patients with metastatic colorectal cancer: a retrospective study
<p>Abstract</p> <p>Background</p> <p>The anti-VEGF antibody bevacizumab associated with an irinotecan or oxaliplatin-based chemotherapy was proved to be superior to the chemotherapy alone in first or second line treatment of metastatic colorectal cancer (mCRC). However, it was reported to have no efficacy in 3<sup>rd </sup>or later-line, alone or with 5FU. The aim of this study was to evaluate the activity of bevacizumab combined with FOLFIRI or FOLFOX in mCRC who have failed prior chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin.</p> <p>Methods</p> <p>Thirty one consecutive patients treated between May 2005 and October 2006 were included in this retrospective study. All of them have progressed under a chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin and received bevacizumab (5 mg/kg) in combination with FOLFIRI or simplified FOLFOX4 every 14 days.</p> <p>Results</p> <p>Ten patients (32.2%) had an objective response (1 CR, 9 PR) and 12 (38.8%) were stabilized. The response and disease control rates were 45.4% and 100% when bevacizumab was administered in 2<sup>nd </sup>or 3<sup>rd </sup>line and 25% and 55% in 4<sup>th </sup>or later line respectively (p = 0.024 and p = 0.008). Among the patients who had previously received the same chemotherapy than that associated with bevacizumab (n = 28) the overall response rate was 35.7% and 39.3% were stabilized. Median progression free survival (PFS) and overall survival (OS) were of 9.7 and 18.4 months respectively. Except a patient who presented a hypertension associated reversible posterior leukoencephalopathy syndrome, tolerance of bevacizumab was acceptable. A rectal bleeding occurred in one patient, an epistaxis in five. Grade 1/2 hypertension occurred in five patients.</p> <p>Conclusion</p> <p>This study suggests that bevacizumab combined with FOLFOX or FOLFIRI may have the possibility to be active in chemorefractory and selected mCRC patients who did not receive it previously.</p
Alectinib versus crizotinib in untreated ALK-positive nonâsmall-cell lung cancer
Alectinib, a highly selective inhibitor of anaplastic lymphoma kinase (ALK), has shown systemic and central nervous system (CNS) efficacy in the treatment of ALK-positive non-small-cell lung cancer (NSCLC). We investigated alectinib as compared with crizotinib in patients with previously untreated, advanced ALK-positive NSCLC, including those with asymptomatic CNS disease.
In a randomized, open-label, phase 3 trial, we randomly assigned 303 patients with previously untreated, advanced ALK-positive NSCLC to receive either alectinib (600 mg twice daily) or crizotinib (250 mg twice daily). The primary end point was investigator-assessed progression-free survival. Secondary end points were independent review committee-assessed progression-free survival, time to CNS progression, objective response rate, and overall survival.
During a median follow-up of 17.6 months (crizotinib) and 18.6 months (alectinib), an event of disease progression or death occurred in 62 of 152 patients (41%) in the alectinib group and 102 of 151 patients (68%) in the crizotinib group. The rate of investigator-assessed progression-free survival was significantly higher with alectinib than with crizotinib (12-month event-free survival rate, 68.4% [95% confidence interval (CI), 61.0 to 75.9] with alectinib vs. 48.7% [95% CI, 40.4 to 56.9] with crizotinib; hazard ratio for disease progression or death, 0.47 [95% CI, 0.34 to 0.65]; P<0.001); the median progression-free survival with alectinib was not reached. The results for independent review committee-assessed progression-free survival were consistent with those for the primary end point. A total of 18 patients (12%) in the alectinib group had an event of CNS progression, as compared with 68 patients (45%) in the crizotinib group (cause-specific hazard ratio, 0.16; 95% CI, 0.10 to 0.28; P<0.001). A response occurred in 126 patients in the alectinib group (response rate, 82.9%; 95% CI, 76.0 to 88.5) and in 114 patients in the crizotinib group (response rate, 75.5%; 95% CI, 67.8 to 82.1) (P=0.09). Grade 3 to 5 adverse events were less frequent with alectinib (41% vs. 50% with crizotinib).
As compared with crizotinib, alectinib showed superior efficacy and lower toxicity in primary treatment of ALK-positive NSCLC. (Funded by F. Hoffmann-La Roche; ALEX ClinicalTrials.gov number, NCT02075840 .)
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