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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Toward More Comprehensive Homologous Recombination Deficiency Assays in Ovarian Cancer, Part 1: Technical Considerations

High-grade serous ovarian cancer (HGSOC), the most frequent and lethal form of ovarian cancer, exhibits homologous recombination deficiency (HRD) in 50% of cases. In addition to mutations in BRCA1 and BRCA2, which are the best known thus far, defects can also be caused by diverse alterations to homologous recombination-related genes or epigenetic patterns. HRD leads to genomic instability (genomic scars) and is associated with PARP inhibitor (PARPi) sensitivity. HRD is currently assessed through BRCA1/2 analysis, which produces a genomic instability score (GIS). However, despite substantial clinical achievements, FDA-approved companion diagnostics (CDx) based on GISs have important limitations. Indeed, despite the use of GIS in clinical practice, the relevance of such assays remains controversial. Although international guidelines include companion diagnostics as part of HGSOC frontline management, they also underscore the need for more powerful and alternative approaches for assessing patient eligibility to PARP inhibitors. In these companion reviews, we review and present evidence to date regarding HRD definitions, achievements and limitations in HGSOC. Part 1 is dedicated to technical considerations and proposed perspectives that could lead to a more comprehensive and dynamic assessment of HR, while Part 2 provides a more integrated approach for clinicians

Identification of new genetic and epigenetic determinants of intestinal tumorigenesis susceptibility using the Apcd14 mouse model

Le cancer colorectal (CCR) représente un problème majeur de Santé publique. Des facteurs de risque environnementaux, ainsi que l'apparition séquentielle d'altérations génétiques et épigénétiques corrélant avec la progression tumorale ont été extensivement décrites. Cependant, les variations épigénétiques préexistant dans le tissu sain, potentiellement responsables de différences notoires de susceptibilité au CCR, sont restées élusives jusqu'à ce jour. Afin de répondre à cette problématique, la lignée murine Apcd14 (porteuse d'une mutation hétérozygote constitutive au niveau du gène Adenomatous polyposis coli) a servi de modèle au cours de ce projet. Les individus de cette lignée comportent une expressivité très variable, au sens qu'ils développent spontanément un nombre plus ou moins important de tumeurs intestinales, impactant sur leur survie. Cette hétérogénéité est observée en dépit de conditions d'élevage et de génomes considérés identiques. L'analyse exhaustive de cette lignée a conduit à y caractériser deux groupes de souris, présentant une gravité différente de phénotype. La variation d'expression génétique dans le tissu sain (i.e en amont de la tumorigenèse) a ensuite été analysée dans le but de comprendre l'établissement de cette hétérogénéité. Ceci a mené à la découverte d'une signature de gènes différemment exprimés entre les deux groupes, permettant de corréler de façon parfaite données moléculaires et phénotype. La potentielle héritabilité de cette signature a par la suite conduit à remettre en cause le statut considéré syngénique de la lignée. Les approches expérimentales effectuées ont déjà permis de cibler une région chromosomique, ce qui mènera à court terme à la caractérisation d'un nouvel acteur impliqué dans la tumorigenèse intestinale. De manière plus générale, les expériences développées durant ce projet ouvrent la voie à la notion de susceptibilité individuelle face au cancer dépendante de la variation d'expression génétique.Colorectal cancer (CRC) is a major public health concern. Environmental clues, as well as sequential genetic and epigenetic alterations correlating with tumor progression have been extensively described. Meanwhile, pre-existing epigenetic variations in the healthy intestinal mucosa, potentially leading to differences in CRC suceptibility, have generally been overlooked. In order to answer to this question, we have made use of the Apcd14 mouse model (carrying a heterozygous mutation in the Adenomatous polyposis coli gene). Although all Apcd14 mice apparently share the same genome and are raised in the same environmental conditions, they exhibit a huge phenotypic variability at the individual level, spontaneously developping a few or numerous intestinal tumors, that ultimately results in differences in survival rates. Through detailed analysis of this strain, two groups have been characterized, exhibiting several phenotypic specificities. Gene expression analysis in the healthy intestinal tissue was then performed in order to understand the differences already existing, prior to tumorigenesis. This led to the identification of a group-specific gene expression signature, allowing a correlation between macroscopic phenotype and molecular data. Consideration of the hereditary potential of this signature led to reconsider the syngeneic status of the Apcd14 strain. Several experimental data already targeted a specific genomic region, and this will allow to identify the genetic alteration involved. More generally, this project opens the way to discover a link between individual susceptibility to intestinal tumorigenesis and gene expression variability

De nouveaux types cellulaires identifiés par séquençage haut débit sur cellule unique

International audienc

Toward More Comprehensive Homologous Recombination Deficiency Assays in Ovarian Cancer Part 2: Medical Perspectives

High-grade serous ovarian cancer (HGSOC) is the most frequent and aggressive form of ovarian cancer, representing an important challenge for clinicians. Half of HGSOC cases have homologous recombination deficiency (HRD), which has specific causes (mainly alterations in BRCA1/2, but also other alterations encompassed by the BRCAness concept) and consequences, both at molecular (e.g., genomic instability) and clinical (e.g., sensitivity to PARP inhibitor) levels. Based on its prevalence and clinical impact, HRD status merits investigation. To date, three PARP inhibitors have received FDA/EMA approval. For some approvals, the presence of specific molecular alterations is required. Three companion diagnostic (CDx) assays based on distinct technical and medical considerations have received FDA approval to date. However, their use remains controversial due to their technical and medical limitations. In this companion and integrated review, we take a “bench-to-bedside” perspective on HRD definition and evaluation in the context of HGSOC. Part 1 of the review adopts a molecular perspective regarding technical considerations and the development of CDx. Part 2 focuses on the clinical impact of HRD evaluation, primarily through currently validated CDx and prescription of PARP inhibitors, outlining achievements, limitations and medical perspectives

Cancer-Related Alopecia: From Etiologies to Global Management

International audienceAlopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance

[Alopécie et cancers : de la physiopathologie à la pratique clinique]

International audienceAlopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.L’alopécie, bien que longtemps considérée comme une conséquence inévitable de la thérapeutique anticancéreuse, représente actuellement un défi aux multiples facettes. La connaissance de la physiologie du cheveu et par voie de conséquence de la physiopathologie de l’alopécie a conduit à montrer qu’il n’y a pas une mais plusieurs types d’alopécies. Transposée au monde de l’oncologie, différents types d’alopécies et voies moléculaires impliquées ont pu être caractérisés, permettant de mieux comprendre les mécanismes à l’œuvre. Ainsi, chez des patients atteints de cancers, l’alopécie peut être iatrogène (chimiothérapies, hormonothérapies, thérapies ciblées, immunothérapies, radiothérapie, chirurgie) ou directement la conséquence de la maladie cancéreuse elle-même (dénutrition, métastases du scalp, syndromes paranéoplasiques). La connaissance du (ou des) mécanisme(s) incriminé(s) permet ainsi de mieux déployer un panel de soins appropriés, que ce soit sur les versants préventif et curatif ou encore en termes de soins de support. Ces derniers s’avèrent notamment essentiels en ce qui concerne le retentissement psychologique causé par l’alopécie, avec des conséquences non négligeables sur la qualité de vie des patients et sur l’observance thérapeutique. Sur le plan préventif, les dernières années ont vu l’avènement du casque réfrigérant automatisé, soutenu par plusieurs essais cliniques randomisés. Sur le plan curatif, plusieurs options thérapeutiques sont actuellement déployées ou en cours de développement afin de proposer une offre de soins pertinente

Loss of Apc Rapidly Impairs DNA Methylation Programs and Cell Fate Decisions in Lgr5 + Intestinal Stem Cells

International audienceColorectal cancer initiation and progression result from the accumulation of genetic and epigenetic alterations. Although aberrant gene expression and DNA methylation profiles are considered hallmarks of colorectal cancer development, the precise timing at which these are produced during tumor establishment remains elusive. Here we investigated the early transcriptional and epigenetic changes induced by adenomatous polyposis coli (Apc) inactivation in intestinal crypts. Hyperactivation of the Wnt pathway via Apc inactivation in crypt base columnar intestinal stem cells (ISC) led to their rapid accumulation driven by an impaired molecular commitment to differentiation, which was associated with discrete alterations in DNA methylation. Importantly, inhibiting the enzymes responsible for de novo DNA methylation restored the responsiveness of Apc-deficient intestinal organoids to stimuli regulating the proliferation-to-differentiation transition in ISC. This work reveals that early DNA methylation changes play critical roles in the establishment of the impaired fate decision program consecutive to Apc loss of function. SIGNIFICANCE: This study demonstrates the functional impact of changes in DNA methylation to determine the colorectal cancer cell phenotype following loss of Apc function