Routine molecular profiling of cancer: results of a one-year nationwide program of the French Cooperative Thoracic Intergroup (IFCT) for advanced non-small cell lung cancer (NSCLC) patients.

International audienceBackground: The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. Methods This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. Findings 18 679 molecular analyses of 17 664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18–98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7–16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17 706 analyses for which data were available, HER2 mutations in 98 (1%) of 11 723, KRAS mutations in 4894 (29%) of 17 001, BRAF mutations in 262 (2%) of 13 906, and PIK3CA mutations in 252 (2%) of 10 678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8–25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients achieving an overall response in first-line treatment (37% [95% CI 34·7–38·2] for presence of a genetic alteration vs 33% [29·5–35·6] for absence of a genetic alteration; p=0·03) and in second-line treatment (17% [15·0–18·8] vs 9% [6·7–11·9]; p<0·0001). Presence of a genetic alteration was also associated with improved first-line progression-free survival (10·0 months [95% CI 9·2–10·7] vs 7·1 months [6·1–7·9]; p<0·0001) and overall survival (16·5 months [15·0–18·3] vs 11·8 months [10·1–13·5]; p<0·0001) compared with absence of a genetic alteration. Interpretation Routine nationwide molecular profiling of patients with advanced NSCLC is feasible. The frequency of genetic alterations, acceptable turnaround times in obtaining analysis results, and the clinical advantage provided by detection of a genetic alteration suggest that this policy provides a clinical benefit

Composer avec le monde

À l’heure où le numérique fait émerger de nouveaux modes d’écriture, d’écoute, d’échange, de circulation et de stockage des données, mais aussi de nouvelles formes d’autorité, d’économies et de types de relation au temps et au monde, ce numéro interroge les notions de création musicale et chorégraphique en contexte de globalisation. À travers une série d’études de cas qui dépassent les distinctions Nord/Sud, écrit/oral, savant/populaire, religieux/profane, on saisit mieux comment ces pratiques participent d’un même régime de création qui, tantôt intègre, tantôt met en tension deux logiques, l’une du renouvellement, l’autre de l’innovation. De la même manière, ces pratiques de composition et de recomposition sont interrogées en termes de régimes d’autorité, ce qui permet de montrer que, dans de multiples régions du monde, des solutions alternatives aux « droits d’auteur », certaines anciennes, d’autres plus récentes, ont été mises en place et s’inscrivent désormais dans ces nouvelles économies de services suscitées par la démocratisation du numérique. As digital technologies set off new modes of writing, listening, exchanging, circulating and data storaging, as well as new forms of authority, economies and types of relationships to time and to the world, this set of texts questions notions of musical and choreographic creation in our globalized context. Through a series of case studies which go beyond the North/South, written/oral, learned/popular and sacred/secular dichotomies, we better understand how these practices participate in the same regime of creation which either integrates or puts in tension two logics, one of renewal, another one of innovation. These practices of composing and recomposing are also questioned in terms of regimes of authority. The interest of this approach is to show that, in various regions of the world, alternative solutions to “copyright” systems, certain old, others more recent, have been set up and are henceforth part of the new service economies sparked off by the democratization of digital technologies