Role of neo-adjuvant hormonal therapy in the treatment of breast cancer: a review of clinical trials

The clinical benefits of endocrine therapy for patients with hormonosensitive breast cancer are well established. For many years, 5 years of tamoxifen was the gold standard of adjuvant treatment. The recent development of new endocrine agents provides physicians with a more effective therapeutic approach. Nevertheless, the success of neoadjuvant endocrine therapy is much more recent and less reported in the literature. This article reviews the studies published about neoadjuvant endocrine treatment (tamoxifen and aromatase inhibitors). According to the literature, neoadjuvant endocrine therapy seems to be effective. In contrast to neoadjuvant chemotherapy, neoadjuvant endocrine therapy is well tolerated, with very few patients having to discontinue the treatment because of side effects. It does not constitute a standard treatment but could have potential for elderly women with operable, hormonosensitive, well differentiated and slowly progressing (SBR I) tumor or for patients with lobular MSBR 1 carcinoma (low chemosensitivity). The newer generation of aromatase inhibitors (letrozole, anastrozole, exemestane) appears to be more active (in terms of overall response rates and conservative surgery rate) than tamoxifen. Patients with an estrogen receptor Allred score of 6 and over are more likely to respond and gain a clinical benefit. The optimal duration of neoadjuvant therapy has not yet been investigated in detail. These preliminary results should be confirmed by further studies

Long-term disease-free survival in advanced melanomas treated with nitrosoureas: mechanisms and new perspectives

BACKGROUND: Median survival of metastatic malignant melanoma is 6.0 to 7.5 months, with a 5-year survival of ~6.0%. Although long-term complete remissions are rare, few reports describe cases after chemotherapy. Fifty-three patients with metastatic melanoma were treated with Cystemustine, a chloroethyl nitrosourea (CENU) (60 or 90 mg/m(2)). CASE PRESENTATION: We describe 5 cases, presenting with complete response with long-term disease-free survival of long-term remission of 14, 12, 9, 7 and 6 years after Cystemustine therapy alone. CONCLUSION: Long-term survival has already been described in literature, but in all cases they have been obtained after chemotherapy associated with or followed by surgery. But despite these noteworthy and encouraging but also rare results, it appears essential to increase cystemustine efficiency

Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse

<p>Abstract</p> <p>Background</p> <p>Weight change during chemotherapy is reported to be associated with a worse prognosis in breast cancer patients, both with weight gain and weight loss. However, most studies were conducted prior to the common use of anthracycline-base chemotherapy and on North American populations with a mean BMI classified as overweight. Our study was aimed to evaluate the prognostic value of weight change during anthracycline-based chemotherapy on non metastatic breast cancer (European population) with a long term follow-up.</p> <p>Methods</p> <p>Patients included 111 women diagnosed with early stage breast cancer and locally advanced breast cancer who have been treated by anthracycline-based chemotherapy regimen between 1976 and 1989. The relative percent weight variation (WV) between baseline and postchemotherapy treatment was calculated and categorized into either weight change (WV > 5%) or stable (WV < 5%). The median follow-up was 20.4 years [19.4 - 27.6]. Cox proportional hazard models were used to evaluate any potential association of weight change and known prognostic factors with the time to recurrence and overall survival.</p> <p>Results</p> <p>Baseline BMI was 24.4 kg/m2 [17.1 - 40.5]. During chemotherapy treatment, 31% of patients presented a notable weight variation which was greater than 5% of their initial weight.</p> <p>In multivariate analyses, weight change (> 5%) was positively associated with an increased risk of both recurrence (RR 2.28; 95% CI: 1.29-4.03) and death (RR 2.11; 95% CI: 1.21-3.66).</p> <p>Conclusions</p> <p>Our results suggest that weight change during breast-cancer chemotherapy treatment may be related to poorer prognosis with higher reccurence and higher mortality in comparison to women who maintained their weight.</p

Diabète et cancer du sein (revue de la littérature, et étude cas-témoins sur une cohorte de 862 patientes traitées pour un cancer du sein localisé)

Objectif : évaluation de la prévalence du diabète type 2 dans une population traitée pour un cancer du sein localisé ; étude de la prise en charge carcinologique, des complications liées aux traitements, et des caractéristiques tumorales, chez les patientes diabétiques type 2 traitées pour un cancer du sein localisé, comparativement aux patientes non diabétiques. Matériel et méthodes : cohorte de 862 patientes traitées, au Centre Jean Perrin, pour un cancer du sein localisé, entre janvier 2008 et juin 2009. Les patientes diabétiques type 1 étaient exclues de l'étude. Un appariement en fonction de l'âge, de l'IMC, du stade TNM, et du type histologique a été réalisé. La population, après appariement, était composée de 52 patientes non diabétiques, et de 32 patientes diabétiques type 2. Les patientes diabétiques constituaient 5.6% de la population étudiée. Dans la population appariée, il n'a pas été retrouvé de différence statistiquement significative, pour la prise en charge chirurgicale (p=0.52), ou médicale (radiothérapie: p=0.11 ; chimiothérapie: p=0.25 ; hormonothérapie: p=0.24). Les patientes diabétiques n'ont pas présenté plus de complications liées au traitement du cancer (chirurgie : p=0.22 ; radiothérapie : p=0.85 ; chimiothérapie : p=0.81 ; hormonothérapie p=0.47). On note une proportion plus importante de cancer du sein bilatéral chez les patientes diabétiques (18,75% versus 1.92%; p=0.021), ainsi qu'un stade TNM plus élevé (stade T4 : 10.20% versus 3.09%; p=0.0064). Il n'a pas été retrouvé de différence en terme de grade SBR (p=0.83), ni en terme de positivité des récepteurs aux estrogènes (p=0.41), à la progestérone (p=0.41), et à HER2 (p=0.79). Les patientes diabétiques doivent bénéficier de la même prise en charge carcinologique que les patientes non diabétiques. Les patientes diabétiques présentent un cancer du sein à un stade tumoral plus avancé et une fréquence plus élevée de tumeur bilatérale. Ces données font évoquer un rôle du diabète dans la cancérogénèse. Des études supplémentaires sont nécessaires pour confirmer ce rôle.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Traitement du mélanome, revue (six cas de rémission complète après cystémustine)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LES TUMEURS GLIALES MALIGNES SUS-TENTORIELLES DE L'ADULTE (ETUDE RETROSPECTIVE DE 118 PATIENTS TRAITES PAR BCNU A FORTE DOSE ET GREFFE DE CELLULES HEMATOPOIETIQUES)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Melatonin supplementation to improve quality of life for elderly cancer patients

International audienc

Durable Response to Crizotinib in a Patient with Pulmonary Adenocarcinoma Harboring MET Intron 14 Mutation: A Case Report

International audienceBackground: For patients with non-epidermal non-small-cell lung cancer (NSCLC), molecular alterations should always be investigated, especially in non-smokers, who have a very high frequency of targetable alterations (EGFR 52%; ALK 8% in particular). MET exon 14 alterations are identified in 3-4% of NSCLCs and MET gene amplification and high protein expression are associated with a poor prognosis. The French recommendations only authorize the use of capmatinib and crizotinib if the mutation concerns exon 14. However, several different types of mutation in exon 14 of MET and its flanking introns can induce a jump in exon 14, activate the MET gene and thus be sensitive to anti-MET tyrosine kinase inhibitors. Case Summary: This case concerns a 76-year-old Caucasian male with a medical history including idiopathic thrombocytopenic purpura, chronic myelomonocytic leukemia (CMML), atrial fibrillation, arterial hypertension, obesity (BMI 36kg/m2), and a 5-10 pack-per-year smoking history. A left upper lobe pulmonary nodule of 12.4 mm was discovered in March 2019. The patient received adjuvant chemotherapy with carboplatin AUC 5 and vinorelbine 25.00 mg/m2. At the end of the adjuvant treatment, the patient was in complete remission for 5 months. In February 2020, the CT scan revealed a mediastinal lymph node progression. A complementary molecular analysis was realized on the initial surgical specimen. A c.3082 +3A>T mutation in the MET gene was identified. This mutation confers susceptibility to anti-MET tyrosine kinase inhibitors. Treatment with crizotinib was initiated with an initial dose of 250 mg/day for 15 days and then increased to 250 mg twice a day. After 7 months of treatment with crizotinib, the disease was still stable according to RECIST 1.1. Conclusion: We report here the original case of a patient presenting a lung adenocarcinoma with an intron 14 mutation and having a durable TKI response

hPG80 (circulating progastrin) as a blood biomarker for high-grade glial tumors: A pilot study

International audienceCurrently, the long-term prognosis and survival rate of patients with high-grade glial tumors remains poor and there are no biomarkers. hPG 80 (circulating progastrin) secreted into the blood by tumor cells has been widely studied in colorectal cancer. Its involvement in tumorigenesis has been demonstrated in the literature. Moreover, according to a recent study, hPG 80 is expressed in the blood of cancer patients at a significantly higher concentration than in the control group composed of healthy blood donors.The PROGLIO study is a pilot, single-center, longitudinal study that primarily seeks to evaluate circulating plasma hPG 80 concentrations over time in patients with high-grade glial tumors. A fasting blood sample will be taken on the start and end day of radiotherapy and during the adjuvant chemotherapy (every 3 cycles). Follow-up monitoring will be performed for 9 months, with a blood sample taken every 3 months on the day of the follow-up MRI. The study plans to recruit 30 patients and recruitment started in February 2022. Trial registration ClinicalTrials.gov , ID NCT05157594; registered on October 27, 2021