Quels sont les patients atteints d'un cancer du sein dont la décision de prise en charge thérapeutique bénéficie de l'utilisation d'un système d'aide à la décision ? Un exemple utilisant la fouille de données et OncoDoc2

Session 2 : Utilisateurs et usagesNational audienceOncoDoc2 est un système d'aide à la décision (SAD) s'appuyant sur des recommandations de pratique clinique (RPC) pour la prise en charge des cancers du sein. Il a été utilisé comme intervention dans un essai randomisé contrôlé dont l'objectif principal était d'évaluer son impact sur la conformité des décisions des réunions de concertation pluridisciplinaire aux RPC. Nous avons utilisé un algorithme de fouille de données pour découvrir les régularités des profils patients, ou " motifs émergents " (ME), associées à la conformité et à la non-conformité des décisions selon que le système OncoDoc2 était ou non utilisé, afin d'évaluer quels profils patients pouvaient bénéficier de l'utilisation du système. Les ME associés à la non conformité des décisions prises sans le système sont associées à la conformité quand le système est utilisé sauf dans certaines situations cliniques pour lesquelles la force de la recommandation est faible

Impact of Physical Activity on Cancer-Specific and Overall Survival of Patients with Colorectal Cancer

Background. Physical activity (PA) reduces incidence of colorectal cancer (CRC). Its influence on cancer-specific (CSS) and overall survival (OS) is controversial. Methods. We performed a literature-based meta-analysis (MA) of observational studies, using keywords “colorectal cancer, physical activity, and survival” in PubMed and EMBASE. No dedicated MA was found in the Cochrane Library. References were cross-checked. Pre- and postdiagnosis PA levels were assessed by MET. Usually, “high” PA was higher than 17 MET hour/week. Hazard ratios (HRs) for OS and CSS were calculated, with their 95% confidence interval. We used more conservative adjusted HRs, since variables of adjustment were similar between studies. When higher PA was associated with improved survival, HRs for detrimental events were set to <1. We used EasyMA software and fixed effect model whenever possible. Results. Seven studies (8056 participants) were included, representing 3762 men and 4256 women, 5210 colon and 1745 rectum cancers. Mean age was 67 years. HR CSS for postdiagnosis PA (higher PA versus lower) was 0.61 (0.44–0.86). The corresponding HR OS was 0.62 (0.54–0.71). HR CSS for prediagnosis PA was 0.75 (0.62–0.91). The corresponding HR OS was 0.74 (0.62–0.89). Conclusion. Higher PA predicted a better CSS. Sustained PA should be advised for CRC. OS also improved (reduced cardiovascular risk)

Patients' preferences for subcutaneous trastuzumab versus conventional intravenous infusion for the adjuvant treatment of HER2-positive early breast cancer: final analysis of 488 patients in the international, randomized, two-cohort PrefHer study

PrefHer revealed compelling and consistent patient preference for subcutaneous (s.c.) trastuzumab, regardless of delivery by single-use injection device or hand-held syringe. s.c. trastuzumab was well-tolerated and safety data, including immunogenicity, were consistent with previous reports. No new safety signals were identified compared with the known intravenous trastuzumab profile in early breast cance

Apprivoiser et dépasser l’injonction de réforme alimentaire en situation de cancer (France)

In the field of oncology, patients face strong medical injunctions to engage in treatment, however demanding these may be. A parallel medical recommendation warns them against excessive weight loss or gain during and beyond the treatments. We investigated how patients react to this medical recommendation by conducting a sociological study and assessing nutrition workshops implemented by a regional health network in the Paris area. Our results show that the nutritional health medical norm is embraced by patients in the hope to enhance their chances of remission. When engaging in nutrition workshops, however, their primary goal is to create social bonds with other patients, and to assert their role whilst family food is destabilized during treatment. Patients thus conform to the norm of nutritional health for medical reasons but in parallel use it as a means to meet needs in their personal, social and family life

Apprivoiser et dépasser l’injonction de réforme alimentaire en situation de cancer (France)

En cancérologie, l’injonction de soins, aussi violents soient-ils, s’accompagne d’une directive parallèle forte des oncologues : éviter de maigrir ou de grossir pendant et au-delà des traitements. Nous nous sommes intéressés à la manière dont réagissent les patients à cette directive médicale en réalisant une étude sociologique et l’évaluation d’ateliers-nutrition mis en place par un réseau territorial de santé en région parisienne. Nos résultats montrent que l’injonction à suivre une norme nutritionnelle stable est adoptée par les patients dans l’espoir de mettre toutes les chances de leur côté pour vaincre la maladie. Mais l’objectif premier de cette injonction est dépassé pour établir ou renforcer des liens entre malades, et pour assoir une position au sein de la famille, alors que l’alimentation familiale se trouve déstabilisée par les effets secondaires des traitements. La norme médicale passe ainsi au second plan pour les soignés. Ils adoptent les dispositifs proposés et les modulent en fonction des besoins qu’ils identifient dans d’autres champs de leur vie sociale, familiale, personnelle.In the field of oncology, patients face strong medical injunctions to engage in treatment, however demanding these may be. A parallel medical recommendation warns them against excessive weight loss or gain during and beyond the treatments. We investigated how patients react to this medical recommendation by conducting a sociological study and assessing nutrition workshops implemented by a regional health network in the Paris area. Our results show that the nutritional health medical norm is embraced by patients in the hope to enhance their chances of remission. When engaging in nutrition workshops, however, their primary goal is to create social bonds with other patients, and to assert their role whilst family food is destabilized during treatment. Patients thus conform to the norm of nutritional health for medical reasons but in parallel use it as a means to meet needs in their personal, social and family life

Jeûne et thérapie du cancer

International audienc

Jeûne et thérapie du cancer

International audienc

Monitoring anti-PD-1-based immunotherapy in non-small cell lung cancer with FDG PET: introduction of iPERCIST

Abstract Background Immunotherapy represents a new therapeutic approach in non-small cell lung carcinoma (NSCLC) with the potential for prolonged benefits. Because of the systemic nature and heterogeneity of tumoral diseases, as well as the immune restoration process induced by immunotherapy, the assessment of therapeutic efficacy is challenging, and the role of FDG PET is not well established. We evaluated the potential of FDG PET to monitor NSCLC patients treated with a checkpoint inhibitor. Results This was a retrospective analysis of 28 NSCLC patients treated with nivolumab, a programmed cell death 1 (PD-1) blocker. All patients underwent a PET scan before treatment (SCAN-1) and another scan 2 months later (SCAN-2). Disease progression was assessed by immune PET Response Criteria in Solid Tumors (iPERCIST), which was adapted from PERCIST; and the immune Response Evaluation Criteria in Solid Tumors (iRECIST). iPERCIST is a dual-time-point evaluation of “unconfirmed progressive metabolic disease” (UPMD) status at SCAN-2. UPMD at SCAN-2 was re-evaluated after 4 weeks with SCAN-3 to confirm PMD. Patients with complete/partial metabolic response (CMR or PMR) or stable metabolic disease (SMD) at SCAN-2 or -3 were considered responders. Patients with UPMD confirmed at SCAN-3 were considered non-responders. The Kaplan-Meier method was used to estimate survival. At SCAN-2, we found 9/28 cases of PMR, 4/28 cases of SMD, 2/28 cases of CMR, and 13/28 cases of UPMD. Four of the 13 UPMD patients were classified as responders at SCAN-3 (PMR n = 1, SMD n = 3). The remaining nine UPMD patients were classified as non-responders due to clinical degradation, and treatment was stopped. The median follow-up was 16.7 months [3.6–32.2]. Responders continued treatment for a mean of 10.7 months [3.8–26.3]. Overall survival was longer for responders than that for non-responders (19.9 vs. 3.6 months, log rank p = 0.0003). The 1-year survival rates were 94% for responders and 11% for non-responders. A comparison with iRECIST showed reclassification in 39% (11/28) of patients with relevant additional prognostic information. Conclusions iPERCIST dual-time-point evaluation might be a powerful tool for evaluating anti-PD-1-based immunotherapy, with the ability to identify patients who can benefit most from treatment. The prognostic value of iPERCIST criteria should be confirmed in large prospective multicentric studies