Agriculture in Viet Nam under the impact of climate change

Over the past 30 years, strong agricultural growth has changed the socio-economic status of Viet Nam: improving food security, boosting agricultural exports, and creating livelihoods for people. However, the agricultural sector has already been impacted by climate change, and projections for the next few decades indicate that the climate warming trends and anthropogenic pressures are likely to be accelerated. In this chapter, we examine evolution in crop yields in the past decades, and its predicted evolution in the future. The results vary widely between crops, agro-ecological zones and climate scenarios, but most findings concur on the decline of crop yields in the 2030–2050 horizon. On the other hand, the habitat suitability for rice and other major crops will undergo drastic changes. We find that without adaptation, the risks of increasing saline intrusion, and that of permanent inundation due to sea level rise, will significantly reduce (up to 50% by 2050) the land suitable for rice cultivation in the Mekong delta . However, these two main threats to rice cultivation are accentuated by anthropogenic pressures (ground water pumping and sand mining), which require specific policies to be mitigated. Among the adaptation practices, we highlight practices that mitigate the greenhouse gas emissions from agriculture. In particular, the Alternate Wetting and Drying irrigation of rice fields is a single mitigation practice that can reduce the methane emissions from rice fields in Viet Nam by 40%. However, to derive adaptation and mitigation measures for the agriculture sector over the coming decades will require assessments against a background of wider environmental, economic and social evolutions.Au cours des 30 dernières années, la forte croissance agricole a changé le statut socio-économique du Viet Nam : amélioration de la sécurité alimentaire, augmentation des exportations agricoles et création de moyens de subsistance pour les populations. Cependant, le secteur agricole a déjà été touché par le changement climatique, et les projections pour les prochaines décennies indiquent que les tendances au réchauffement climatique et les pressions anthropiques sont susceptibles de s’accélérer. Dans ce chapitre, nous examinons l’évolution des rendements des cultures au cours des dernières décennies et l’évolution prévue dans le futur. Les résultats varient considérablement entre les cultures, les zones agro-écologiques et les scénarios climatiques, mais la plupart des résultats concordent sur la baisse des rendements des cultures à l’horizon 2030–2050. D’un autre côté, les terres adaptées à la culture du riz et celles des autres cultures subiront des changements drastiques. Nous constatons que sans adaptation, les risques d’augmentation des intrusions salines, et celui d’inondations permanentes dues à l’élévation du niveau de la mer réduiront considérablement (jusqu’à 50% d’ici 2050) les terres propices à la riziculture dans le delta du Mékong. Cependant, ces deux principales menaces pesant sur la riziculture sont accentuées par les pressions anthropiques (pompage des nappes phréatiques et extraction de sable) dont la réduction nécessitera des politiques spécifiques.. Parmi les pratiques d’adaptation, nous soulignons les pratiques qui atténuent les émissions de gaz à effet de serre provenant de l’agriculture. En particulier, l’irrigation alternée des rizières est une pratique d’atténuation unique qui permet de réduire de 40% les émissions de méthane des rizières au Viet Nam. Cependant, pour dériver des mesures d’adaptation et d’atténuation pour le secteur agricole au cours des prochaines décennies, il faudra des évaluations dans un contexte d’évolutions environnementales, économiques et sociales plus larges

Factors Affecting Tamoxifen Metabolism in Patients With Breast Cancer: Preliminary Results of the French PHACS Study

International audienceIn addition to the effect of cytochrome P450 (CYP) 2D6 genetic polymorphisms, the metabolism of tamoxifen may be impacted by other factors with possible consequences on therapeutic outcome (efficacy and toxicity). This analysis focused on the pharmacokinetic (PK)-pharmacogenetic evaluation of tamoxifen in 730 patients with adjuvant breast cancer included in a prospective multicenter study. Plasma concentrations of tamoxifen and six major metabolites, the genotype for 63 single-nucleotide polymorphisms, and comedications were obtained 6 months after treatment initiation. Plasma concentrations of endoxifen were significantly associated with CYP2D6 diplotype (P < 0.0001), CYP3A4*22 genotype (P = 0.0003), and concomitant intake of potent CYP2D6 inhibitors (P < 0.001). Comparison of endoxifen levels showed that the CYP2D6 phenotype classification could be improved by grouping intermediate metabolizer (IM)/IM and IM/poor metabolizer diplotype into IM phenotype for future use in tamoxifen therapy optimization. Finally, the multivariable regression analysis showed that formation of tamoxifen metabolites was independently impacted by CYP2D6 diplotype and CYP3A4*22, CYP2C19*2, and CYP2B6*6 genetic polymorphisms

Bevacizumab Maintenance Versus No Maintenance During Chemotherapy-Free Intervals in Metastatic Colorectal Cancer: A Randomized Phase III Trial (PRODIGE 9)

International audiencePurpose Conflicting results are reported for maintenance treatment with bevacizumab during chemotherapy-free intervals (CFI) in metastatic colorectal cancer after induction chemotherapy. Patients and Methods In this open-label, phase III, randomized controlled trial, we compared the tumor control duration (TCD) observed with bevacizumab maintenance and with no treatment (observation) during CFI subsequent to induction chemotherapy with 12 cycles of fluorouracil, leucovorin, and irinotecan plus bevacizumab. After disease progression, the induction regimen was repeated for eight cycles, followed by a new CFI. Results From March 2010 to July 2013, 491 patients were randomly assigned. Disease progression or death occurred during induction chemotherapy in 85 patients (17%); 261 patients (53%) had at least one reinduction, 107 (22%) had two reinductions, and 56 (11%) had three or more reinductions. The median TCD was 15 months in both groups; the median progression-free survival (PFS) from randomization was 9.2 and 8.9 months in the maintenance group and observation groups, respectively. The TCD observed in both groups was higher compared with the TCD hypotheses of the trial. The median overall survival (OS) was 21.7 and 22.0 months in the maintenance and observation groups, respectively. In the per-protocol population, defined as patients with at least one reinduction after the first progression, the median duration of the first CFI was 4.3 months in both arms; the median TCD was 17.8 and 23.3 months ( P = .339), the median PFS was 9.9 and 9.5 months, and the median OS was 27.6 and 28.5 months in the maintenance and observation groups, respectively. Multivariable analysis revealed that female gender, WHO performance status ≥ 2, and unresected primary tumors were associated with a shorter TCD. Conclusion Bevacizumab maintenance monotherapy did not improve TCD, CFI duration, PFS, or OS

Early evaluation using a radiomic signature of unresectable hepatic metastases to predict outcome in patients with colorectal cancer treated with FOLFIRI and bevacizumab

International audiencePurpose: The objective of this study was to build and validate a radiomic signature to predict early a poor outcome using baseline and 2-month evaluation CT and to compare it to the RECIST1·1 and morphological criteria defined by changes in homogeneity and borders.Methods: This study is an ancillary study from the PRODIGE-9 multicentre prospective study for which 491 patients with metastatic colorectal cancer (mCRC) treated by 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) and bevacizumab had been analysed. In 230 patients, computed texture analysis was performed on the dominant liver lesion (DLL) at baseline and 2 months after chemotherapy. RECIST1·1 evaluation was performed at 6 months. A radiomic signature (Survival PrEdiction in patients treated by FOLFIRI and bevacizumab for mCRC using contrast-enhanced CT TextuRe Analysis (SPECTRA) Score) combining the significant predictive features was built using multivariable Cox analysis in 120 patients, then locked, and validated in 110 patients. Overall survival (OS) was estimated with the Kaplan-Meier method and compared between groups with the logrank test. An external validation was performed in another cohort of 40 patients from the PRODIGE 20 Trial.Results: In the training cohort, the significant predictive features for OS were: decrease in sum of the target liver lesions (STL), (adjusted hasard-ratio(aHR)=13·7, p=1·93×10-7), decrease in kurtosis (ssf=4) (aHR=1·08, p=0·001) and high baseline density of DLL, (aHR=0·98, p0·02 had a lower OS in the training cohort (p<0·0001), in the validation cohort (p<0·0008) and in the external validation cohort (p=0·0027). SPECTRA Score at 2 months had the same prognostic value as RECIST at 6 months, while non-response according to RECIST1·1 at 2 months was not associated with a lower OS in the validation cohort (p=0·238). Morphological response was not associated with OS (p=0·41).Conclusion: A radiomic signature (combining decrease in STL, density and computed texture analysis of the DLL) at baseline and 2-month CT was able to predict OS, and identify good responders better than RECIST1.1 criteria in patients with mCRC treated by FOLFIRI and bevacizumab as a first-line treatment. This tool should now be validated by further prospective studies

Patients' self-assessment versus investigators' evaluation in a phase III trial in non-castrate metastatic prostate cancer (GETUG-AFU 15)

BACKGROUND: Toxicity, which is a key parameter in the evaluation of cancer treatments, can be underestimated by clinicians. We investigated differences between patients and physicians in reporting adverse events of androgen deprivation therapy (ADT) with or without docetaxel in a multicentre phase III trial in non-castrate metastatic prostate cancer. METHODS: The 385 patients included were invited to complete a 26-symptom questionnaire 3 and 6months after the start of treatment, among which eighteen symptoms were also assessed by physicians, reported in medical records and graded using the Common Toxicity Criteria of the National Cancer Institute. Positive and negative agreements as well as Kappa concordance coefficients were computed. FINDINGS: Data were available for 220 and 165 patients at 3 and 6months respectively. Physicians systematically under-reported patients' symptoms. Positive agreement rates (at respectively 3 and 6months) for the five most commonly reported symptoms were: 61.0% and 64.3% hot flushes, 50.0% and 43.6% fatigue, 29.4% and 31.1% sexual dysfunction, 24.4% and 14.4% weigh gain/loss, 16.7% and 19.3% for joint/muscle pain. For symptoms most frequently reported as disturbing or very disturbing by patients, the clinicians' failure to report them ranged from 50.8% (hot flushes) to 89.5% (joint/muscle pain) at 3months, and from 48.2% (hot flushes) to 88.4% (joint/muscle pain) at 6months. INTERPRETATION: Physicians often failed to report treatment-related symptoms, even the most common and disturbing ones. Patients' self-evaluation of toxicity should be used in clinical trials to improve the process of drug assessment in oncology. FUNDING: French Health Ministry and Institut National du Cancer (PHRC), Sanofi-Aventis, Astra-Zeneca, and Amgen