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Electronic journal of oncology
Febrile neutropenia incidence and hematological toxicity with the FEC100-docetaxel regimen in the treatment of early-stage breast cancer
Sophie Cousin, Émilie Le Rhun, Audrey Mailliez, Charles Fournier, Jacques Bonneterre
which can reduce the delivered dose and compromise the survival benefit. Because FEC100-docetaxel (FEC100-D) is a common protocol for ESBC, we evaluated its febrile neutropenia (FN) incidence and the role of its hematological toxicity on the individual relative dose-intensity (RDI).
<b>Patients and methods.</b> It is a French single-center, observational, retrospective study. Patients received adjuvant/neoadjuvant FEC100-D treatment, without primary prophylaxis by granulocyte colony-stimulating factors (G-CSF). The neutrophil count the day before the planned chemotherapy cycle had to be over 1,500.mm
<sup>-3</sup> for the treatment to be administered. Data collected included: date and dose of chemotherapy cycles, FN and high grade of hematological toxicity occurrence for each course, G-CSF prescription.
<b>Results.</b> One thousand, seven hundred and fifty-seven cycles in 284 patients were delivered. FN was observed in 4.9% (
<i>n</i> = 14) of the patients, without hospitalizations or deaths after. Grade 3-4 neutropenia occurred in 5.8% of the cycles, during the first cycle in 40% of cases. Seventeen percent of our patients received less than 85% of RDI.
<b>Conclusion.</b> The hematotoxicity of this treatment is acceptable. The risk of FN is low. No G-CSF primary prophylaxis is needed without additional risk factor.
Tribune libre
La France peine à transformer son excellence scientifique en applications concrètes contre le cancer
Petrus J Pauwels, Laurent Lévy
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Cabazitaxel dans le cancer de la prostate métastatique résistant à la castration ayant progressé pendant ou après traitement par docétaxel : l’expérience française de l’essai TROPIC
Damien Pouessel, Stéphane Oudard, Gwenaëlle Gravis, Frank Priou, Liji Shen, Stéphane Culine
prostate cancer who progressed on or after docetaxel treatment. We report the data on efficacy and toxicity observed in the subgroup of patients included in the French centers. In this phase III randomized international trial, patients received prednisone and were treated with either 25 mg/m
<sup>2</sup> cabazitaxel or 12 mg/m
<sup>2</sup> mitoxantrone intravenously every three weeks. The primary endpoint was overall survival. The secondary endpoints included progression-free survival (PFS) and safety. Analyses were performed on the intention-to-treat population. Among the 90 patients enrolled in France, the median overall survival was 18 months for the cabazitaxel arm
<i>versus</i> 14.3 months for the mitoxantrone arm. An improvement in PFS was also observed, with a median of 1.4 months for the mitoxatrone arm compared to a median of 2.5 months for the cabazitaxel arm. The most common grade ≥ 3 adverse events were hematologic with neutropenia, usually afebrile and digestive with 4 % of patients reporting diarrhea. These results are comparable to those reported for the overall population and the safety profile remains favorable without any toxic death related to cabazitaxel.
Étude observationnelle sur les conditions d’accès à l’analyse de la mutation du gène KRAS chez les patients atteints de cancer colorectal métastatique recevant un traitement par panitumumab
Frédéric Bibeau, Christophe Louvet, Pauline Afchain, Emmanuel Mitry, Pascal Artru, Thierry André
or panitumumab.
<i>KRAS</i> mutations are unambiguously linked to a lack of response to these targeted therapies. Because of the major clinical impact of
<i>KRAS</i> status, an observational study has been designed in France, focusing on the ability to perform
<i>KRAS </i>testing between october 2008 and october 2009. The study was retro-prospective, national, multicentric, descriptive and non interventional, concerning public and private institutions and
<i>KRAS </i>non mutated patients treated with panitumumab. The primary objective of this study was to evaluate delays between the genotyping
<i>KRAS</i> request and the result. Secondary objectives were: type of genotyping requests (systematic/prospective or specific/retrospective), prevalence of the different genotyping techniques, delays between the genotyping
<i>KRAS</i> request and therapy with panitumumab. Overall, 329 patients from 66 centres have been included. About half of them belonged to private institutions. The results were obtained with a mean delay of 33.4 ± 39.8 days (CI 95%: [28.8; 37.9] days; median: 24 days). Most of
<i>KRAS </i>genotyping tests were performed on specific requests (65.3%), from a primary tumor (80.4%) and from a surgical specimen (73.9%). The more frequently used techniques for
<i>KRAS</i> genotyping were: real time PCR (36.2%), sequencing (24.8%) and pyrosequencing (13.2%). This study emphasizes the functionality of cancer molecular genetic platforms dedicated to
<i>KRAS</i> genotyping, which allow the use of molecular predictive biomarkers by different medical institutions. This study also underlines the broad spectrum of genotyping techniques (no consensus). The delays of response are still longer than expected but might be improved by optimizing the procedures.
Mise en place d’une étude pilote de sensibilisation au réentraînement à l’activité physique dans deux populations sélectionnées atteintes d’un cancer du sein
Julie Charbonnier, Antonin Levy, Jean-Baptiste Guichard, Martin Garet, Pierre Auberdiac, Frédéric Roche, Nadia Malkoun, Coralie Moncharmont, Jean-Philippe Jacquin, Guy de Laroche, Nicolas Magné
cancer by using the questionnaire POPAQ (Population Physical Activity Questionnaire). This is a prospective study including two groups of 15 consecutive breast cancer patients (≤ 50 years Group 1 and Group 2 > 50 and < 70 years) followed in the department of radiotherapy at the Institute of Cancer of the Loire from January to July 2011. A questionnaire of physical activity assessment was used at two different times before the diagnosis/treatment of breast cancer (t0) and at 6 months (t6) to measure the impact of the awareness method. Comparison of different measures of daily energy expenditure (t0) between groups 1 and 2 was statistically significant (1,1803 and 9434 kJ/24 h, respectively,
<i>p</i> = 0.0005). Daily energy expenditure of professional activity was statistically different between the two groups (1437 and 457 kJ/24 h, in groups 1 and 2, respectively;
<i>p</i> = 0.003). Between t0 and t6, we observed a significant decrease in total energy consumption in group 1 (1,1803 to 1,0876 kJ/24 h) while there was no significant change between the group 2, except energy expended at rest (basal metabolism). There were differences in daily energy expenditure based on age may influence behavioral patterns deal with energy expenditure in physical activities. Tomorrow's challenges are to provide re-entrainment programs tailored to targeted populations.
Synthèse
Place de l’échoendoscopie œsophagienne (EUS) et bronchique (EBUS) dans l’évaluation des adénopathies médiastinales<!--<query id="Q1">Merci de valider le titre abrégé de l’article en haut de page proposé : [Place de l’EUS et EBUS dans l’évaluation des adénopathies médiastinales].</query>-->
Dominique Béchade, François Chomy
and systemic processes (e.g, sarcoidosis) can cause mediastinal adenopathy. In the posterior and inferior mediastinum, endoscopic ultrasound visualizes and directs transesophageal fine needle aspiration of adenopathy. In the anterior mediastinum, endobronchial ultrasound visualizes and directs transbronchial fine needle aspiration of adenopathy. We discuss the role of EUS and EBUS in the evaluation of mediastinal adenopathy according to their anatomical localization.
Carcinomes épidermoïdes primitifs du sein : étude clinique et revue de la littérature
Johanna Mychaluk, Marc Baron, Éric Fondrinier, Sophie Laberge, Jean Gondry, Raffaèle Fauvet
presents as a large palpable mass in a woman over 50 years old. There are no specific iconographic features, but a relative frequency of presentation as abscess or cyst. The overall and disease-free survivals are worse than other histological types of breast cancer. These neoplasms have a basal-like and triple negative profile and they respond poorly to standard treatment of breast carcinomas. They are usually treated by radical surgery. Optimal chemotherapy regimens is not yet determined and platin based chemotherapy could offer an effective alternative as the developpement of specific targeted therapies (anti Her1) could do.
Impact du cancer du sein sur la vie professionnelle. Enquête parmi les femmes de la cohorte ELIPPSE
Lucie Gallardo, Dominique Rey, Patrick Peretti-Watel
of cancer on professional trajectory among working women after a breast cancer diagnosis. We conducted in-depth interviews with 21 women from the ELIPPSE cohort. They were aged under 40 at cancer diagnosis, and they were interviewed from 16 months to 3 years after diagnosis. Several participants reported a deterioration of their professional situation even before they stopped working, with long-lasting consequences on their daily allowance. Others reported such deterioration during their sick leave. For all of them, returning to work after cancer treatment was very important, but they faced several obstacles. For example, some of them had to give up their former profession because of treatment side-effects. Moreover, the cancer experience frequently changed their attitude and expectations toward their working career. Finally, in order to find a new job these women were prone to hide their cancer experience and to resort to their social network (this network was also helpful to face the financial consequences of their sick leave).
Crizotinib, modalités pratiques d’un traitement personnalisé
Vincent Fallet, Cécile Toper, Martine Antoine, Jacques Cadranel, Marie Wislez
lung cancer with ALK rearrangements. With such results, the crizotinib followed an accelerated procedure in the United States and obtained the Food and Drug Administration (FDA) approval based on the results of phase I studies. The results should be confirmed with one phase II study and two phase III studies in patients with ALK rearrangements. In France, the Commission of Authorization for Marketing has granted an Authorization of Temporary Use (ATU) for cohort on the 15 December 2011 to allow its administration in patients before marketing authorization.
Tumeurs rares
Le pancréatoblastome chez l’enfant : du diagnostic à la prise en charge thérapeutique
Anne-Sophie Defachelles, Nathalie Rocourt, Sophie Branchereau, Michel Peuchmaur
tumour are hardly known by most paediatric surgeons and oncologists. The clinical symptomatology is often discrete, such as abdominal pain and/or intestinal transit disturbances, and the revealing sign is usually the discovery of a voluminous abdominal mass. Pancreatoblastoma is most often located in the head or body of the pancreas but can be seen in any part of the pancreas. It forms a full mass, rather well encapsulated, round and soft in consistency, often large in size and that can develop beyond the limits of the pancreatic gland. The metastases may be present in the lymph nodes, liver, lungs and spleen. It is an embryonic organ tumour that morphologically resembles what the nephroblastoma or the hepatoblastoma are for the kidneys or liver, respectively. The pathological analysis characteristically shows two components in which cell density is often high: an epithelial component and a mesenchymatic component. The lab test evaluation should include an assay of alpha-foetoprotein. Elevated levels of this marker are often present in these tumours. An assay of this marker is therefore interesting, not only at the time of diagnosis, but especially for early diagnosis of relapses. The pancreatoblastoma treatment is above all surgical and only complete exeresis makes recovery possible. However, at the time of diagnosis, many patients are inoperable due to the extension of the tumour. The combination of cisplatin + adriamycin seems to be the most effective neoadjuvant chemotherapy regimen. Patients who have had an incomplete tumour exeresis pose a real problem due to the frequency of local relapses and/or metastases. Local irradiation is indicated in this case, as chemotherapy has not yet provided proven results in this context.
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