Objectifs pédagogiques Appréhender les évolutions technologiques à court ou moyen terme et mesure... more Objectifs pédagogiques Appréhender les évolutions technologiques à court ou moyen terme et mesurer leur impact pratique, organisationnel et économique.
tration of recombinant human interleukin-2 and recombinant inter-9. Rubin LA, Jay G, Nelson DL. T... more tration of recombinant human interleukin-2 and recombinant inter-9. Rubin LA, Jay G, Nelson DL. The released interleukin-2 receptor feron-cr-2a in cancer patients: a phase I study.3
ABSTRACT Pretherapeutic assessment of patients with lung cancer is of paramount importance for tr... more ABSTRACT Pretherapeutic assessment of patients with lung cancer is of paramount importance for treatment decision making. Performance status estimated either by Karnofsky or ECOG scales is the major factor with, according to the type of treatment planned, pulmonary function tests, cardiovascular assessment, renal, hepatic and hematological functions. In elderly patients, Performance status is unable to summarize their clinical status and especially the ability to receive chemotherapy. Other factors which are part of a comprehensive geriatric assessment are to be taken into account such as the activity Daily Living or the Instrumental Activity Daily Living scores but also the Mini Mental Status, the Timed up and go, comorbities rating, depression and nutritional evaluation. This comprehensive geriatric assessment is (CGA) time consuming and some screening scores were developed in order to select those patients who really need this CGA. After geriatric assessment, elderly patients will be classified in one of the three Balducci groups with according to the group, a proposal of a very similar treatment to that of younger counterparts or an adapted treatment or to best supportive care only. If the prognostic role of some of the geriatric scores is well-established, their predictive role still needs to be studied.
Parce que les thérapeutiques ciblées, exerçant un effet cytostatique n'induisent le plus souvent ... more Parce que les thérapeutiques ciblées, exerçant un effet cytostatique n'induisent le plus souvent pas de réduction de la masse tumorale l'évaluation de leur efficacité en termes de réponse doit être différente de celle des chimiothérapies. Les notions de "contrôle de la maladie" et de "durée du bénéfice clinique" ont été récemment introduites regroupant réponses et stabilités. Ces critères, sans être formellement validés, sont de plus en plus fréquemment retrouvés, notamment dans les études concernant le cancer bronchique non à petites cellules métastatique. Les nouvelles thérapeutiques ciblées donnent ainsi l'occasion aux cliniciens que nous sommes, aidés par les statisticiens, de faire preuve d'originalité et de progresser dans la construction d'essais cliniques adaptés.
Stratégie thérapeutique chez la personne âgée ayant un CBNPC métastatique Therapeutic strategy in... more Stratégie thérapeutique chez la personne âgée ayant un CBNPC métastatique Therapeutic strategy in elderly subjects with metastatic NSCLC Article rédigé par Laurence Beaumont (Paris)*, d'après la communication de E. Quoix (Strasbourg) 1
Maladie oligométastatique dans le cancer bronchique non à petites cellules
Revue des Maladies Respiratoires Actualités, 2014
ABSTRACT Oligometastatic non-small cell lung cancers are an infrequent feature comprising 1 to 5 ... more ABSTRACT Oligometastatic non-small cell lung cancers are an infrequent feature comprising 1 to 5 metastatic sites only which may be synchrones (diagnosed within 6 months after primary site) or metachrones. The major sites which have been studied, mainly as case report's, are adrenal glands, brain, and lung in which bifocal surgery and/or stereotactic radiation therapy have been proposed associated in most instances with systemic treatment. Longterm survival may be observed essentially if there is no mediastinal lymph nodes involved. Even more infrequently, oligometastatic lung tumors involving bone, skin, liver, kidney… have been reported as being amenable to radical treatment. In those cases also, the main prognostic factor is the involvement of mediastinal nodes. The exact role of systemic treatment remains to be established as in all cases isolated reports have been described. It is more than probable that these oligometastatic non-small cell lung cancer which do not progress toward plutimetastatic forms have a special biological profile as some studies recently suggested.
Mutations rares des exons 18 et 20 de l’EGFR dans les cancers bronchiques non à petites cellules chez 10 117 patients : étude observationnelle multicentrique du réseau ERMETIC de l’IFCT
ASA404 (5,6-dimethylxanthenone-4-acetic acid or DMXAA) is a small-molecule tumour-vascular disrup... more ASA404 (5,6-dimethylxanthenone-4-acetic acid or DMXAA) is a small-molecule tumour-vascular disrupting agent (Tumour-VDA). This randomised phase II study evaluated ASA404 plus standard therapy of carboplatin and paclitaxel in patients with histologically confirmed stage IIIb or IV non-small cell lung cancer (NSCLC) not previously treated with chemotherapy. Patients were randomised to receive </=6 cycles of carboplatin area under the plasma concentration-time curve 6 mg ml(-1) min and paclitaxel 175 mg m(-2) (CP, n=36) or standard therapy plus ASA404 1200 mg m(-2) (ASA404-CP, n=37). There was little change in the systemic exposure of either total or free carboplatin or paclitaxel on addition of ASA404. Safety profiles were similar and manageable in both groups, with most adverse effects attributed to standard therapy. Tumour response rate (31 vs 22%), median time to tumour progression (5.4 vs 4.4 months) and median survival (14.0 vs 8.8 months, hazard ratio 0.73, 95% CI 0.39, 1.38)...
[IFCT-0302 trial: randomised study comparing two follow-up schedules in completely resected non-small cell lung cancer]
Revue des maladies respiratoires, 2007
The authorities advocate a minimalist attitude towards the follow-up of resected bronchial carcin... more The authorities advocate a minimalist attitude towards the follow-up of resected bronchial carcinoma (clinical examination and chest x-ray). A survey showed that 70% of French respiratory physicians have chosen to use the CT scanner and often endoscopy. The published data are equivocal and are often based on retrospective studies. Lung cancer is a good model for a study of post-operative surveillance. Recurrences often occur in easily observed areas, they may be detected while still asymptomatic and are sometimes potentially curable. Second primary tumours may develop at the same site. The Intergroupe Francophone de Cancerologie Thoracique (IFCT) has initiated a trial comparing simple follow-up (clinical examination, chest x-ray) with a more intensive follow-up (CT scan, fibreoptic bronchoscopy). The surveillance will take place every 6 months for 2 years and then annually until 5 years. The main aim is to determine whether intensive follow-up improves patient survival. The opposite...
The use of chemotherapy is considered standard therapy in patients with locally advanced non-smal... more The use of chemotherapy is considered standard therapy in patients with locally advanced non-small-cell lung cancer that cannot be treated with radiotherapy and in those with metastatic non-small-cell lung cancer and good performance status. This approach is also accepted in patients with earlier stage disease, when combined with radiotherapy in those with non-resectable locally advanced disease, or in the preoperative setting. Randomised clinical studies and meta-analyses of the literature have confirmed the beneficial survival effect of platinum-based chemotherapy. Cisplatin and carboplatin have been successfully used with other drugs in a wide variety of well-established two-drug combinations while three-drug combinations are still under investigation. Cisplatin and carboplatin use is limited by toxicity and inherent resistance. These considerations have prompted research into new platinum agents, such as the trinuclear platinum agent BBR3464, the platinum complex ZD0473 and oxal...
Recent analyses of series of small-cell lung cancer (SCLC) patients included in clinical trials h... more Recent analyses of series of small-cell lung cancer (SCLC) patients included in clinical trials have shown improved survival over time, but it has been impossible to determine whether this was due to selection biases, stage migration, or true therapeutic improvement. To determine if there has been a true improvement of survival over time, we reviewed the medical records of all consecutive patients diagnosed with SCLC between 1981 and 1994 in the Bas-Rhin in France. Among the 787 patients (median age 63), there was no significant period effect for sex, age, or stage. Staging work-ups became increasingly thorough (significant period effect). The mean number of investigations and of tumour sites detected correlated significantly. The chemotherapy rate increased (from 76.4% in 1981-1983 to 91.7% in 1993-1994, P = 10(-5)) and mediastinal irradiation decreased (to roughly 25% of patients after 1983). Median survival time increased for the overall population from 6.6 months in 1981-1983 to...
[Radiation- and chemically-induced respiratory manifestations]
Revue des maladies respiratoires, 1997
There are frequently respiratory complications with cancer particularly in primary lung carcinoma... more There are frequently respiratory complications with cancer particularly in primary lung carcinoma. Among these are bronchopulmonary infections with or without endobronchial obstruction, carcinomatous lymphangitis, thromboembolic disease and haemorrhagic disease as well. Radiotherapy and chemotherapy may induce various respiratory complications which diagnosis can be of varying shades of difficulty. The classical post radiation pneumonitis occurring exclusively in the field of radiation hardly poses any problem unless it could be masking a recurrence. Certain clinical manifestations address very difficult problems of differential diagnosis by their lack of specificity and by their often unforeseeable character (except for bleomycin fibrosis which is perfectly dose dependent). Moreover patients often have multiple treatments and the identification of the single responsible agent becomes very difficult. We will not discuss here the infectious or secondary haemorrhagic complications of ...
Dose-intensity of a four-drug chemotherapy regimen with or without recombinant human granulocyte-macrophage colony-stimulating factor in extensive-stage small-cell lung cancer: a multicenter randomized phase III study
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1997
We investigated whether a high-dose chemotherapy regimen of cyclophosphamide 1,800 mg/m2, 4'-... more We investigated whether a high-dose chemotherapy regimen of cyclophosphamide 1,800 mg/m2, 4'-epidoxorubicin 60 mg/m2, etoposide 330 mg/m2, and cisplatin 120 mg/m2 given monthly for four cycles with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) support (5 micrograms/kg daily for 10 days) could improve the survival of patients with extensive-stage small-cell lung cancer (SCLC) compared with a standard-dose regimen (cyclophosphamide 1,200 mg/m2, 4'-epidoxorubicin 40 mg/m2, etoposide 225 mg/m2, and cisplatin 100 mg/m2) given monthly for six cycles. Planned cumulative doses of the drugs were the same in both treatment arms except for cisplatin (which was 80% in the higher-dose plus rhGM-CSF group). At the time of the preplanned interim analysis, 125 patients, 60 in the standard-dose group and 65 in the higher-dose plus rhGM-CSF group, had entered the study; 116 were eligible, 55 in the standard-dose group and 61 in the higher-dose group. All patien...
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