RELEVANCE OF A SYSTEMATIC GERIATRIC SCREENING AND ASSESSMENT IN OLDER PATIENTS WITH CANCER RESULTS OF A PROSPECTIVE MULTICENTRIC STUDY
; ; et al
in Annals of Oncology (2013)Detailed reference viewed: 41 (2 ULg)
Phase III study of ACVBP versus ACVBP plus rituximab for patients with localized low-risk diffuse large B-cell lymphoma (LNH03-1B).
; ; et al
in Annals of Oncology (2013), 24/n°4
Background The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparaison with cyclophosphamide, doxorubicin, vincristin and prednisone ... [more ▼]
Background The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparaison with cyclophosphamide, doxorubicin, vincristin and prednisone plus radiotherapy for Young patients with localized diffuse large B-cell lymphoma (DLBCL) was previously demonstrated. We report the results of a trial which évaluâtes the role of rituximab combined with ACVBP (R- ACVBP) in these patients. Patients and methods untreated patients younger than 66 years with stage I or II DLBCL and no adverse prognostic factors of the age-adjusted International Prognostic Index were randomly assigned to receive three cycles of ACVBP plus sequential consolidation with or without the addition of four infusions of rituximab. Results a total of 223 patients were randomly allocated to the study, 110 in the R-ACVBP group and 113 in the ACVBP group. After a median follow-up of 43 months, our 3-year estimate of event-free survival was 93% in the R-ACVBP group and 82% in the ACVBP group (P=0.0487). Three-year estimate of progression-free survival was increased in the R-ACVBP group (95% versus 83%, P=0.0205). Overall survival did not differ between the two groups with a 3-year estimâtes of 98% and 97%, respectively (P=0.686). Conclusion in Young patients with low-risk localized DLBCL, rituximab combined with three cycles of ACVBP plus consolidation is significantly Superior to ACVBP plus consolidation alone. [less ▲]Detailed reference viewed: 28 (12 ULg)
Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study.
; ; POLUS, Marc et al
in Annals of Oncology (2012), 23(6), 1525-30
BACKGROUND: Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in locally advanced rectal cancer (LARC). To evaluate in LARC patients, the feasibility and efficacy ... [more ▼]
BACKGROUND: Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in locally advanced rectal cancer (LARC). To evaluate in LARC patients, the feasibility and efficacy of a short intense course of induction oxaliplatin before preoperative chemoradiotherapy (CRT). PATIENTS AND METHODS: Patients with T2-T4/N+ rectal adenocarcinoma were randomly assigned to arm A-preoperative CRT with 5-fluorouracil (5-FU) continuous infusion followed by surgery-or arm B-induction oxaliplatin, folinic acid and 5-FU followed by CRT and surgery. The primary end point was the rate of ypT0-1N0 stage achievement. RESULTS: Fifty seven patients were randomly assigned (arm A/B: 29/28) and evaluated for planned interim analysis. On an intention-to-treat basis, the ypT0-1N0 rate for arms A and B were 34.5% (95% CI: 17.2% to 51.8%) and 32.1% (95% CI: 14.8% to 49.4%), respectively, and the study therefore was closed prematurely for futility. There were no statistically significant differences in other end points including pathological complete response, tumor regression and sphincter preservation. Completion of the preoperative CRT sequence was similar in both groups. Grade 3/4 toxicity was significantly higher in arm B. CONCLUSIONS: Short intense induction oxaliplatin is feasible in LARC patients without compromising the preoperative CRT completion, although the current analysis does not indicate increased locoregional impact on standard therapy. [less ▲]Detailed reference viewed: 27 (5 ULg)
Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of intravenous iron
; ; et al
in Annals of Oncology (2012), 23
Background: Chronic diseases reduce the availability of iron for effective erythropoiesis. This review summarises clinical consequences of iron deficiency (ID) and anaemia in cancer patients, mechanisms ... [more ▼]
Background: Chronic diseases reduce the availability of iron for effective erythropoiesis. This review summarises clinical consequences of iron deficiency (ID) and anaemia in cancer patients, mechanisms how impaired iron homeostasis affects diagnosis and treatment of ID, and data from clinical trials evaluating i.v. iron with or without concomitant erythropoiesis-stimulating agents (ESAs). Design: Clinical trial reports were identified in PubMed and abstracts at relevant major congresses. Results: Reported prevalence of ID in cancer patients ranges from 32 to 60% and most iron-deficient patients are also anaemic. Randomised clinical trials have shown superior efficacy of i.v. iron over oral or no iron in reducing blood transfusions, increasing haemoglobin, and improving quality of life in ESA-treated anaemic cancer patients. Furthermore, i.v. iron without additional ESA should be evaluated as potential treatment in patients with chemotherapyinduced anaemia. At recommended doses, i.v. iron is well tolerated, particularly compared with oral iron. No serious drug-related adverse effects were seen during long-term use in renal disease and no effect on tumour growth has been observed in trials with anaemic cancer patients. Conclusions: Reliable diagnosis and treatment of ID are recommended key steps in modern cancer patient management to minimise impact on quality of life and performance status. [less ▲]Detailed reference viewed: 59 (1 ULg)
Ph Ib/II study of BKM120 plus trastuzumab in patients with trastuzumab-resistant HER2+ advanced breast cancer
; ; et al
in Annals of Oncology (2012), 23(supplément 9), 116Detailed reference viewed: 52 (7 ULg)
Diffuse large B-cell lymphoma of Waldeyer's ring has distinc clinicopathologic features: a GELA study.
de Leval, Laurence ; Bonnet, Christophe ; et al
in Annals of Oncology (2012), 23(12)
Background Diffuse large B-cell lymphomas (DLBCLs) arising in specific extranodal sites have peculiar clinicopathologic features. Patients and methods We analyzed a cohort of 187 primary Waldeyer's ring ... [more ▼]
Background Diffuse large B-cell lymphomas (DLBCLs) arising in specific extranodal sites have peculiar clinicopathologic features. Patients and methods We analyzed a cohort of 187 primary Waldeyer's ring (WR) DLBCLs retrieved from GELA protocols using anthracyclin-based polychemotherapy. Results Most patients (92%) had stage I–II disease. A germinal center B-cell-like (GCB) immunophenotype was observed in 61%, and BCL2 expression in 55%, of WR DLBCLs. BCL2, BCL6, IRF4 and MYC breakpoints were observed in, respectively, 3 of 42 (7%), 9 of 36 (25%), 2 of 26 (8%) and 4 of 40 (10%) contributive cases. A variable follicular pattern was evidenced in 30 of 68 (44%) large biopsy specimens. The 5-year progression-free survival (PFS) and the overall survival (OS) of 153 WR DLBCL patients with survival information were 69.5% and 77.8%, respectively. The GCB immunophenotype correlated with a better OS (P = 0.0015), while BCL2 expression predicted a worse OS (P = 0.037), an effect overcome by the GCB/non-GCB classification. Compared with matched nodal DLBCLs, WR DLBCLs with no age-adjusted international prognostic index factor disclosed a better 5-year PFS rate (77.5% versus 70.7%; P = 0.03). Conclusions WR DLBCLs display distinct clinicopathologic features compared with conventional DLBCLs, with usual localized-stage disease, common follicular features and a high frequency of GCB immunophenotype contrasting with a low rate of BCL2 rearrangements. In addition, they seem to be associated with a better outcome than their nodal counterpart. [less ▲]Detailed reference viewed: 15 (2 ULg)
An open-label expanded access study of lapatinib and capecitabine in patients with HER2-overexpressing locally advanced or metastatic breast cancer.
; ; et al
in Annals of Oncology (2010), 21(3), 474-80
BACKGROUND: The Lapatinib Expanded Access Program (LEAP) was designed to provide access to lapatinib plus capecitabine for HER2-positive metastatic breast cancer patients who previously received an ... [more ▼]
BACKGROUND: The Lapatinib Expanded Access Program (LEAP) was designed to provide access to lapatinib plus capecitabine for HER2-positive metastatic breast cancer patients who previously received an anthracycline, a taxane, and a trastuzumab and had no other treatment options. PATIENTS AND METHODS: LEAP opened globally and enrollment continued until lapatinib received regulatory approval in each participating country. Patients were assessed for progression-free survival (PFS) and overall survival (OS) and monitored for serious adverse events (SAEs). RESULTS: As of 30 September 2008, 4283 patients from 45 countries enrolled in LEAP. The median treatment duration was 24.7 weeks. The most common drug-related SAEs were diarrhea (9.7%), vomiting (4.3%), and nausea (2.4%) and were mainly grade 3 or higher. The incidences of special interest SAEs were decreased left ventricle ejection fraction (0.5%), interstitial lung disease/pneumonitis (0.2%), and serious hepatobiliary events (0.4%). This safety profile is consistent with the overall lapatinib program. The median PFS and OS were 21.1 [95% confidence interval (CI) = 20.1-22.3] and 39.6 (95% CI = 37.7-40.7) weeks, respectively (n = 4006). Subgroup analysis showed longer PFS and OS in patients who had not received prior capecitabine. CONCLUSIONS: These results demonstrate the safety and efficacy of lapatinib in a broader patient population compared with a clinical trial. [less ▲]Detailed reference viewed: 84 (6 ULg)
Prognostic significance of aberrant promoter hypermethylation of CpG islands in patients with diffuse large B-cell lymphomas
; ; et al
in Annals of Oncology (2008), 19(10), 1774-1786
Background: Diffuse large B-cell lymphoma (DLBCL) exhibits heterogeneous clinical features and a marked variable response to treatment. Patients and methods: We investigated the prognostic significance of ... [more ▼]
Background: Diffuse large B-cell lymphoma (DLBCL) exhibits heterogeneous clinical features and a marked variable response to treatment. Patients and methods: We investigated the prognostic significance of the methylation status of DAPK, GSTP1, P14, P15, P16, P33, RB1, SHP1, CDH1, APC, BLU, VHL, TIMP3, and RASSF1A genes in 46 DLBCL specimens from Tunisian patients. Methylation status of each gene was correlated with clinicopathological parameters including the International Prognostic Index (IPI), the germinal center immunophenotype, and response to treatment and survival. Overall survival (OS) and disease-free survival (DFS) rates were calculated by the Kaplan–Meier method and differences were compared with the log-rank test. Results: Hypermethylation of SHP1 was associated with elevated lactate dehydrogenase level (P = 0.031). P16 and VHL were frequently hypermethylated in patients with high IPI scores (P = 0.006 and 0.004) and a performance status of two or more (P = 0.007 and 0.047). In addition, hypermethylation of P16 was significantly associated with advanced clinical stages and B symptoms (P = 0.041 and 0.012). Interestingly, hypermethylation of DAPK was significantly correlated with resistance to treatment (P = 0.023). With regard to survival rates, promoter hypermethylation of DAPK, P16, and VHL were significantly associated with shortened OS (P = 0.003, 0.001, and 0.017, respectively) and DFS (P = 0.006, 0.003, and 0.046, respectively). In multivariate analysis, hypermethylation of DAPK remains an independent prognostic factor in predicting shortened OS (P = 0.001) and DFS (P = 0.024), as well as the IPI and the germinal center status. Conclusions: This study demonstrates that DLBCLs with hypermethylated P16, VHL, DAPK, and SHP1 commonly show a biologically aggressive phenotype and worse prognosis. Interestingly, hypermethylation of DAPK was found to be an independent prognostic factor that may be used in conjunction with the conventional prognostic factors such as the IPI and the germinal center status. [less ▲]Detailed reference viewed: 45 (0 ULg)
Diffuse large B-cell lymphoma (DLBCL) of the waldeyer'ring (WR) frequently have a GC-like phenotype: a clinico-pathological study of 209 patients from the groupe d'étude des lymphomes de l'adulte (GELA).
; Bonnet, Christophe ; et al
in Annals of Oncology (2008), 13(suppl 4)Detailed reference viewed: 15 (0 ULg)
Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians
; ; et al
in Annals of Oncology (2006), 17(9), 1450-1458
Background: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation ... [more ▼]
Background: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. Patients and methods: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. Results: No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed. Conclusions: This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences. [less ▲]Detailed reference viewed: 48 (6 ULg)
Diagnostic and therapeutic management of carcinoma of unknown primary: radio-imaging investigations.
Jerusalem, Guy ; Rorive, Andrée ; et al
in Annals of Oncology (2006), 17 Suppl 10Detailed reference viewed: 12 (3 ULg)
No advantage of chemoradiotherapy over chemotherapy alone in elderly patients with localized low risk aggressive lymphoma: results of the LNH93-4 GELA study.
Fillet, Georges ; Bonnet, Christophe ; et al
in Annals of Oncology (2005), 16 (suppl 5)Detailed reference viewed: 13 (0 ULg)
Subcellular localization of the bovine leukaemia virus (BLV) R3 et G4 accessory proteins in BLV producing cells.
; ; et al
in Annals of Oncology (2004), 15(3),Detailed reference viewed: 14 (2 ULg)
Early detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease.
Jerusalem, Guy ; Beguin, Yves ; Fassotte, Marie-France et al
in Annals of Oncology (2003), 14(1), 123-30
BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron ... [more ▼]
BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron emission tomography (PET) for the detection of preclinical relapse. PATIENTS AND METHODS: Thirty-six patients underwent 2-[fluorine-18]fluoro-2-deoxy-D-glucose ((18)F-FDG) PET at the end of treatment and than every 4-6 months for 2-3 years after the end of polychemotherapy and/or radiotherapy. In those cases of abnormal (18)F-FDG accumulation a confirmatory study was performed 4-6 weeks later. RESULTS: One patient had residual tumor and four patients relapsed during a follow-up of 5-24 months. All five events were correctly identified early by (18)F-FDG PET. Residual tumor or relapse was never first diagnosed based on clinical examination, laboratory findings or computed tomography (CT) studies. Two patients presented B symptoms and the three others were asymptomatic at the time of residual disease or relapse. Confirmation of residual disease or relapse was obtained by biopsy in four patients 1, 1, 5 and 9 months after PET and by unequivocal clinical symptoms and CT studies in one patient 3 months after PET. False-positive (18)F-FDG PET studies incorrectly suggested possible relapse in six other patients, but the confirmatory PET was always negative. Our study also provides important information about physiological (18)F-FDG uptake in the thymus. CONCLUSIONS: Our data suggest the potential of (18)F-FDG PET to detect preclinical relapse in patients with HD. This could help identify patients requiring salvage chemotherapy at the time of minimal disease rather than at the time of clinically overt relapse. Further studies are warranted to determine the impact of PET on treatment management and outcome. In fact, the aim of follow-up procedures is not only to detect preclinical relapse but mainly to obtain better results by starting salvage treatment earlier. A cost-benefit analysis will also be necessary before (18)F-FDG PET can be used routinely in the follow-up of patients with HD. [less ▲]Detailed reference viewed: 56 (3 ULg)
Radiotherapy is unnecessary in elderly patients with localized agressive non Hodgkin's lymphoma: results of the LNH 93-4 study.
Bonnet, Christophe ; Fillet, Georges ; et al
in Annals of Oncology (2002), 13 (suppl 2)Detailed reference viewed: 16 (0 ULg)
Immunocytochemical study of subcellular distribution of bovine leukaemia virus regulatory Tax protein.
; ; Portetelle, Daniel et al
in Annals of Oncology (2002), 13(2), 14Detailed reference viewed: 8 (3 ULg)
The value of positron emission tomography (PET) imaging in disease staging and therapy assessment.
Jerusalem, Guy ; Hustinx, Roland ; Beguin, Yves et al
in Annals of Oncology (2002), 13 Suppl 4Detailed reference viewed: 17 (5 ULg)
Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) for the staging of low-grade non-Hodgkin's lymphoma (NHL).
Jerusalem, Guy ; Beguin, Yves ; et al
in Annals of Oncology (2001), 12(6), 825-30
BACKGROUND: Although PET has been shown to be highly sensitive in the primary staging of lymphoma, previous studies with small numbers of patients indicated that low-grade NHL may not always be adequately ... [more ▼]
BACKGROUND: Although PET has been shown to be highly sensitive in the primary staging of lymphoma, previous studies with small numbers of patients indicated that low-grade NHL may not always be adequately detected by PET. We undertook this study to determine factors influencing the detection of lesions by PET in low-grade NHL and to evaluate the utility of PET in this indication. PATIENTS AND METHODS: Forty-two patients underwent conventional staging procedures (clinical examination, oto-rhino-laryngologic examination, computed tomography of the chest, abdomen and pelvis, gastroscopy and bone marrow biopsy as well as whole-body non-attenuation corrected 18F-FDG-PET RESULTS: PET detected 40% more abnormal lymph node areas than conventional staging in follicular lymphoma but was inappropriate for the staging of small lymphocytic lymphoma where it detected less than 58% of abnormal lymph node areas. PET showed more lesions than conventional staging for peripheral (34% more lymph node areas detected) and thoracic lymph node (39% more) areas but not for abdominal or pelvic lymph nodes (26% fewer areas detected). The sensitivity to detect bone marrow infiltration was unacceptably low for PET. In contrast, PET was as effective as standard procedures for the detection of other extranodal localizations, although a few localizations were detected only by PET and a few others only by conventional procedures. CONCLUSIONS: PET may contribute to the management of patients with low-grade follicular NHL. For the other low-grade lymphoma subtypes, the role of PET is less evident. Further studies using PET to evaluate the results of treatment or to diagnose disease recurrence are warranted in low-grade follicular NHL. [less ▲]Detailed reference viewed: 65 (19 ULg)
Clinical evaluation of whole-body 18F-fluorodeoxyglucose positron emission tomography in the detection of liver metastases.
Hustinx, Roland ; ; et al
in Annals of Oncology (1998), 9(4), 397-401
BACKGROUND: Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases ... [more ▼]
BACKGROUND: Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases. PATIENTS AND METHODS: Sixty-four patients with malignancy and possible liver involvement were included. Liver metastases were present in 31 cases, demonstrated by histopathological analysis in 15 cases and by follow-up in 16 cases. The negative cases were confirmed by pathology in four cases, peroperative ultrasonography in 12 cases, and follow-up in 17 cases. Whole-body FDG PET was compared to CT (n = 53) and US (n = 43). RESULTS: PET demonstrated a 97% sensitivity, an 88% specificity and a 92% accuracy, compared to 93%, 75% and 85%, respectively, for CT (P = NS). Concordant results were obtained in 44 of 64 patients (69%: 19 TP. 25 TN). PET provided new and accurate information in 15 of 64 patients (23.4%). PET demonstrated liver metastases in 11 patients in whom conventional methods yielded negative (two cases) or doubtful (nine cases) results. Four patients free of liver involvement were correctly staged with PET, while CT/US were equivocal. PET was erroneous in five of 64 cases (7.8%, four FP, one FN). CONCLUSIONS: FDG PET allows an accurate screening of liver involvement in patients with malignancy. Combined with CT, it provides additional diagnostic information that could directly affect the management of these patients. [less ▲]Detailed reference viewed: 34 (13 ULg)