Center Medical Of Bligny

Bligny-lès-Beaune, France

Center Medical Of Bligny

Bligny-lès-Beaune, France

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PubMed | Hopital Saint Louis, Hopital Georges Pompidou, Institute Paoli Calmettes, Institute Bergonie and 14 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

There is continuing controversy regarding the optimal regimen for neoadjuvant chemotherapy (NAC) in bladder cancer.We performed a retrospective analysis of 241 consecutive bladder cancer patients who received a combination of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) using a standard (52 patients) or an accelerated schedule (189 patients) as NAC before radical cystectomy in 17 centres of the French GEnito-urinary TUmour Group from March 2004-May 2013.The median age was 62 years. As expected, the median number of cycles, the median total dose of cisplatin and the median cisplatin dose intensity were higher in patients treated with the accelerated regimen. Conversely, the median duration of chemotherapy was shorter. Regarding toxicity, grade III/IV neutropenia, grade III thrombocytopenia and grade III anaemia as well were more frequently observed in patients treated with the standard regimen. Among 211 (88%) patients who proceeded to cystectomy, 75 (35%) patients achieved an ypT0 pN0 status (no pathologic residual tumour cells) with no significant difference according to the MVAC schedule. Three-year overall survival rates were 66.5% (95% confidence interval [CI], 56-79) and 72% (95% CI, 59.5-88) in the standard and accelerated cohorts, respectively. In the multivariate analysis, two independent prognostic parameters were retained: the ypT0 stage and the ypN0 stage. Heterogeneity test did not show any interaction with NAC regimens.Similar pathological response and survival rates were observed whatever the chemotherapy regimen used. Haematological toxicity was greater in patients who received standard MVAC.


Fruehauf J.,University of California at Irvine | Lutzky J.,Mount Sinai Medical Center | McDermott D.,Beth Israel Deaconess Medical Center | Brown C.K.,Midwestern Regional Medical Center | And 7 more authors.
Clinical Cancer Research | Year: 2011

Purpose: This multicenter, open-label, phase II study evaluated the safety and clinical activity of axitinib, a potent and selective second-generation inhibitor of vascular endothelial growth factor receptors (VEGFR)-1, 2, and 3, in patients with metastatic melanoma. Experimental Design: Thirty-two patients with a maximum of one prior systemic therapy received axitinib at a starting dose of 5 mg twice daily. The primary endpoint was objective response rate. Results: Objective response rate was 18.8% [95% confidence interval (CI), 7.2-36.4], comprising one complete and five partial responses with a median response duration of 5.9 months (95% CI, 5.0-17.0). Stable disease at 16 weeks was noted in six patients (18.8%), with an overall clinical benefit rate of 37.5%. Six-month progression-free survival rate was 33.9%, 1-year overall survival rate was 28.1%, and median overall survival was 6.6 months (95% CI, 5.2-9.0). The most frequently (>15%) reported nonhematologic, treatment-related adverse events were fatigue, hypertension, hoarseness, and diarrhea. Treatment-related fatal bowel perforation, a known class effect, occurred in one patient. Axitinib selectively decreased plasma concentrations of soluble VEGFR(sVEGFR)-2 and sVEGFR-3 compared with soluble stem cell factor receptor (sKIT). No significant association was noted between plasma levels of axitinib and response. However, post hoc analyses indicated potential relationships between efficacy endpoints and diastolic blood pressure of 90 mm Hg or higher as well as baseline serum lactate dehydrogenase levels. Conclusions: Axitinib was well tolerated, showed a selective VEGFR-inhibitory profile, and showed single-agent activity in metastatic melanoma. Further evaluations of axitinib, alone and combined with chemotherapy, are ongoing. ©2011 AACR.


Denis B.,Pasteur Hospital | Sauleau E.A.,University of Strasbourg | Gendre I.,Association for Colorectal Cancer Screening in Alsace ADECA Alsace | Exbrayat C.,Association for Cancer Screening in Isere ODLC 38 | And 6 more authors.
Digestive and Liver Disease | Year: 2014

Background: Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme. Methods: Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme. Results: We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r= 0.90, p < 0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r= 0.84, p= 0.01). Conclusion: The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme. © 2013 Editrice Gastroenterologica Italiana S.r.l.


PubMed | Association for Cancer Screening in Cote dOr ADECA 21, Association for Cancer Screening in Finistere ADEC 29, Association for Cancer Screening in Isere ODLC 38, Pasteur Hospital and 5 more.
Type: Journal Article | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2014

Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme.Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme.We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r=0.90, p<0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r=0.84, p=0.01).The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme.


Van Cutsem E.,University Hospital Gasthuisberg | Khayat D.,Hospital Pitie Salpetriere | Verslype C.,University Hospital Gasthuisberg | Billemont B.,Hospital Cochin | And 6 more authors.
European Journal of Cancer | Year: 2013

Background: To determine dose-limiting toxicities (DLTs), recommended phase II trial dose (RPTD), safety, preliminary antitumour activity and pharmacokinetics of intravenous aflibercept with irinotecan, 5-fluorouracil and leucovorin (LV5FU2). Patients and methods: In this open-label study, 38 patients with advanced solid tumours received aflibercept 2, 4, 5, or 6 mg/kg on day 1, then irinotecan and LV5FU2 on days 1 and 2 every 2 weeks. Results: Two grade 3/4 aflibercept-associated DLTs occurred with 4 mg/kg: proteinuria lasting >2 weeks and acute nephrotic syndrome with thrombotic microangiopathy. Two DLTs with 5 mg/kg (grade 3 stomatitis and grade 3 oesophagitis reflux) and three with 6 mg/kg (febrile neutropenia, grade 3 stomatitis and grade 3 abdominal pain) were considered related to concurrent chemotherapy and underlying disease. The most common grade 3/4 adverse events were neutropenia, hypertension and diarrhoea. Nine patients had partial responses, five with 4 mg/kg. Twenty-two patients had stable disease (five with 4 mg/kg), lasting >3 months in 17 patients. No anti-aflibercept antibodies were detected. Free aflibercept was in excess of bound in most patients on 4 mg/kg. Conclusion: Based on pharmacokinetics, acceptable safety and encouraging antitumour activity, aflibercept 4 mg/kg was selected as the RPTD with irinotecan and LV5FU2 every 2 weeks. © 2012 Elsevier Ltd. All rights reserved.


Charansonney O.L.,Center Medical Of Bligny
Discovery medicine | Year: 2011

The benefits of physical activity in preventing premature mortality have been established by a large set of epidemiological studies. These benefits have been shown both in middle-aged and elderly individuals. Furthermore, the reduction of acute events such as myocardial infarction observed with higher levels of physical activity together with the increase in disease-free life expectancy among the most active individuals supports physical activity's anti-aging effect. This review highlights two models supporting this effect. The first model describes the path to frailty and the second explains that immobilization is a stressor which triggers stress-responses responsible for many chronic diseases. Aging reduces the physiological reserve and can lead to frailty when this reserve cannot allow an appropriate adaptation of the aging body to environmental challenges. The components of this physiological reserve can easily be measured by cardiorespiratory testing. Among them are heart rate reserve and VO(2max), the maximal body oxygen consumption. The opposite effects of exercise training and aging on the physiological reserve are detailed. Underlying mechanisms of both exercise training and aging are described. Sedentary lifestyle accelerates the effects of aging in susceptible individuals. Sedentary lifestyle induces mechanisms which lead to risk factors of chronic diseases and, eventually, to premature death. These pathological mechanisms and their consequences constitute the sedentary lifestyle syndrome.


Philippe C.,Service des explorations fonctionnelles multidisciplinaires | Viau F.,Center Medical Of Bligny
Medecine du Sommeil | Year: 2011

Adaptive servo-ventilation (ASV) is a novel therapy that provides inspiratory pressure support superimposed on fixed or automatic positive expiratory pressure. This inspiratory pressure is modified cycle by cycle according to the patient's ventilation. It was initially conceived to correct the Cheyne-Stokes respiration in patients with stable cardiac failure and receiving optimal medical treatment. Today, indications widened in eucapnic/hypocapnic sleep central apnea, even if the level of proof of its efficiency to normalize the apnea/hypopnea index is weaker. During the institution of an ASV or modifications of the pressures, HF patients, and it especially if the HF is severe, have to benefit from a clinical supervision and arteriel pressure monitoring. As any ventilation, the choice of the mask and the management of the leaks must be meticulous; the beginning pressures have to allow the best comfort. The modifications of the other parameters require a fine analysis of poly(somno) graphic data and software. The persistence of obstructive abnormalities will be managed by the increase of the expiratory pressure. For the central abnormalities, it is necessary to be patient. The modifications of the inspiratory pressure support limits and\or a modification of the back up rate can be proposed. © 2010 Elsevier Masson SAS.


Meric J.B.,Center Medical Of Bligny | Billemont B.,Center Medical Of Bligny | Rixe O.,Center Medical Of Bligny
Bulletin du cancer | Year: 2010

New medical strategies have emerged over the past decade for the treatment of advanced renal cell carcinoma based on the discovery of specific molecular abnormalities. However, molecular targeted therapeutics including anti-angiogenics have demonstrated significant limits (limited impact on overall survival, development of potential severe toxicities). We review the future directions for drug development based on specific interaction with cellular and extra-cellular pathways. Both von Hippel-Lindau alterations and high immunogenicity profile represent two remarkable characteristics identified in clear cell carcinoma. The new generation of anti-angiogenics (including HIF, Notch, or angiopoietin inhibitors) and recent developments in immunotherapy also provide opportunities to modify the prognosis of advanced renal cell carcinoma.


PubMed | Center Medical Of Bligny
Type: Journal Article | Journal: Discovery medicine | Year: 2011

The benefits of physical activity in preventing premature mortality have been established by a large set of epidemiological studies. These benefits have been shown both in middle-aged and elderly individuals. Furthermore, the reduction of acute events such as myocardial infarction observed with higher levels of physical activity together with the increase in disease-free life expectancy among the most active individuals supports physical activitys anti-aging effect. This review highlights two models supporting this effect. The first model describes the path to frailty and the second explains that immobilization is a stressor which triggers stress-responses responsible for many chronic diseases. Aging reduces the physiological reserve and can lead to frailty when this reserve cannot allow an appropriate adaptation of the aging body to environmental challenges. The components of this physiological reserve can easily be measured by cardiorespiratory testing. Among them are heart rate reserve and VO(2max), the maximal body oxygen consumption. The opposite effects of exercise training and aging on the physiological reserve are detailed. Underlying mechanisms of both exercise training and aging are described. Sedentary lifestyle accelerates the effects of aging in susceptible individuals. Sedentary lifestyle induces mechanisms which lead to risk factors of chronic diseases and, eventually, to premature death. These pathological mechanisms and their consequences constitute the sedentary lifestyle syndrome.


PubMed | Center Medical Of Bligny
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2012

The benefits of physical activity in preventing premature mortality have been established by a large set of epidemiological studies. These benefits have been shown both in middle-aged and elderly individuals. Furthermore, the reduction of acute events such as myocardial infarction observed with higher levels of physical activity together with the increase in disease-free life expectancy among the most active individuals supports physical activitys antiaging effect. This review highlights two models supporting this effect. The first model describes the path to frailty and the second explains that immobilization is a stressor which triggers stress-responses responsible for many chronic diseases. Aging reduces the physiological reserve and can lead to frailty when this reserve cannot allow an appropriate adaptation of the aging body to environmental challenges. The components of this physiological reserve can easily be measured by cardiorespiratory testing. Among them are heart rate reserve and VO(2)max, the maximal body oxygen consumption. The opposite effects of exercise training and aging on the physiological reserve are detailed. Sedentary lifestyle accelerates the effects of aging in susceptible individuals. Sedentary lifestyle induces mechanisms which lead to risk factors of chronic diseases and, eventually, to premature death. These inappropriate mechanisms and their consequences constitute the sedentary lifestyle syndrome.

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