Institute Regional Du Cancer Of Montpellier Icm
Institute Regional Du Cancer Of Montpellier Icm
Perotin V.,Institute Regional Du Cancer Of Montpellier Icm
Medecine Palliative | Year: 2016
In France, the law passed on 22 April 2005 on the right of patients and end of life imposed a demanding reflection in the light of the complexity of current medical situations. Modifications of this law are proposed in an increasingly insistent way, in particular in reports that have followed one another during the last three years. This article sheds light on the founding principles of the so-called 'Leonetti Law', looks briefly at the positioning of the media and the polls, and summarises the recent debates about changing this legal frame. The author comments the report of the French committee for reflection over the end of life, the opinions of the French national ethic committee (CCNE, opinion 121) and of a conference of citizens, as well as a recent law proposition that lead to a new law voted on 2 February 2016. The reflection focuses on the following controversial themes: early directives, sedation, assisted suicide, euthanasia. These opinions illustrate the mentality of our time that puts forward individualism rather than universal considerations, simplifying complex questions, even claiming to bring a response to all problems. Modifications of the Leonetti Law are however necessary and the author recommends an evolution which would strengthen the quality of the proposed answers by using more collegial cooperation with a wider scope of interventions and more ethical requirements. © 2017 Elsevier Masson SAS.
Kurtz J.-E.,Hopitaux Universitaires Of Strasbourg |
D'Hondt V.,Institute Regional Du Cancer Of Montpellier Icm |
Lecuru F.,Service de chirurgie cancerologique gynecologique et du sein |
Lhomme C.,Gustave Roussy
Bulletin du Cancer | Year: 2017
Metastatic or recurrent cervical cancer/treatment The prognosis of metastatic or recurrent cervical cancer remains dismal. The poor chemosensitivity of this tumor- is an issue, especially in case of recurrence in irradiated fields. Still, chemotherapy has shown some efficacy, and mostly consists in platinum-based doublets. The addition of bevacizumab to chemotherapy has been recently validated. However, most of these patients present with complex clinical situations and the treatment strategy has to be discussed in multidisciplinary tumor boards. © 2017 Elsevier Masson SAS
Rouanet P.,Institute Regional Du Cancer Of Montpellier Icm |
Rullier E.,University of Bordeaux 1 |
Lelong B.,Institute Paoli Calmettes |
Maingon P.,Center Georges Francois Leclerc |
And 4 more authors.
Diseases of the Colon and Rectum | Year: 2017
BACKGROUND: Preoperative radiochemotherapy and total mesorectal excision are the standard-of-care for locally advanced rectal carcinoma, but some patients could be over- or undertreated. OBJECTIVE: This study aimed to assess the feasibility of radiochemotherapy tailored based on the tumor response to induction chemotherapy (FOLFIRINOX) to obtain a minimum R0 resection rate of 90% in the 4 arms of the study. DESIGN: This study is a multicenter randomized trial (NCT01333709). SETTING: This study was conducted at 16 French cancer specialty centers. PATIENTS: Two hundred six patients with locally advanced rectal carcinoma were enrolled between 2011 and 2014. INTERVENTIONS: Good responders (≥75% tumor volume reduction) were randomly assigned to immediate surgery (arm A) or standard radiochemotherapy (Cap 50: 50 Gy irradiation and 1600 mg/m2 oral capecitabine daily) plus surgery (arm B). Poor responders were randomly assigned to Cap 50 (arm C) or intensive radiochemotherapy (Cap 60, 60 Gy irradiation, arm D) before surgery. OUTCOME MEASURES: The primary end point was a R0 resection rate (circumferential resection margin >1 mm). STATISTICAL CONSIDERATIONS: The experimental strategies were to be considered effective if at least 28 successes (R0 resection) among 31 patients in each arm of stratum I and 34 successes among 40 patients in each arm of stratum II were reported (Simon 2-stage design). RESULTS: After induction treatment (good compliance), 194 patients were classified as good (n = 30, 15%) or poor (n = 164, 85%) responders who were included in arms A and B (16 and 14 patients) and arms C and D (113 and 51 patients). The trial was prematurely stopped because of low accrual in arms A and B and recruitment completion in arms C and D. Data from 133 randomly assigned patients were analyzed: 11, 19, 52, and 51 patients in arms A, B, C, and D. Good responders had smaller tumors than poor responders (23 cm3 vs 45 cm3; p < 0.001). The surgical procedure was similar among groups. The R0 resection rates [90% CI] were 100% [70-100], 100% [85-100], 83% [72-91], and 88% [77-95]. Among the first 40 patients, 34 successes were reported in arms C and D (85% R0 resection rate). The circumferential resection margin ≤1 rates were 0%, 0%, 12%, and 5% in arms A, B, C, and D. The rate of transformation from positive to negative circumferential resection margin was 93%. LIMITATIONS: There was low accrual in arms A and B. CONCLUSION: Tailoring preoperative radiochemotherapy based on the induction treatment response appears safe for poor responders and promising for good responders. Long-term clinical results are needed to confirm its efficacy.
Portales F.,Institute Regional Du Cancer Of Montpellier Icm |
Hammel P.,French Institute of Health and Medical Research
Hepato-Gastro et Oncologie Digestive | Year: 2017
Locally-advanced (LA) pancreatic cancers account for one third of all pancreatic cancers. Theirmanagement has not yet reached a consensus.Gemcitabine wasthe single option with a median survival of 7-9 months but there is likely a future for more aggressive systemic chemotherapies using FOLFIRINOX and gemcitabinenab- paclitaxel'' currently used as standards for metastatic cancers. This option, however, is not yet validated, as for radiotherapy. Only retrospective studies are available and assess chemo- or radiotherapy with variable results in terms of median survival, probably because these studies are not randomized, and in heterogeneous populations (borderline and LA tumors). Few meta-analyses have shown median survival of superior to 15 months. Results of a phase II study comparing gemcitabine-nab-paclitaxel combination (LAPACT) and of phase III comparing FOLFIRINOX combination to gemcitabine gemcitabine (NEOPAN) should answer regarding the superiority of the association. Chemoradiotherapy, still controversial, showed recently with the only randomized phase III trial (LAP-07) a lack of superiority of chemoradiotherapy over chemotherapy alone, but with a significantly longer time without treatment. New opportunities for development are ongoing, especially in the field of mechanisms of resistance to chemotherapy, of peritumoral stromal response or of tumoral inhibition of the immune system, but also in the field of exome sequencing to develop new therapeutic targets The study of circulating tumor cells (CTC) as new biomarkers. Resectability after medical treatment in LA cancers was non envisageable, but before the availability since 5 years of more efficient sytemic chemotherapies, it became an important aim in order to change a treatment said palliative in an induction treatment. In conclusion, prognosis of LA pancreatic cancers has improved with a median survival of 15-16 months. Optimizing systemic treatment is probably the key to prognosis improvement, using prognostic tools. Including patients in therapeutic trials may be the means to answer remaining questions regarding this ''intermediate'' form of pancreatic cancer. Copyright © 2017 John Libbey Eurotext.
PubMed | Clinique Mutualiste de Bellevue, Institute Paoli Calmettes, Institute Bergonie, Institute National du Cancer and 14 more.
Type: | Journal: Nature communications | Year: 2016
HER2-positive breast cancer has long proven to be a clinically distinct class of breast cancers for which several targeted therapies are now available. However, resistance to the treatment associated with specific gene expressions or mutations has been observed, revealing the underlying diversity of these cancers. Therefore, understanding the full extent of the HER2-positive disease heterogeneity still remains challenging. Here we carry out an in-depth genomic characterization of 64 HER2-positive breast tumour genomes that exhibit four subgroups, based on the expression data, with distinctive genomic features in terms of somatic mutations, copy-number changes or structural variations. The results suggest that, despite being clinically defined by a specific gene amplification, HER2-positive tumours melt into the whole luminal-basal breast cancer spectrum rather than standing apart. The results also lead to a refined ERBB2 amplicon of 106kb and show that several cases of amplifications are compatible with a breakage-fusion-bridge mechanism.
PubMed | Breast Pathology Unit, Institute Regional Du Cancer Of Montpellier Icm, Institute Of Cancerologie Of Louest, Center Leon Berard and Institute Claudius Regaud
Type: Journal Article | Journal: Breast cancer research and treatment | Year: 2016
Few data are currently available regarding the efficacy and safety of T-DM1 in breast cancer (BC) patients with unselected brain metastases (BM), since most clinical trials have excluded BM patients or have only included highly selected patients. HER2+BC patients with BM treated with T-DM1 in 5 French centers were included in this retrospective study. Clinical management was performed according to the product guidelines. Efficacy was evaluated recording tumor response rates, progression-free (PFS) and overall survival, treatment compliance, and safety. Thirty nine patients received T-DM1, among whom 82% presented with concomitant extra-cerebral disease. Median number of previous metastatic chemotherapy and HER2-directed targeted therapy regimens was 2 (range 0-8) and 1 (0-7), respectively. Thirty six patients had received BM loco-regional treatment (72% whole-brain radiation therapy). After a median follow-up of 8.1months (1.4-39.6), 24 patients had progressed (first site of progression: brain 14; meningeal 2; outside of the central nervous system 5; both intra- and extra-cerebral 3), 12 patients had died (disease progression), and 27 patients were still alive. Median number of T-DM1 cycles was 8 (1-43). There were 17 partial responses (44%) and 6 patients achieved disease stabilization (59% clinical benefit rate). Median PFS was 6.1months (95%CI 5.2-18.3), with one- and two-year PFS rates of 33 and 17%, respectively. Treatment was well tolerated, without unexpected toxicities, treatment delay, or dose reduction. In this retrospective study, T-DM1 appeared to be an effective and well-tolerated therapeutic option in unselected HER2+BC patients with BM. These findings require a prospective validation.
Satge D.,Institut Universitaire de France |
Sauleau E.-A.,University of Strasbourg |
Jacot W.,Institute Regional Du Cancer Of Montpellier Icm |
Raffi F.,Tulle hospital |
And 2 more authors.
BMC Cancer | Year: 2014
Background: Breast cancer has been poorly studied in women with intellectual disability (ID), which makes designing a policy for screening the nearly 70 million women with ID in the world difficult. As no data is available in the literature, we evaluated breast cancer at diagnosis in women with ID.Methods: Women with ID were searched retrospectively among all women treated for invasive breast cancer in a single hospital over 18 years. Age at diagnosis was compared among the whole group of women. Tumor size, lymph node involvement, SBR grade, TNM classification, and AJCC stage were compared to controls matched for age and period of diagnosis using conditional logistic regression.Results: Among 484 women with invasive breast cancer, 11 had ID. The mean age at diagnosis was 55.6 years in women with ID and 62.4 years in the other women. The mean tumor size in women with ID was 3.53 cm, compared to 1.80 cm in 44 random controls from among the 473 women without ID. Lymph node involvement was observed in 9 of the 11 women with ID compared to 12 of the controls (OR = 11.53, p = 0.002), and metastases were found in 3 of the 11 women with ID compared to 1 of the 44 controls (OR = 12.00, p = 0.031). The AJCC stage was higher in women with ID compared to controls (OR = 3.19, p = 0.010).Conclusions: Women with ID presented at an earlier age with tumors of a higher AJCC stage than controls despite no significant differences in tumor grade and histological type. Thus, delayed diagnosis may be responsible for the differences between disabled and non-disabled women. © 2014 Satgé et al.; licensee BioMed Central Ltd.
Samalin E.,Institute Regional Du Cancer Of Montpellier Icm |
Ychou M.,Institute Regional Du Cancer Of Montpellier Icm
World Journal of Clinical Oncology | Year: 2016
Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. While the incidence of gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction adenocarcinoma is rising rapidly in Western countries. Considering that surgical resection is currently the major curative treatment, and that the 5-year survival rate highly depends on the pTNM stage at diagnosis, gastroesophageal adenocarcinoma management is very challenging for oncologists. Several treatment strategies are being evaluated, and among them systemic chemotherapy, to decrease recurrences and improve overall survival. The MAGIC and FNCLCC-FFCD trials showed a survival benefit of perioperative chemotherapy in patients with operable gastric and lower esophageal cancer, and these results had an impact on the European clinical practice. New strategies, including induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies in combination with perioperative chemotherapy and the new cytotoxic regimens, are currently assessed to improve current standards and help developing patienttailored therapeutic interventions. © The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
PubMed | Institute Regional Du Cancer Of Montpellier Icm
Type: Journal Article | Journal: Journal of robotic surgery | Year: 2016
Rectal cancer continues to be a surgical challenge. As more technology is developed, the surgeon must both incorporate this new technology into his practice and, at the same time, keep improving oncologic surgery and overall outcomes. We describe a standardized approach and fully robotic proctectomy, using four arms and one single docking (SI system). Patient cart and ports placement, as well as arms position to avoid collision, are key points to perform the entire procedure with one single docking. Although the place of robotic surgery might still need to be defined, standardizing the procedures is a step towards its evaluation. We propose with this report a solution to perform a single docking four arms robotic proctectomy.
PubMed | Institute Regional Du Cancer Of Montpellier Icm
Type: Journal Article | Journal: World journal of clinical oncology | Year: 2016
Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. While the incidence of gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction adenocarcinoma is rising rapidly in Western countries. Considering that surgical resection is currently the major curative treatment, and that the 5-year survival rate highly depends on the pTNM stage at diagnosis, gastroesophageal adenocarcinoma management is very challenging for oncologists. Several treatment strategies are being evaluated, and among them systemic chemotherapy, to decrease recurrences and improve overall survival. The MAGIC and FNCLCC-FFCD trials showed a survival benefit of perioperative chemotherapy in patients with operable gastric and lower esophageal cancer, and these results had an impact on the European clinical practice. New strategies, including induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies in combination with perioperative chemotherapy and the new cytotoxic regimens, are currently assessed to improve current standards and help developing patient-tailored therapeutic interventions.