Omuro A.,A+ Network |
Chinot O.,Aix - Marseille University |
Taillandier L.,Center Hospitalier Of Nancy |
Ghesquieres H.,Center Leon Berard |
And 19 more authors.
The Lancet Haematology
BACKGROUND: No standard chemotherapy regimen exists for primary CNS lymphoma, reflecting an absence of randomised studies. We prospectively tested two promising methotrexate-based regimens, one more intensive and a milder regimen, for primary CNS lymphoma in the elderly population, who account for most patients. METHODS: In this open-label, randomised phase 2 trial, done in 13 French institutions, we enrolled immunocompetent patients who had neuroimaging and histologically confirmed newly diagnosed primary CNS lymphoma, were aged 60 years and older, and had a Karnofsky performance scale score of 40 or more. Participants were stratified by Karnofsky performance scale score (<60 vs ≥60) and treating institution and randomly assigned (1:1) to receive methotrexate (3·5 g/m2) with temozolomide (150 mg/m2) or methotrexate (3·5 g/m2), procarbazine (100 mg/m2), vincristine (1·4 mg/m2), and cytarabine (3 mg/m2). Neither regimen included radiotherapy; both included prophylactic G-CSF and corticosteroids. The primary endpoint was 1-year progression-free survival. Analysis was intent to treat, in a non-comparative phase 2 trial design. This study is registered with ClinicalTrials.gov, number NCT00503594. FINDINGS: Between July 16, 2007, and March 25, 2010, 98 patients were enrolled, of whom 95 were randomly assigned and analysed; 48 to methotrexate with temozolomide and 47 to methotrexate, procarbazine, vincristine, and cytarabine. 1-year progression-free survival was 36% (95% CI 22-50) in the methotrexate, procarbazine, vincristine, and cytarabine group and 36% (22-50) in the methotrexate with temozolomide group; median progression-free survival was 9·5 months (95% CI 5·3-13·8) versus 6·1 months (3·8-11·9), respectively. Objective responses were noted in 82% (95% CI 68-92) of patients in the methotrexate, procarbazine, vincristine, and cytarabine group versus 71% (55-84) of patients in the methotrexate with temozolomide group. Median overall survival was 31 months (95% CI 12·2-35·8) in the methotrexate, procarbazine, vincristine, and cytarabine group and 14 months (8·1-28·4) in the methotrexate with temozolomide group. No differences were noted in toxic effects between the two groups. The most common grades 3 and 4 toxicities in both groups were liver dysfunction (21 [4%] in the the methotrexate and temozolomide group and 18 [38%] in the methotrexate, procarbazine, vincristine, and cytarabine group), lymphopenia (14 [29%] and 14 [30%]), and infection (six [13%] and seven [15%]). To date, 33 (69%) patients in the methotrexate and temozolomide group have died, versus 31 (55%) in the methotrexate, procarbazine, vincristine and cytarabine group. Quality-of-life evaluation (QLQ-C30 and BN20) showed improvements in most domains (p=0·01-0·0001) compared with baseline in both groups. Prospective neuropsychological testing showed no evidence of late neurotoxicity. INTERPRETATION: In this study of two different methotrexate-based combination regimens in elderly patients, the efficacy endpoints tended to favour the methotrexate, procarbazine, vincristine, and cytarabine group. Both regimens were associated with similar, moderate toxicity, but quality of life improved with time, suggesting pursuing treatment in these poor prognosis patients is worthwhile. New alternatives are needed to improve response duration in this population. FUNDING: Schering-Plough/Merck and French Government. © 2015 Elsevier Ltd. All rights reserved. Source
Baffert S.,University Pierre and Marie Curie |
Hoang H.L.,University Pierre and Marie Curie |
Bredart A.,University Pierre and Marie Curie |
Asselain B.,University Pierre and Marie Curie |
And 13 more authors.
Background: A care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient's home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope. Methods/Design: An observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. We will include and follow during 1 year 1,000 patients. The study consists of 3 work-packages: Discussion: The assessment of care pathways encourages the implementation of new payment models. Our approach could help health care professionals and policymakers to establish other cost-of-illness studies and plan the allocation of resources on a patient basis rather than a visit basis. © 2015 Baffert et al. Source
Mosbah R.,Institute Curie Rene Huguenin |
Rouzier R.,Institute Curie Rene Huguenin |
Rouzier R.,University of Versailles |
Guinebretiere J.-M.,Rene Huguenin Center |
And 3 more authors.
Aim: The objective of the present study was to describe the biological characteristics of each lesion in patients with bifocal/bicentric (BF/BC) breast cancer. Patients and Methods: We retrospectively reviewed the charts of 205 patients diagnosed with BF/BC cancer. The degree of concordance between the two lesions was assessed using Pearson product-moment correlation coefficients. Results: A total of 205 patients were included. Both tumors displayed the same histological type in 182 patients (89%). The same grade was found for both tumors in 178 of the cases (96.7% and 100% for grade 3 lesions). Immunohistochemical concordance between the two tumors was excellent, with correlation coefficients of 0.98, 0.96 and 0.99 for estrogen receptors (ER), progesterone receptors (PR) and Ki67, respectively. Human Epidermal growth factor Receptor 2 (HER2) status was available for both tumors in 177 cases (86%), with a perfect concordance. We did not find any differences in molecular sub-type between tumor foci. Conclusion: Immunohistochemistry should be performed only on the main tumor in cases of BF/BC cancer. Source
Hequet D.,Institute Curie Rene Huguenin |
Hequet D.,University of Versailles |
Pouget N.,Institute Curie Rene Huguenin |
Estevez J.-P.,Institute Curie Rene Huguenin |
And 3 more authors.
Bulletin du Cancer
SummaryIntroduction Human papillomavirus (HPV) is the main cause of cervical cancer. In France, since March 2007, HPV vaccination has been recommended for girls aged 14, in addition to a catch-up program for girls aged 15 to 23. In October 2012, the target population was changed to 11- to 14-year-old girls. The main objective of the present study was to evaluate the impact of the recommendation change on HPV vaccination coverage and compliance. Methods We conducted a descriptive study of the Échantillon Généraliste des Bénéficiaires (EGB), which is a random 1/97 permanent sample from the French National Health Insurance Database. We focused our analyses on girls aged 11 to 17 years who were covered by the main insurance scheme (which covers 77% of the French population). Results We included 16,195 girls in this analysis. At the last update of the database (06/15/2014), 42% of 17-year-old girls had been vaccinated, with more than 50% of them having been vaccinated at age 14. Between January 2012 and June 2014, patients were reimbursed for a total of 7698 doses of the HPV vaccine. During the first trimester of 2013, the number of vaccinated 11- to 13-year-old girls increased, growing by more than 20-fold between the last trimester of 2012 (n = 8) and the last trimester of 2013 (n = 178). Less than 60% of the vaccinated patients received 3 injections. Discussion Implementation of the new recommendations was rapid but had only a slight impact on vaccination coverage. © 2015 Société Française du Cancer Published by Elsevier Masson SAS. All rights reserved. Source