Paoletti X.,Institute National du Cancer |
Oba K.,Kyoto University |
Burzykowski T.,Hasselt University |
Michiels S.,Institute Gustave Roussy |
And 8 more authors.
JAMA - Journal of the American Medical Association | Year: 2010
Context: Despite potentially curative resection of stomach cancer, 50% to 90% of patients die of disease relapse. Numerous randomized clinical trials (RCTs) have compared surgery alone with adjuvant chemotherapy, but definitive evidence is lacking. Objectives: To perform an individual patient-level meta-analysis of all RCTs to quantify the potential benefit of chemotherapy after complete resection over surgery alone in terms of overall survival and disease-free survival, and to further study the role of regimens, including monochemotherapy; combined chemotherapy with fluorouracil derivatives, mitomycin C, and other therapies but no anthracyclines; combined chemotherapy with fluorouracil derivatives, mitomycin C, and anthracyclines; and other treatments. Data Sources: Data from all RCTs comparing adjuvant chemotherapy with surgery alone in patients with resectable gastric cancer. We searched MEDLINE (up to 2009), the Cochrane Central Register of Controlled Trials, the National Institutes of Health trial registry, and published proceedings from major oncologic and gastrointestinal cancer meetings. Study Selection: All RCTs closed to patient recruitment before 2004 were eligible. Trials testing radiotherapy; neoadjuvant, perioperative, or intraperitoneal chemotherapy; or immunotherapy were excluded. Thirty-one eligible trials (6390 patients) were identified. Data Extraction: As of 2010, individual patient data were available from 17 trials (3838 patients representing 60% of the targeted data) with a median follow-up exceeding 7 years. Results: There were 1000 deaths among 1924 patients assigned to chemotherapy groups and 1067 deaths among 1857 patients assigned to surgery-only groups. Adjuvant chemotherapy was associated with a statistically significant benefit in terms of overall survival (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.76-0.90; P<.001) and disease-free survival (HR, 0.82; 95% CI, 0.75-0.90; P<.001). There was no significant heterogeneity for overall survival across RCTs (P=.52) or the 4 regimen groups (P=.13). Five-year overall survival increased from 49.6% to 55.3% with chemotherapy. Conclusion: Among the RCTs included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone. ©2010 American Medical Association. All rights reserved.
Nowak F.,Institute National du Cancer |
Soria J.-C.,Institute Gustave Roussy |
Calvo F.,Institute National du Cancer
Nature Reviews Clinical Oncology | Year: 2012
The use of tumour molecular profiles for therapeutic decision making requires that molecular diagnostics be introduced into routine clinical practice. To this end, the French National Cancer Institute and French Ministry of Health have set up a national network of 28 regional molecular genetics centres. These facilities perform selected molecular tests, free of charge, for all patients in their region, regardless of the institution where they are treated. A specific programme has also been implemented to anticipate the launch of new targeted treatments and reduce time-to-access to new drugs and experimental therapies. In 2011, 55,000 patients with cancer in France benefited from molecular predictive tests. The French nationwide initiative for tumour molecular profiling is a tool to fight inequalities in access to molecular testing and targeted therapy, and demonstrates that molecular stratification of tumours for therapeutic decisions is a cost-effective strategy that can be successfully integrated into the health-care system. © 2012 Macmillan Publishers Limited. All rights reserved.
Challenges and guiding principles of a national coordination of actors involved in producing, implementing and evaluating clinical guidelines for patients with cancer (in part I: What Cancer Plans have brought to the improvement of professional practices) [Enjeux et principes d’une coordination nationale des acteurs pour la production, l’implémentation et l’évaluation des outils d’aides à la décision médicale en cancérologie (in partie I : Les apports des Plans cancer au service de l’amélioration des pratiques professionnelles)]
Mazeau-Woynar V.,Institute national du cancer
Oncologie | Year: 2014
In oncology, a large number of actors are involved in clinical guidelines development at the local or national level. This attests the need for decision-making tools, in the context of rapidly evolving knowledge and practices. However, the multiplicity of available guidelines, their redundancy and sometimes their divergence, questions the efficiency of the current scheme and the risks of disparity in terms of patient care. To address these issues, the new Cancer Plan entrusts to INCa the responsibility for coordinating actors at a national level in the production, implementation and evaluation of the impact of those tools. © 2014, Springer-Verlag France.
Key contributions of French Cancer Plans in professional practices improvement in oncogeriatrics — Institutional point of view (in part I: What Cancer Plans have brought to the improvement of professional practices) [L’organisation spécifique en oncogériatrie, le point de vue institutionnel (in partie I : Les apports des Plans cancer au service de l’amélioration des pratiques professionnelles)]
Brechot J.-M.,Institute national du cancer
Oncologie | Year: 2014
Following a pilot phase during the first French Cancer Plan, a national roll-out of a specific organization for elderly people with cancer took place in the second Cancer Plan, to ensure every elderly with cancer access to an appropriate care. Two actions of the third Cancer Plan are dedicated to oncogeriatrics, one to support research, the other the training in geriatrics for oncologists. © 2014, Springer-Verlag France.
The French National Cancer Institute (INCa): an institute dedicated to a strong and lasting action in the fight against this disease [L’Institut national du cancer : un institut dédié au cancer pour garantir une impulsion forte et continue de la lutte contre cette maladie]
Burstin A.,Institute national du cancer
Oncologie | Year: 2014
The French National Cancer Institute (INCa) is the preeminent health and science agency in charge of cancer control. Created under the Public Health Act of 2004, the French National Cancer Institute is an original and unique model among State agencies and at international level; it covers all modes of action to fight against the disease: research, observation and evaluation, prevention and screening, care organization and public information. The Institutes’ work is based on coordinating and integrating all intervention programmes. This coordination is a major mission of INCa and translates in its status of public interest group: it gathers all key stakeholders -charities, public sector, professional, industries- and favours constant exchanges. Along with the integration of all aspects of the fight against cancer, they warrants the expertise and relevance of INCa-driven actions. The inherent liability of an institute dedicated to the most deadly diseases in France is another key element that leads INCa to steer the 2014–2019 Cancer Plan, in close collaboration with the Ministries for Health and Research. © 2014, Springer-Verlag France.
Agency: European Commission | Branch: H2020 | Program: ERA-NET-Cofund | Phase: HCO-08-2014 | Award Amount: 22.57M | Year: 2015
Cancer is a worldwide health burden and represents a major public health challenge in Europe. It is responsible for 25% of all deaths, being the second most common cause of death after cardio-vascular diseases and the main cause of mortality among people aged 4564. Today, an estimated 9 million individuals in Europe live with cancer (Globocan 2008, http://globocan.iarc.fr/). Cancer became a chronic disease which contributed substantially to the growth of medical expenditures and constitutes a major socio-economic challenge for Europe as well as globally. A rapid and effective bidirectional transfer of relevant cancer research findings between bench and bedside would play a pivotal role in addressing top-priority needs at the EU level to reduce incidence and mortality of malignancies and to improve the quality of life of cancer patients. The proposed ERA-NET Cofund TRANSCAN-2, in continuity with the preceding and ongoing TRANSCAN ERA-NET, aims at linking translational cancer research funding programmes in 15 Member States, 3 Associated Countries, and a third country. By concentrating transnational resources, TRANSCAN-2 will provide a critical financial and scientific mass for tackling large-scale problems, relevant for improving translational cancer research globally. A co-funded joint transnational call (JTC) will be launched focusing on the topic Intratumour heterogeneity in resistance to therapy and recurrence followed by three additional JTCs that will be implemented in a frame of multinational translational cancer research programmes. In addition, strategies will be developed for the enlargement of the network, for improvement of coordination and for an efficient communication and dissemination of the results of the consortium as well as of the research projects funded through the JTCs. The monitoring of the projects funded through the JTCs and the critical assessment of the performance of TRANSCAN-2, based on key indicators, will be also realised.
Agency: European Commission | Branch: FP7 | Program: CP-IP | Phase: HEALTH-2009-2.1.1-2 | Award Amount: 13.88M | Year: 2010
All cancers arise due to somatically acquired mutations in their genomes which alter the function of key cancer genes. Understanding these critical mutational events underlying cancer development is paramount for advancing prevention, early detection, monitoring and treatment of the disease. Breast cancer is the most common class of cancer diagnosed in women worldwide with more than one million cases diagnosed annually. It is responsible for >400,000 deaths per year making it the leading cause of cancer deaths in women and is the most common cause of all deaths in women aged >40yrs. Breast cancer is a heterogeneous disease with a number of subtypes. We propose here to generate complete catalogues of somatic mutations in 500 breast cancers, of the ER\ve HER2- subclass, under the International Cancer Genome Consortium model by high coverage, shotgun genome sequencing of both tumour and normal DNA. All classes of mutations are expected to be detected including base substitutions, insertions, deletions, copy number changes and rearrangements. These catalogues of mutations will afford us statistical power to identify cancer genes that are mutated at a frequency of greater than 3% in this class of breast cancer. Complementary catalogues of epigenomic changes (genome-wide DNA methylation) will be generated for the same cancer samples together with transcript expression profiles. Integrated analyses of these data will be carried out and compared to parallel datasets from other classes of breast cancer and other types of cancer. The potential clinical utility of these findings for detection and monitoring of minimal residual disease will be investigated. Finally, data will be made rapidly available to all scientific researchers with minimal restrictions. The results of this exhaustive and comprehensive set of studies will have an enormous impact on our understanding of the causes and biology of breast cancer and will lead to major advances in detection, prevention and treatment of breast cancer
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2010.2.4.1-1 | Award Amount: 2.42M | Year: 2011
Cancer is a worldwide health burden and a major public health challenge in Europe, responsible for 25% of all deaths; a situation expected to worsen with population ageing. The strengthening of translational cancer research is an urgent need in European cancer research, i.e. the integration of basic, epidemiological, preclinical and clinical research with the implementation and evaluation of interventions in prevention, diagnosis, prognosis, treatment and care. The proposed ERA-NET TRANSCAN aims at linking translational cancer research funding programmes in 19 Member States and Associated Countries. By concentrating transnational resources TRANSCAN will provide a critical financial and scientific mass for tackling large scale problems, relevant for improving translational cancer research in each Member State or Associated Country as well as overall in Europe. The objectives of TRANSCAN will be achieved through interconnected activities, structured into six work packages (WP) and facilitated by the project coordination and management (WP1). A survey and analysis of national cancer research funding (WP2) will provide a comprehensive picture of the nature and extent of translational cancer research funding in the EU. Based on this knowledge, TRANSCAN will identify gaps in and opportunities for coordinated translational research, and will thus contribute to the development of a coordinated funding research policy shared by European countries. Based also on the outcome of these activities, three joint transnational calls for multinational translational cancer research programmes will be designed (WP3) and implemented (WP4). In this context, training programmes/activities of multi-disciplinary translational cancer research teams will be supported (WP5). The TRANSCAN performance will be monitored and confronted with the partners expectations, and a sustainability plan for the network beyond TRANSCAN will be elaborated (WP6), contributing to the building of a pan-European platform for translational cancer research.
Agency: European Commission | Branch: FP7 | Program: CP-CSA-Infra | Phase: INFRA-2007-2.2-01 | Award Amount: 7.16M | Year: 2008
The Preparatory Phase for a pan-European Biobanking and Biomolecular Resources Research Infrastructure (BBMRI) will focus on technical, legal, governance, and financial issues to prepare to construct BBMRI, building on existing biobanks, resources and technologies, specifically complemented with innovative components and properly embedded into European scientific, ethical, legal and societal frameworks, provide the concept for a key resource to increase excellence and efficacy in biomedical sciences, drug development and public health, expand and secure competitiveness of European research and industry in a global context, develop a sustainable financial framework. Biomedical quality-assessed samples and data as well as biomolecular resources and molecular analysis tools are essential for academic and industry-driven research to treat and prevent human diseases. Although currently established national biobanks and biomolecular resources are a unique European strength, valuable collections typically suffer from fragmentation of the European biobanking-related research community. This hampers the collation of biological samples and data from different biobanks required to achieve sufficient statistical power. Moreover, it results in duplication of effort and jeopardises sustainability due to the lack of long-term funding. BBMRI will comprise: biobanks of different formats (collections of blood, DNA, tissue, etc., together with medical, environmental, life-style and follow-up data), biomolecular resources (antibody and affinity binder collections, ORF clone collections, siRNA libraries, proteins, cellular resources etc.), enabling technologies and high-throughput analysis platforms and molecular tools to decipher gene, protein and metabolite functions and their interactions, harmonized standards for sample collection, storage, preanalytics and analysis harmonized databases and biocomputing infrastructure, ethical, legal and societal
Agency: European Commission | Branch: FP7 | Program: CSA-SA | Phase: HEALTH.2013.4.1-4 | Award Amount: 645.12K | Year: 2013
The Health Directorate of the European Commissions DG Research and Innovation recently stated that Personalized Medicine is one of the most innovative areas in the future of health research with a high potential for patients, citizens and the economy. However, today the full potential can not be developed due to fragmented activities, insufficient communication and lack of generic solutions in the different areas of Personalized Medicine.The implementation of Personalized Medicine is, therefore, a major challenge in Europe and beyond. It calls for appropriate governance strategies at the European and global level as it challenges the way in which healthcare systems worldwide are set up. Thus, the EC itself, EuroBioForum, the European Health Forum Gastein (EHFG) and others have organized conferences to tackle these challenges. Furthermore, key European organizations and institutions have come up with reports, guidelines, roadmaps aiming to give guidance in this emerging and important health research field amongst others the European Science Foundation (ESF) Forward Look, the Manifesto of the European Alliance for Personalised Medicine (EAPM), the European Best Practice Guidelines of the Public Health Genomics European Network (PHGEN), the Roche report on Personalized Medicine or the report of the European Hospital and Healthcare Federation (HOPE). Based on these initiatives European and national decision-makers and funding bodies not only have expressed the urgent need for a CSA, but also initiated this specific CSA to step up coordination efforts between the European key stakeholders to allow synergies and avoid duplication or competition, to ensure maximum transparency and openness preparing Europe for leading the global way.