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Marseille, France

Thomas L.,Service de Neuro Oncologie | Di Stefano A.L.,University Pierre and Marie Curie | Ducray F.,Service de Neuro Oncologie | Ducray F.,French Institute of Health and Medical Research
Current Opinion in Oncology

PURPOSE OF REVIEW: This review summarizes recent studies on the predictive value of molecular markers in adult gliomas, including 1p/19q codeletion, MGMT methylation, IDH mutation and markers identified using omics and next-generation sequencing studies. RECENT FINDINGS: The long-term results of the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer trials in anaplastic oligodendroglial glioma have shown that the 1p/19q codeletion predicts an overall survival benefit from early PCV (procarbazine CCNU vincristine) chemotherapy. This benefit can also be predicted using gene expression-based molecular subtypes of gliomas while the predictive value of the IDH mutation in this context requires further study. In elderly patients with glioblastoma, the analysis of MGMT methylation status in two phase III trials suggests that this alteration may guide treatment decisions; however, this finding still needs confirmation in prospective studies. Omics and next-generation sequencing studies have identified additional potential predictive markers. In particular, IDH mutations, BRAF V600E mutations and FGFR gene fusions might predict efficacy of therapies targeted against these alterations. SUMMARY: Currently, the 1p/19q codeletion is the only well established predictive marker with clinical utility. However, it is likely that other molecular markers such as MGMT methylation, IDH mutation and those identified using omics and next-generation sequencing studies will further guide treatment decisions in adult gliomas. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins. Source

Cordesse V.,Reseau SLA Ile de France | Jametal T.,Service de neurologie 2 | Guy C.,Institute Of La Memoire Et Of La Maladie Dalzheimer | Lefebvre S.,Service de Neuro Oncologie | And 4 more authors.
Revue Neurologique

Neurological diseases are characterized by the complexity of care and by a constant and changing disability. More and more frequently, their impact on the clinical pathway remains unknown. Seven postgraduate rehabilitation students (Master coordination du handicap, université Pierre-et-Marie-Curie, Paris) reconstructed the clinical pathway of 123 patients with various neurological diseases: multiple sclerosis, Alzheimer disease, amyotrophic lateral sclerosis, spinal trauma, Parkinson disease and brain tumors. There was a significant correlation between disease duration and the number of specialists involved in care, the number of prescribed drugs and the number of short-term hospitalizations; there was no correlation with age. This result suggests that with time an increasing number of complications related to the initial neurological disease developed. Hospitalization in rehabilitation units was highly correlated with the degree of disability and also with the help received by the patients during the course of their disease. This result suggests that these hospitalizations were a direct consequence of burn out among relatives. General practitioners (GP) were highly involved only during the initial part of the pathway, and their involvement rapidly declined thereafter, suggesting a probable relation with the specificities and the complexity of care for neurological diseases which induces a progressive transfer of responsibilities from the GP to the hospital. Social care was always incomplete and occurred too late during the course of the disease. The feeling by the patients that their care pathway was chaotic was highly correlated with the quality of the information given to the patient at the time of the announcement of their disease. This study confirms that cares for neurological diseases is highly specific and that expert centers and coordination networks are in a key position to ensure an efficient care pathway. Source

Badaoui N.,Service de Neuro Oncologie | Meyronet D.,University Claude Bernard Lyon 1 | Meyronet D.,French Institute of Health and Medical Research | Cartalat-Carel S.,Service de Neuro Oncologie | And 15 more authors.
Revue Neurologique

Introduction The treatment of glioblastomas (GBMs) has changed significantly since 2005. However, the extent to which this change has improved overall survival (OS) of patients treated outside clinical trials remains to be determined. Methods We compared the patterns of care and OS of all GBM patients diagnosed in 2004 (n = 105) and in 2008 (n = 130) in our center. Results Younger patients (aged < 70 years) diagnosed in 2008 received temozolomide radiochemotherapy as the initial treatment and bevacizumab at recurrence more frequently than those diagnosed in 2004 (69% vs 26% P < 10-4 and 41% vs 3%, P < 10-4, respectively). Elderly patients (aged 70 years) diagnosed in 2008 received an oncological treatment (radiotherapy and/or chemotherapy) more frequently than those diagnosed in 2004 (67% vs 38%, P = 0.006). The patients diagnosed in 2008 had longer OS than those diagnosed in 2004 (10.5 months vs 5.3 months, P = 0.001). This finding was true for both younger and elderly patients (15.3 months vs 8.9 months, P = 0.02 and 6.4 months vs 3.2 months, P = 0.0002, respectively) and when considering only IDH1 wild-type patients (8.9 months vs 5.3 months, P = 0.004). Conclusion In our center, the change in the patterns of care for GBMs between 2004 and 2008 has been associated with a significant improvement in OS. © 2014 Elsevier Masson SAS. Source

Alentorn A.,AP HP | Alentorn A.,Paris-Sorbonne University | Alentorn A.,French Institute of Health and Medical Research | Alentorn A.,French National Center for Scientific Research | And 50 more authors.

Objectives: We aimed to study the potential clinical relevance of 9p allelic loss, with or without copy number variation, in 1p/19q codeleted anaplastic oligodendroglial tumors (AOTs). Methods: This study enrolled 216 patients with 1p/19q codeleted AOT. The prognostic value of 9p allelic loss was investigated using a French nation-wide prospective registry, POLA (prise en charge des tumeurs oligodendrogliales anaplasiques) and high-density single nucleotide polymorphism arrays. We validated our results using the Repository of Molecular Brain Neoplasia Data (REMBRANDT) dataset. Results: The minimal common region of allelic loss in chromosome arm 9p was 9p21.3. Allelic loss of 9p21.3, detected in 41.7% of tumors, was associated with shorter progression-free and overall survival rates in univariate (p 5 0.008 and p , 0.001, respectively) and multivariate analyses (p 5 0.009 and p 5 0.009, respectively). This finding was validated in the REMBRANDT dataset in univariate and multivariate analysis (p 5 0.01 and p 5 0.01, respectively). Conclusion: Our study highlights a novel potential prognostic biomarker in 1p/19q codeleted AOT. Further prospective studies are warranted to investigate our finding. © 2015 American Academy of Neurology. Source

Tabouret E.,Institute Paoli Calmettes | Barrie M.,Service de Neuro Oncologie | Vicier C.,Institute Paoli Calmettes | Goncalves A.,Institute Paoli Calmettes | And 3 more authors.
World Journal of Surgical Oncology

Background: Lung carcinoid tumor and low grade glioma are two uncommon malignancies.Patients and methods: We report the case of 24-year-old man who presented with respiratory disease. Imaging investigations showed a right lung tumor and histological analysis confirmed a typical carcinoid tumor. As part of initial staging, brain MRI revealed an asymptomatic right frontal lesion. First, a right pulmonary lobectomy was performed without adjuvant treatment. In second time, brain tumorectomy was performed. Histological examination confirmed the diagnosis of low grade glioma (LGG). The patient remained in complete remission 2.5 years after the initial diagnosis.Results: This is the first case reporting the association between LGG and lung carcinoid tumor, while no association between LGG and a systemic tumor have been published to date. Association of lung carcinoid tumor with other malignant diseases has been reported but remained uncommon. Only minimal data support a potential molecular common origin.Conclusion: This exceptional association may be fortuitous. However, their concomitant diagnoses suggest a potential association between both rare diseases. A genetic susceptibility remains possible. © 2012 Tabouret et al.; licensee BioMed Central Ltd. Source

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