F. Grassin

Combined Etoposide, Ifosfamide, and Cisplatin in the Treatment of Patients with Advanced Thymoma and Thymic Carcinoma. A French Experience

Introduction: The value of a nonanthracyclin regimen in thymic carcinoma and malignant thymoma is not well defined. These regimens may be useful in some patients, particularly with cardiac diseases. The objective of this study is to evaluate the response rate, progression free survival, overall survival and toxicity of combined etoposide, ifosfamide, and cisplatin in patients with advanced thymoma and thymic carcinoma. Methods: From October 1995 to April 2001, 18 patients with advanced thymoma or thymic carcinoma were entered on trial, and receive etoposide (100 mg/m2 on days 1–3), ifosfamide (1500 mg/m2 on days 1–3), s and cisplatin (30 mg/m2 on days 1–3). Cycles were repeated every 3 weeks for a total of six cycles. Results: Among 16 evaluable patients, there were no complete responses and four partial responses (complete and partial responses rate, 25%; confidence interval [CI] 95, 7–48%). The median follow-up was 32.6 months (range, <9–84 months), and the median overall survival has not yet been reached because more than 50% of patients are still alive. Based on Kaplan-Meier estimates, the 1-year and 2-year survival rates were 93.8 and 78.1%, respectively. The toxicity was predominantly myelosuppresion and alopecia. Conclusions: The combined etoposide, ifosfamide, and cisplatin regimen has moderate activity in patients with advanced thymic tumors. Our results confirm the Eastern Cooperative Oncology Group trial published in 2001. Response rates appear to be lower to many phase II trials, but survival seems similar.

Targeted therapy for localized non-small-cell lung cancer: a review.

Targeted therapies have markedly improved the management of patients with advanced non-small-cell lung cancer (NSCLC), but their efficacy in localized NSCLC is less well established. The aim of this review is to analyze trials of targeted therapies in localized NSCLC. In patients with wild-type EGFR, tyrosine kinase inhibitors have shown no efficacy in Phase III trials. Few data are available for EGFR-mutated localized NSCLC, as routine biological profiling is not recommended. Available studies are small, often retrospectives, and/or conducted in a single-center making it difficult to draw firm conclusions. Ongoing prospective Phase III trials are comparing adjuvant tyrosine kinase inhibitor administration versus adjuvant chemotherapy. By analogy with the indication of bevacizumab in advanced NSCLC, use of antiangiogenic agents in the perioperative setting is currently restricted to nonsquamous NSCLC. Several trials of adjuvant or neoadjuvant bevacizumab are planned or ongoing, but for the moment there is no evidence of efficacy. Data on perioperative use of biomarkers in early-stage NSCLC come mainly from small, retrospective, uncontrolled studies. Assessment of customized adjuvant or neoadjuvant therapy in localized NSCLC (with or without oncogenic driver mutations) is a major challenge.

Bronchoscopy with the Vision Sciences BF100 Disposable-Sheath Device: French Experience after 328 Procedures

Background: In spite of adhesion to recommended disinfection procedures, the transmission of infections by bronchoscopes is a permanent problem. Objective: The new device may prevent nosocomial infections because it consists of two parts: a specific bronchoscope Vision Sciences BF100 and a single-use protective sheath for each procedure. The aim of this paper is to report our practice and the difficulties encountered when using this system. Methods: We report our experience from 1997 to 2002 after 328 elective and emergency endoscopic procedures with the BF100 device. In a retrospective study, we describe the population and the incidents during procedure. We discuss the impact of the use of BF100 on the cost of bronchoscopies. Results: The major constraint is the care required in assembling the optical device and disposable sheath. The intrinsic qualities of the optics are confirmed; any sample may be taken although image quality and suction capacity are inferior to videoscopes. Maneuverability is inferior to videoscopes, but improves with a short experience. In addition, this device is expensive. Conclusions: The technical performances of the BF100 device are inferior to those of videoscopes but the concept of sterile single-use sheaths is able to prevent the nosocomial infections related to bronchoscopes. Because of the cost, examination with the BF100 should be reserved to patients with proved or suspected infection (multiresistant bacteria, tuberculosis, hepatitis C and B virus, HIV, prions) and immunosuppression (hematologic diseases).

Compression médullaire par extension intra-canalaire d’un mésothéliome pleural malin

Resume Le diagnostic de mesotheliome pleural epithelial est realise apres une thoracoscopie-talcage chez un homme de 58 ans qui presente une pleuresie. L’evolution est rapidement defavorable malgre une chimiotherapie systemique, avec des douleurs dorsales revelant un envahissement vertebral et du canal rachidien, responsable d’une compression medullaire 3 mois apres le diagnostic du mesotheliome.

Présentation pseudo-tumorale de l’histoplasmose pulmonaire américaine

Resume En France, l’histoplasmose pulmonaire americaine est une mycose profonde d’importation, secondaire a l’inhalation de spores d’ Histoplasma capsulatum . La presentation clinique de cette affection exotique est volontiers proteiforme, pouvant simuler une tuberculose ou un cancer. Nous rapportons deux observations d’histoplasmose americaine a forme pseudo-tumorale chez des sujets immunocompetents, expatries au Venezuela, presentant des nodules pulmonaires multiples.

Manifestations pleuropulmonaires révélatrices de l’amibiase hépatique

During a mission in ex-Yugoslavia between 2001 and 2004, three French soldiers were sent home because of right pneumopathy, right pleurisy after appendicectomy, haemoptysis and liver haematoma, respectively. They previously were stationed in Africa and/or South America. The initial diagnosis was quickly modified: pleuropulmonary manifestations of amoebic hepatic abscess in two cases, and pleuropulmonary amoebiasis in the last case. The outcome was favourable with standard anti-amoebic treatment. The reports illustrate the possibility of hepatic amoebiasis with local pleuropulmonary manifestations and an exceptional case of pleuropulmonary amoebiasis with hepatobronchial fistula. The authors report this experience because it demonstrates that amoebiasis in European countries remains an often forgotten diagnosis. Although known for a long time in developing countries, amoebiasis in the military or in tourists should be systematically considered.

Insuffisance cardiaque aiguë sous itraconazole : une complication prévisible ?

INTRODUCTION Itraconazole is an azole derivative used for the treatment of aspergillosis. Cardiac failure is a rare complication of treatment. Most cases occur in patients with cardiovascular risk factors, or taking multiple medications, and a causal relationship is not well-established. CASE REPORT We report the case of a patient, without cardiovascular risk factors, presenting with cardiac failure during treatment with itraconazole. Pre-treatment stress testing and echocardiography were normal. Resolution was complete without sequelae. CONCLUSION Cardiac failure can occur in association with itraconazole despite normal cardiological investigations before treatment.

Atteinte laryngée révélatrice d’une tuberculose pulmonaire méconnue

Resume La tuberculose laryngee est rare. Exceptionnellement isolee, cette atteinte peut reveler une tuberculose pulmonaire cliniquement meconnue. Nous rapportons deux observations illustrant cette eventualite. Une presentation endoscopique pseudo-tumorale risque d’orienter a tort vers une neoplasie. Le diagnostic est facilement redresse par la bacteriologie. Les nouvelles methodes de diagnostic genomique par hybridation (Gen-Probe) et de culture permettent un diagnostic particulierement rapide. L’evolution sous traitement anti-tuberculeux standard est toujours favorable.