T. de La Motte Rouge

Survival and reproductive function of 52 women treated with surgery and bleomycin, etoposide, cisplatin (BEP) chemotherapy for ovarian yolk sac tumor

BACKGROUND Ovarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Chemotherapy has dramatically improved the prognosis. Current treatment consists of surgery followed by bleomycin, etoposide, and cisplatin (BEP) chemotherapy. However, given the rarity of this tumor, ovarian YST-specific survival and outcome after such treatment are not precisely known. PATIENTS AND METHODS This report concerns prospectively recorded cases that were either treated at Institut Gustave Roussy (Villejuif, France) or referred there for advice about therapy. From 1990 to 2006, 52 patients underwent surgery followed by BEP chemotherapy. Data on patient characteristics, treatment, survival, and fertility outcome were analyzed to assess treatment efficacy and gonadal toxicity after achieving a complete remission. RESULTS Thirty-five patients had stage I/II tumors while 17 patients presented with stage III/IV disease. With a median follow-up of 68 months, the overall 5-year survival and disease-free survival rates were 94% and 90%, respectively. Forty-one women underwent fertility-sparing surgery. Pregnancy was achieved in 12 of 16 (75%) women who attempted conception. Overall, 19 pregnancies have been recorded. CONCLUSIONS BEP chemotherapy following fertility-sparing surgery is a very effective treatment of ovarian YSTs. Most of the patients who attempt conception after complete remission will have children.

Diethylstilbestrol (DES) retains activity and is a reasonable option in patients previously treated with docetaxel for castration-resistant prostate cancer

Docetaxel-based chemotherapy is currently the standard treatment for metastatic castration-resistant prostate cancer (CRPC). Two large randomized studies demonstrated that this treatment prolongs survival and also improves time-to-disease progression, pain control and prostate-specific antigen (PSA) response, as compared with mitoxantrone and prednisone [1, 2]. However, patients eventually experience cancer progression within several months and there is currently no established standard treatment after failure of front-line docetaxel-based chemotherapy. Many data indicate that CRPC continues to depend on androgen-receptor signaling even after failure of docetaxel-based chemotherapy [3, 4]. Evidence has also been provided that combining an estrogen-containing drug, estramustine, with chemotherapy may improve overall survival in patients with CRPC [5]. Diethylstilbestrol (DES) is a synthetic ethynil estrogen often used in CRPC as salvage therapy after several hormone manipulations [6]. The activity of DES in patients exhibiting progression after docetaxel-based chemotherapy has not previously been reported. We carried out an analysis to evaluate DES as salvage therapy after first-line docetaxel-based chemotherapy in patients with progressive CRPC. Twenty patients (median age 65.7 years) were treated with DES, given orally at an initial dose of 1 mg daily. None of these patients had received DES before docetaxel. The median duration of prior sensitivity to androgen deprivation therapy was 23 months (range 5–95 months). The median baseline serum PSA value was 45 ng/ml (range 4–680). A PSA response as defined as a PSA decline ‡30% and ‡50% was observed in five (25%) and three (15%) patients, respectively. Among the two patients who had progressive disease while receiving docetaxel, one had a 67% decline in serum PSA. Median progression-free survival was 3.7 months [95% confidence interval (CI) 2.7– 4.7 months] and median overall survival was 20.7 months (95% CI 13.4– 28.0 months). The cause of DES discontinuation was progressive cancer in all patients. Ten patients have received a preventive anticoagulation by low-dose aspirin. DES was well tolerated overall and only one thromboembolic complication was reported. These results add to the compelling data indicating that CRPC is hormone sensitive in a significant proportion of cases, even when pretreated with docetaxel-based chemotherapy. Since there is no standard of care when progression occurs after docetaxel-based chemotherapy in patients with CRPC, DES appears as a reasonable option worth considering in this setting.

Why do residents choose the medical oncology specialty? Implications for future recruitment—results of the 2007 French Association of Residents in Oncology (AERIO) Survey

BACKGROUND The aim of this study was to analyze demography, motivation behind the choice of the medical oncology specialty, career plans, and the quality of training in medical oncology and to provide guidance to candidates for boosting the number of oncologists. METHODS In 2007, the French Association of Residents in Oncology conducted a nationwide study of all medical oncology residents in France. RESULTS The strongest factors that had influenced their decision to become a medical oncology specialist were an interest in medical oncology (98%), exposure to this branch of medicine during graduate training as a medical student (83%), interest in research (81%), and the diversity of the activity (75%). The mean score for the quality of training was 6 (0-10). More time for reading during working hours as well as for attending staff meetings and greater availability of teaching oncologists would improve the quality of training. The most popular career choice was working in a public hospital but most residents stated that they had not received adequate information about the different career plans. CONCLUSIONS No data are available regarding how training in medical oncology is perceived. This study provides useful data for future policies to boost the number of oncologists.

Suite aux communications faites au congrès de l'American Society of Clinical Oncology 2010, qu'est ce qui va changer nos pratiques ? Le point de vue du comité de rédaction du Bulletin du cancer

The congress of Asco made the object of numerous summaries of congress made in the heat of the moment and the Bulletin du Cancer decided to ask to his editorial board, a digested summary, at distance of the congress, to try to sum up the data of the congress which are going to change practice. Of the considerable number of communications, editorial board chose 40 communications which appeared to answer these rules. Best understanding of biological mechanisms and new molecules to inhibit targets allow in certain case, to use therapeutic targeting in the true sense. The identification of the gene of fusion EML4-ALK in lung adenocarcinoma, and its inhibition by the crizotinib, constitute a considerable progress for 5% of patients with this disease. Molecular biology with the mutations of the exon 11 in GIST, allow to better define the population which is going to benefit from adjuvant imatinib. In Advanced non-small cell lung cancer, myeloma and advanced lymphoma, maintenance therapy by monoclonal anti-body or inhibitors of tyrosines kinases showed the proof of their effectiveness. In advanced melanoma, ipilimumab is a light of hope in a pathology in always prognostic is so dark. In metastatic adenocarcinoma of the pancreas, there is finally an alternative to gemcitabine with the Folfirinox regimen, with an improvement of overall survival. Biological personalization of cancer treatments is on the road run but the road is still long.

Nouvelles thérapeutiques du cancer de la prostate métastatique résistant à la castration

Despite that greater knowledge of prostate cancer biology has led to the isolation of many new and promising targets, treatment of metastatic prostate cancer is still challenging. New agents targeting these molecules are currently under development in large randomized phase III trials, to improve overall survival and the quality of life of patients with metastatic castrate-resistant prostatic cancer (CRPC). Cytotoxic chemotherapy (docetaxel-based chemotherapy) demonstrated clinical benefit on overall survival, but could be improved. Drugs targeting directly or not the androgen receptor such as abiraterone or new specific peripheral anti-androgens (MDV3100) are very promising. Bone targeted therapies (endothelin1 receptor A inhibitor, RANK ligant, metabolic irradiation) are also very promising and are in development in large phase III trials. Antiangiogenic therapies could also be effective in CRPC. Autologous vaccin against prostatic acid phosphatase seems to prolong overall survival and other vaccin and immunotherapy strategies are in development (anti-CTLA4 antibody). A recent analogue of thalidomide, probably more efficient, lenalidomide is also in development.

938PDNeed for a stratified analysis in stage I malignant ovarian germ cell tumors (MOGCT): Prospective survival analysis of cases collection from the French rare malignant ovarian tumors (TMRO) network & GINECO group

T. de la Motte Rouge, F. Derquin, A. Floquet, J. Edeline, J-P. Lotz, J. Alexandre, P. Pautier, G. Ferron, E. Boissier, C. Lefeuvre-Plesse, H. Vegas, A. Patsouris, E. Kalbacher, D. Berton-Rigaud, A-C. Hardy Bessard, V. Lavoué, I.L. RayCoquard Medical Oncology, Centre Eugene Marquis, Rennes, France, Oncologie Médicale, Institute Bergonié, Bordeaux, France, Medical Oncology, APHP, CancerEst, Tenon University Hospital, Paris, France, Medical Oncology, Hôpital Cochin, Paris, France, Medecine, Gustave Roussy, Villejuif, France, Surgical Department, Centre ClaudiusRegaud, Toulouse, France, Medical Oncology, European George Pompidou Hospital, Paris, France, Medical Oncology, CHRU Bretonneau, Tours, France, Medical Oncology, Centre Paul Papin, Angers, France, Medical Oncology, CHU Besançon, Hôpital Jean Minjoz, Besançon, France, Medical Oncology, ICO Institut de Cancerologie de l’Ouest René Gauducheau, Saint-Herblain, France, Medical Oncology, Hôpital Privé des Côtes d’Armor, Plérin, France, Gynaecology Department, CHU Anne-de-Bretagne, Rennes, France, Medical Oncology, Centre Léon Bérard, Lyon, France

Suite aux communications faites au congrès de l'American Society of Clinical Oncology 2010, qu'est ce qui va changer nos pratiques ? Le point de vue du comité de rédaction du Bulletin du cancerFollowing communications made at American Society of Clinical Oncology 2010, what will change our practice? The point of view of the editorial board of Bulletin du Cancer

The congress of Asco made the object of numerous summaries of congress made in the heat of the moment and the Bulletin du Cancer decided to ask to his editorial board, a digested summary, at distance of the congress, to try to sum up the data of the congress which are going to change practice. Of the considerable number of communications, editorial board chose 40 communications which appeared to answer these rules. Best understanding of biological mechanisms and new molecules to inhibit targets allow in certain case, to use therapeutic targeting in the true sense. The identification of the gene of fusion EML4-ALK in lung adenocarcinoma, and its inhibition by the crizotinib, constitute a considerable progress for 5% of patients with this disease. Molecular biology with the mutations of the exon 11 in GIST, allow to better define the population which is going to benefit from adjuvant imatinib. In Advanced non-small cell lung cancer, myeloma and advanced lymphoma, maintenance therapy by monoclonal anti-body or inhibitors of tyrosines kinases showed the proof of their effectiveness. In advanced melanoma, ipilimumab is a light of hope in a pathology in always prognostic is so dark. In metastatic adenocarcinoma of the pancreas, there is finally an alternative to gemcitabine with the Folfirinox regimen, with an improvement of overall survival. Biological personalization of cancer treatments is on the road run but the road is still long.

Nouvelles thérapeutiques du cancer de la prostate métastatique résistant à la castrationNew drugs in metastatic castration-resistant prostate cancer

Despite that greater knowledge of prostate cancer biology has led to the isolation of many new and promising targets, treatment of metastatic prostate cancer is still challenging. New agents targeting these molecules are currently under development in large randomized phase III trials, to improve overall survival and the quality of life of patients with metastatic castrate-resistant prostatic cancer (CRPC). Cytotoxic chemotherapy (docetaxel-based chemotherapy) demonstrated clinical benefit on overall survival, but could be improved. Drugs targeting directly or not the androgen receptor such as abiraterone or new specific peripheral anti-androgens (MDV3100) are very promising. Bone targeted therapies (endothelin1 receptor A inhibitor, RANK ligant, metabolic irradiation) are also very promising and are in development in large phase III trials. Antiangiogenic therapies could also be effective in CRPC. Autologous vaccin against prostatic acid phosphatase seems to prolong overall survival and other vaccin and immunotherapy strategies are in development (anti-CTLA4 antibody). A recent analogue of thalidomide, probably more efficient, lenalidomide is also in development.