Xavier Dhalluin

Bevacizumab and weekly paclitaxel for non-squamous non small cell lung cancer patients: A retrospective study

BACKGROUND Combination of bevacizumab and weekly paclitaxel showed synergitic effects, anti-tumor efficacy and a good toxicity profile for patients with breast cancer but has never been evaluated in non small cell lung cancer (NSCLC). We retrospectively reviewed safety and efficacy of this regimen in metastatic non-squamous NSCLC as fourth-line therapy or beyond. METHODS Patients were identified from a prospective database. Treatment consisted in paclitaxel 80 mg/m(2) on days 1, 8 and 15 and bevacizumab 15 mg/kg on day 1, every 3 weeks until progression or unacceptable toxicity. RESULTS Twenty patients were included in this study. Objective response rate at first evaluation was 40% (8/20), confirmed response rate was 15% (3/20) and disease control rate was 75% (15/20). The median progression-free survival and overall survival were 6.4 months (CI95% 4.1-9) and 9.6 months (CI95% 7-19.7). Grade 3-4 adverse events included neutropenia (4/20), onycholysis (2/20) and infection (2/20). One patient died from a bowel perforation and another one died from unknown cause. Prolonged responses were observed in a patient who had received bevacizumab as part of first-line chemotherapy and in another one who harbored an ALK rearrangement. CONCLUSIONS In our experience, combination of bevacizumab and weekly paclitaxel exhibited acceptable toxicity and had encouraging anti-tumor efficacy as fourth-line treatment or beyond for non-squamous NSCLC patients, supporting further evaluation in larger prospective studies.

Chemotherapy and Radiotherapy for Mesothelioma

Previously considered to be rare, malignant pleural mesothelioma (MPM) is a highly aggressive tumor with an increasing incidence linked to asbestos exposure, its main etiological factor. MPM is also a very important issue because patients have usually a short survival (median <12 months) despite current treatments. Moreover an optimal treatment for MPM is not defined yet, even if ERS/ESTS experts recently provided clear and up-to-date guidelines on MPM management. These guidelines on chemotherapy and radiotherapy for mesothelioma, as well as new therapeutic developments, are presented in this chapter.

Pleural ultrasonography, new standard for para pneumonic effusion? French multicentric prospective study. Preliminary report

Introduction: Parapneumonic pleuritis are frequently associated with high morbidity and severe sequelae. Management of this complication include early pleural evacuation. Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pleural effusion. Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is evaluate pleural sequelae with early use of LUS in detection Methods: In this multicentric prospective study, a consecutive sample of suspected patients with CAP was underwent daily LUS. Each patient received a chest x-ray and ultrasound on admission every day. The analysis of the pleural fluid was left to the discretion of the physician . The patients were monitored only 4 days if they had no para pneumonic pleurisy and benefited from an appropriate management if not. Complete respiratory explorations were carried out at 3 and 6 months. Results: In this preliminary reports , 65 patients with CAP were enroled : 48,3% females , mean age 64,4 years Sensitivity of LUS and CXR in detection of parapneumonic effusion were 91% and 40% respectively. Specificity of CXR was 40% while the LUS specificity was 92%. The evolution of pleurisy was unpredictable over the observation period with a significant diagnostic delay of the CXR. No pleurisy occurred after the 4-day period, the failure was 4.6% Compared with nearly 20% of the literature. Conclusion: Findings of the present study demonstrated high incidence of parapneumonic effusion and the higher diagnostic accuracy of LUS versus CXR. A daily echography is necessary and sufficient to detect the effusion and take care of it.

Actualités du traitement médical du mésothéliome pleural malin en 2016

Introduction : le mesotheliome pleural malin (MPM) est un cancer assez rare mais d’incidence croissante, de mauvais pronostic, le plus souvent secondaire a une exposition a l’amiante. Etat des connaissances : sans traitement curatif valide a ce jour, le traitement medical standard, peu efficace, repose sur une chimiotherapie par un doublet cisplatine et pemetrexed en premiere ligne. De plus, aucun traitement n’est recommande en cas d’echec de cette chimiotherapie hormis la proposition d’inclusion en essai clinique. Perspectives : cependant, le congres mondial 2016 de l’International Mesothelioma Interest Group (iMig) a permis de souligner les resultats tres prometteurs de nouveaux traitements et strategies therapeutiques. De multiples essais cliniques innovants sont aussi en cours ou prevus, pouvant combiner la chimiotherapie standard, diverses immunotherapies anti-tumorales, ou encore des therapies ciblees. Conclusions : la France participe largement a l’evaluation de ces nouveaux differents traitements et strategies par des essais cliniques prospectifs multicentriques (e.g. essai MAPS-2 de l’IFCT), favorisee par le reseau national clinique des centres experts du MPM, appele MESOCLIN, en lien avec les associations de patients.