Impact of early palliative care on additional line of chemotherapy in metastatic breast cancer patients: results from the randomized study OSS.

Purpose: The most appropriate criteria and timing for palliative care referral remain a critical issue, especially in patients with metastatic breast cancer for whom long-term chemosensibility and survival are observed. We aimed to compare the impact of early palliative care including formal concertation with oncologists on decision for an additional line of chemotherapy compared with usual oncology care.

Methods: This randomized prospective study enrolled adult women with metastatic breast cancer and visceral metastases with a 3rd- or 4th-line chemotherapy (CT).

Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial.

Background: Patients with muscle-invasive urothelial carcinoma of the bladder have poor survival after cystectomy. The EORTC 30994 trial aimed to compare immediate versus deferred cisplatin-based combination chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder.

Methods: This intergroup, open-label, randomised, phase 3 trial recruited patients from hospitals across Europe and Canada.

Risk of breast cancer by individual insulin use: an international multicenter study.

OBJECTIVE Several studies have been published in 2009 suggesting a possible association between insulin glargine and increased risk of malignancies, including breast cancer. The objective of this study was to assess the relation between the individual insulins (glargine, aspart, lispro, and human insulin) and development of breast cancer. RESEARCH DESIGN AND METHODS Seven hundred seventy-five incident cases of primary invasive or in situ carcinoma breast cancer occurring in women with diabetes from 92 centers in the U.

Gemcitabine or gemcitabine plus oxaliplatin in the first-line treatment of patients with advanced transitional cell carcinoma of the urothelium unfit for cisplatin-based chemotherapy: a randomized phase 2 study of the French Genitourinary Tumor Group (GETUG V01).

Background: The optimal chemotherapy for patients with advanced transitional cell carcinoma of the urothelium who are not eligible for cisplatin remains to be defined.

Objective: To assess the activity of gemcitabine alone (GEM) or in combination with oxaliplatin (GEMOX) in a randomized phase 2 trial.

Design, Setting, And Participants: The primary end point was the objective response rate according to Response Evaluation Criteria in Solid Tumors criteria.

[Survival of breast cancers patients with meningeal carcinoma].

Purpose: Among all solid tumors breast cancer is the most common cause of meningeal carcinomatosis (MC). The purpose of this study was to analyze clinical and biological responses as well as overall survival in MC patients (pts) of breast primary treated with intrathecal methotrexate (MTX).

Methods And Materials: Single-center retrospective series of MC pts treated between 2000 and 2007.

[Brain metastases in breast cancer. Epidemiology and natural history. The Institut Curie experience].

Breast cancer is the second cause for brain metastases. Their incidence is rising, partly due to the therapeutic improvements which alter the natural history of breast cancer. Predictive factors for brain metastases have been identified: HER2 oncogene overexpression, lack of expression of hormone receptors, young age and triple negative status.

Concordant analysis of KRAS status in primary colon carcinoma and matched metastasis.

KRAS somatic mutations are the main predictive factor for non response to EGFR-targeted monoclonal antibodies in metastatic colorectal cancer (mCRC) patients. We compared KRAS mutational status in the primary tumour and the corresponding metastases (1 to 4 sites) in 38 mCRC patients. KRAS mutational status was analysed using direct sequencing, SNAPShot multiplex PCR and Scorpion Taqman PCR analysis.

A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer.

Background: The distinction between primary and secondary ovarian tumors may be challenging for pathologists. The purpose of the present work was to develop genomic and transcriptomic tools to further refine the pathological diagnosis of ovarian tumors after a previous history of breast cancer.

Methods: Sixteen paired breast-ovary tumors from patients with a former diagnosis of breast cancer were collected.

Urokinase-type plasminogen activator and plasminogen-activator-inhibitor type 1 predict metastases in good prognosis breast cancer patients.

Unlabelled: This retrospective analysis was designed to confirm the predictive role of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type I (PAI-1) in the outcome of early stage, node-negative breast cancer patients.

Patients And Methods: Node-negative patients having not received adjuvant chemotherapy, and for whom frozen samples were available, were selected.

Results: Among the 169 patients included, 56.

Different outcome of invasive cervical cancer associated with high-risk versus intermediate-risk HPV genotype.

Human papillomavirus (HPV) DNA sequences are associated with the large majority of invasive cervical carcinoma but the role of specific genotype(s) in the outcome of the disease is still debated. To determine the viral epidemiology in the French population of patients and the prognostic value of HPV genotypes in cervical cancer, we performed a retrospective study in 515 patients treated in our Institution from 1985 to 2005. Ninety-six percent of the cases were found associated with HPV DNA whereas 4% remained HPV negative.

Time to metastatic relapse and breast cancer cells dissemination in bone marrow at metastatic relapse.

Breast cancer dissemination can be monitored in patients by detecting circulating and/or disseminated tumor cells. However, bone marrow disseminated tumor cells (BM DTC) may undergo a dormancy during several years before growing (or not) into clinically detectable metastases. We therefore hypothesized that breast cancers which have formed BM DTC in the course of their metastatic growth might exhibit a longer interval before metastatic relapse.

Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?

Background: This study was performed to describe the treatment plan modifications after a geriatric oncology clinic. Assessment of health and functional status and cancer assessment was performed in older cancer patients referred to a cancer center.

Patients And Methods: Between June 2004 and May 2005, 105 patients 70 years old or older referred to a geriatric oncology consultation at the Institut Curie cancer center were included.

Disseminated tumor cells of breast cancer patients: a strong prognostic factor for distant and local relapse.

Purpose: Clinical significance of disseminated tumor cells (DTC) in bone marrow of early breast cancer patients has been reported, but improvements in detection methods are needed.

Experimental Design: Bone marrow aspirates from 621 patients with stage I to III breast cancer were screened for cytokeratin-positive (CK+) cells. CK+ cells were categorized into DTC only if they had specific morphologic features of tumor cells.

Pre-operative Concomitant Radio-chemotherapy in Bulky Carcinoma of the Cervix: A Single Institution Study.

Objective: To evaluate the treatment results of patients (pts) with FIGO stage IB2, IIA, IIB cervical carcinoma (CC) treated with pre-operative radio-chemotherapy, followed by extended radical hysterectomy.

Methods: Retrospective study of 148 women treated to the Institut Curie for operable FIGO Stage IB2 to IIB, biopsy proved CC. Among them, 70 pts, median age 46 years, were treated using the same regimen associating primary radio-cisplatinum based chemotherapy, intracavitary LDR brachytherapy, followed by extended radical hysterectomy.

[Trastuzumab (Herceptin) and breast cancer: mechanisms of resistance].

The detection of overexpression of human epidermal growth factor receptor 2 (HER2) in some breast cancer tumors has led to the development of a targeted treatment that is tumor selective, effective at extending life expectancy in the patients with advanced or early breast cancers. Trastuzumab (Herceptin), a humanized monoclonal antibody to HER2 is indicated for patients whose tumor demonstrates an amplified copy number for the HER2 oncogene and/or overexpresses the HER2 oncoprotein. Despite a high level of efficacy in combination with chemotherapy, trastuzumab as single agent has limited effectiveness (up to 30% response rates) and patients who respond to trastuzumab will relapse despite continued treatment.

[Oxaliplatin and ovarian cancer].

Oxaliplatin was brought into clinical evaluation in ovarian cancer because of the in vitro and in vivo antitumor activity observed in experimental models resistant to cisplatin. As single agent at 130 mg/m2 every 3 weeks, the objective response rates rage from 16% to 29% in patients treated after failure of one or two regimens. As first line, in a randomized trial cyclophosphamide-cisplatin versus cyclophosphamide-oxaliplatine, no significant statistical differences were observed in efficacy parameters (response rate, progression free survival and overall survival).

[Cancer of the breast and pregnancy: the point of view of the breast cancer specialist].

Breast cancer is the most common cancer in pregnant women occurring in about 1 in 3,000 pregnancies; the engorgement of the breasts in this period may hinder detection of masses and delays in diagnosis are common; this delay, the young age can explain that overall survival of pregnant women is generally worse than in nonpregnant women. In early stage cancer surgery is recommended as the primary treatment; radiation must be avoided during this period but chemotherapy, if considered necessary, specially in late stage disease, may be given after the first trimester without risk of fetal malformation; termination of pregnancy has not been shown to have any beneficial effect but may be considered if maternal treatments are limited by continuation of pregnancy. In contrast, pregnancy in patients with a prior history of breast cancer does not appear compromise the survival of women and no deleterious effects have not been demonstrated in the fetus: if a risk of relapse exists for the breast carcinoma, it's recommended that patients wait two or three years after diagnosis before attempting to conceive.

After cystectomy, is it justified to perform a bladder replacement for patients with lymph node positive bladder cancer?

Purpose: After cystectomy for bladder cancer, when pelvic lymph nodes are positive, bladder replacement remains controversial. The aim of this study was to evaluate the outcome of patients who underwent neobladder replacement despite bladder cancer metastasis to the regional lymph nodes.

Materials And Methods: From 1981 to 1997, a total of 504 consecutive cystectomies for bladder cancer were performed at our institution.