PURPOSE:To outline supportive-care considerations for using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) during chemotherapy and/or radiotherapy, focusing on nutrition, body composition, and treatment tolerance. METHODS:This Comment addresses the supportive-care implications of this situation and draws on evidence from obesity trials, cardiovascular outcomes trials, pharmacokinetic studies, and oncology literature on sarcopenia and treatment tolerance. RESULTS:GLP-1 RAs improve cardiometabolic risk and, in selected high-risk populations, reduce major adverse cardiovascular events. However, body-composition studies indicate that their weight loss is not exclusively adipose; approximately 20-30% may be lean mass. In oncology, low skeletal muscle mass has been associated with higher rates of severe toxicity, more dose modifications, and worse survival. Delayed gastric emptying may lower maximum concentration and delay time to maximum concentration of oral co-medications while usually preserving overall exposure in non-oncology settings. CONCLUSION:Although GLP-1 RAs have preventive and cardiometabolic benefits, these do not exclude possible concerns during active cancer therapy. Systematic screening, dietetic support, resistance exercise, and body-composition monitoring should guide initiation or continuation decisions during active treatment.

BACKGROUND:Microsatellite instability (MSI) and mismatch repair (MMR) deficiency are key predictive biomarkers for immune checkpoint inhibitors (ICIs) in metastatic colorectal cancer (mCRC). In real-world practice, however, diagnostic pathways often involve heterogeneous testing modalities, which may lead to discordant or inconclusive results. METHODS:We conducted a retrospective study of patients with mCRC who underwent at least one MSI/MMR assessment between 2015 and 2025. Diagnostic modalities included IHC, tissue-based and liquid-based MSI testing. A predefined decision algorithm classified results as conclusive or inconclusive; discordant cases underwent adjudication that integrated a pathology review, molecular features, and technical considerations. Patients were ultimately assigned to definitive MSS or definitive MSI groups. Clinical characteristics, treatment patterns, and outcomes-particularly in relation to immunotherapy-were evaluated. RESULTS:Among 727 evaluable patients, the MSI/MMR status was conclusive in 695 (95.6%) and inconclusive in 32 (4.4%). Inconclusive cases resulted from isolated MMR protein loss, heterogeneous or equivocal staining, inter-tumoral discordance, or discrepancies between tissue- and liquid-based assays. After adjudication, 54 patients (7.4%) were classified as definitive MSI and 673 (92.6%) as definitive MSS. Definitive MSI tumors were associated with female sex, right-sided primaries, high-grade histology, nodal involvement, and BRAF V600E mutations. Among the definitive MSI patients, 31 (57.4%) received immunotherapy, achieving a complete response rate of 48.4% and an overall response rate of 71.0%. Median PFS and OS were not reached in the definitive MSI group, whereas definitive MSS patients treated with ICIs experienced significantly poorer outcomes. Conclusive and adjudicated MSI groups demonstrated comparable responses to immunotherapy. CONCLUSIONS:In real-world practice, a meaningful proportion (4%) of mCRC patients experience inconclusive MSI/MMR assessment, with important clinical implications. Both technical and biological factors contribute to diagnostic uncertainty. Integrating orthogonal testing modalities and applying structured adjudication improves classification accuracy and ensures appropriate access to immunotherapy.

Background Dietary supplements (DS) and adapted physical activity (PA) are recognized as complementary strategies in oncology; however, guidelines for DS use during cancer treatment are lacking. Many patients self-prescribe DS and their adherence to PA guidelines remains low. Combined integrative approaches, such as supplementation and exercise, can induce synergistic effects rather than each intervention alone. This study investigated patterns of DS behavior across cancer phases. Understanding the potential link between motivations for DS and interest in PA may provide insights into the design of multidisciplinary approaches for oncology patients, with the goal of enhancing their quality of life. Methods A cross-sectional study was conducted among 114 cancer patients using DS (106 women, 8 men), 27–79 years. Clinical data, DS behavior, and PA interest and levels (according to international guidelines) were collected by self-administered questionnaire. Descriptive statistics and chi-square tests were used. An exploratory binary logistic regression examined the association between DS behaviors and interest in PA. Results Vitamin D and magnesium were the most used DS across all treatment phases, while olive oil and vitamin C were frequently reported during active treatment. Although oncologists were the preferred counselling source (59.6%), the main recommendations came from naturopaths, general practitioners, and personal networks. 38.6% of participants self-prescribed DS. Self-prescription was significantly associated with reasons for not informing general practitioners about DS use (χ²=10.371, p=0.016). Interest in structured PA programs was higher among patients using DS for general strengthening, dietary support, and sleep (p<0.05), but not among those using DS for fatigue, stress, or anxiety. Conclusion Among DS users, self-prescription was common despite a clear preference for oncologist guidance. Many patients rely on non-medical sources. The observed association between motivations for DS use and interest in PA highlights the need to further investigate the impact of integrated supportive care strategies in oncology.

La santé intégrative suscite un intérêt croissant dans les politiques de santé. Pourtant, son déploiement à large échelle reste limité par l’absence de modélisations médico-économiques robustes et communicables aux décideurs. Dans cet article nous avons structuré le débat autour de scénarios crédibles, et avons tenté d’objectiver ce qui reste souvent perçu comme subjectif ou marginal. Nous nous demandons pourquoi objectiver les impacts cliniques et économiques ? Comment aider à la décision publique et institutionnelle, et convaincre les financeurs et les assureurs ? Pourquoi prioriser les investissements dans la recherche et la formation et intégrer la santé intégrative dans une logique de parcours de santé global ? Favoriser une approche centrée sur la valeur en santé ( value-based healthcare ) et mieux communiquer avec les parties prenantes : médecins, décideurs, patients, est indispensable. Une démarche théorisée, même fondée sur des hypothèses encore fragiles, offre un langage commun aux chercheurs, cliniciens, financeurs et institutions, tout en mettant en lumière les angles morts actuels de la recherche. Elle crée ainsi un socle utile pour orienter les futures études, plaider pour des expérimentations ciblées et amorcer une logique de valorisation rigoureuse.

Background/Objectives: The prognostic significance of blood tumor mutational burden (bTMB) in metastatic colorectal cancer (mCRC) remains poorly defined. While tissue-based TMB has been associated with favorable outcomes in selected colorectal cancer subgroups, the clinical meaning of bTMB in real-world practice is unclear. This study evaluated the prognostic impact of bTMB measured through liquid biopsy in an unselected cohort of patients with mCRC. Methods: This monocentric, real-world study included 255 adult patients with pMMR/MSS mCRC who underwent routine comprehensive genomic profiling using the FoundationOne® Liquid CDx assay. bTMB was quantified in mutations per megabase (mut/Mb), and patients were classified into bTMB-low and bTMB-high groups using the cohort median. The primary endpoint was overall survival (OS). Subgroup analyses, including stratification by RAS/BRAF mutation status, were descriptive. Results: The median bTMB was 5 mut/Mb. Patients in the bTMB-high group had an increased risk of death compared with those in the bTMB-low group (hazard ratio (HR) 1.88). The adverse prognostic effect for OS of high bTMB was more pronounced in patients with RAS mutant tumors (HR 2.32) than with RAS/BRAF wild-type tumors (HR 1.81), while no prognostic impact was observed in BRAFV600E mutant tumors (HR 0.90). bTMB was strongly correlated with ctDNA fraction (p < 0.0001). Conclusions: In routine clinical practice, elevated bTMB is associated with poor prognosis in pMMR/MSS mCRC, particularly in RAS mutant tumors. These results contrast with prior tissue-based studies and indicate that bTMB may reflect tumor burden and aggressive disease biology rather than tumor immunogenicity. Prospective studies integrating bTMB with ctDNA fraction, tumor burden metrics, and longitudinal molecular dynamics are warranted to refine its clinical utility.

BACKGROUND:Genetic counseling and molecular tumor boards have become essential components of oncology care pathways. Since 2012, a private-sector oncogenetics program supported by the National Cancer Institute (INCa), has been established within the Hauts-de-Seine health cooperation group, in connection with partner laboratories and a dedicated molecular tumor board. METHODS:The study includes 10,071 oncogenetic consultations carried out between 2013 and 2024, and 1012 patients who underwent circulating tumor DNA (ctDNA) analysis between 2020 and 2024. Results were discussed in molecular and oncogenetic tumor boards. RESULTS:The median delay for a first consultation was 3 weeks, compared to 10 weeks nationally. Mutation detection rates in hereditary breast-ovarian syndromes ranged from 11 to 16%, higher than the national average (8.8%). Among the 1012 ctDNA-tested patients, 411 (40%) presented actionable tumor alterations, including 284 (28%) classified as ESCAT I. Additional constitutional testing was triggered in 112 patients, revealing 27 unsuspected pathogenic variants (2.7%). CONCLUSION:Private-practice oncogenetics and molecular tumor boards can achieve performance comparable to national indicators in terms of delays and mutation detection. The coordination between constitutional and tumor genetics activities enhances both therapeutic decisions and familial risk assessment.

Background: Complementary and integrative medicine (CIM) encompasses over 400 modalities, according to the World Health Organization (WHO). In 2011, 70% of the European Union's population reported having used CIM at least once, with 25% using it annually. This study examines the engagement, motivations, and satisfaction of users in the French health care system through data from Medoucine, France's largest online platform for complementary therapies. Methods: A cross-sectional descriptive analysis was conducted using Medoucine's database from 2017 to 2023, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were sourced from practitioner profiles, appointment logs, and patient comments collected at baseline (day 0, J0) and follow-up (day 30, J30). Survey questions, including "What type of complementary therapy are you seeking?" provided clarity on how CIM therapies were introduced. The study included a "recommendation question" at baseline to evaluate satisfaction: "Would you recommend this practitioner to your friends and family?". Response rates varied between 10% and 67%, depending on the question. Categorical variables were analyzed as percentages. Results: Among 225,251 platform users, 67.7% (152,464) responded to the recommendation question at J0, 15% (33,823) reported health improvements at J30, and 10% (22,596) discovered sustainable health strategies. Most users were women (68.6%). Key motivations included well-being and personal development (17.4%), stress, anxiety, and phobias (17.1%), and sleep disorders (7%). Hypnosis (15%), traditional Chinese medicine (8.4%), and reflexology (6.7%) were the most commonly selected modalities. At J30, 74.8% reported health improvements, with notable benefits for well-being (80.7%) and stress (76.3%). Conclusion: This study underscores the growing demand for CIM therapies in France, driven by a need for stress relief, personal development, and physical and psychological health management. High satisfaction rates and perceived health benefits highlight the potential of CIM to complement conventional care. Integrating evidence-based CIM into mainstream health care systems, as recommended by the WHO, offers an opportunity to address patient needs and enhance health care delivery.

PURPOSE:Based on the results of the ASCENT trial, sacituzumab govitecan (SG) has been approved for the treatment of breast cancer. With the expanding indications across multiple cancers, data on its combination with radiation therapy (RT) are needed. METHODS AND MATERIALS:ATTENTION is a retrospective multicenter study from 6 French institutions. Eligibility criteria included patients with breast cancer who received RT and SG between September 2021 and January 2025. Concomitant treatment was defined as RT administered within 4 days before or after SG administration. Data were collected through an online questionnaire and centralized after medical record review, and protocol validation by the local ethics committee. The primary endpoint was safety profiles according to the Common Terminology Criteria for Adverse Events, version 5.0. Secondary endpoints included treatment response, evaluated according to Response Evaluation Criteria in Solid Tumors, version 1.1 criteria and/or clinical symptom improvement. Assessment was performed 4-12 weeks after RT. RESULTS:Fifty-five patients (63 lesions) were included. The median age was 56 years (37-82). SG and RT were administered concurrently in 37 lesions (median, 3 days), sequentially in 26 lesions (median, 10 days). Subtypes included human epidermal growth factor receptor 2 (HER2)-/hormone receptors (HR)- (30%), HER2-/HR+ (27%), HER2-low/HR+ (24%), HER2-low/HR- (18%), and HER2+ (2%). SG was given as second-line in 16%, and ≥ fourth-line in 54%. RT was symptomatic in 57% and for progression in 43%, mostly targeting bone (49%) and brain (32%), using 3D conformal RT (52%), stereotactic body RT (40%), or intensity modulated RT (8%). With a median follow-up of 7.9 months (1.7-35.4), RT-related toxicities of grade 1-2 occurred in 17 cases (27%), (3 dermatitis, 4 esophagitis, and 1 brain radionecrosis). No grade ≥ 3 toxicity occurred with concomitant SG. The overall response rate was 25% complete and 80% partial responses. Median overall survival was 12.9 months (95% CI, 7.97-17.77). CONCLUSIONS:ATTENTION is the largest study that confirms the feasibility and promising efficacy of concurrent treatment, pending confirmation in prospective trials.

Circulating tumor DNA (ctDNA) analysis offers a non-invasive approach to molecular profiling. While RAS mutations are well-established predictive biomarkers in metastatic colorectal cancer (mCRC), the prognostic value of their variant allele frequency (VAF) remains unclear. We retrospectively analyzed individual patient data with mCRC who underwent ctDNA testing using the FoundationOne® Liquid CDx assay. The primary objective was to determine the optimal RAS VAF cutoff for overall survival (OS) prognostication. Between November 2020 and July 2024, 282 patients were enrolled. Among 265 eligible patients, 134 (50.6%) were ctRAS mutant, 25 (9.4%) ctBRAFV600E mutant, and 106 (40.0%) were ctRAS/BRAF wild-type. A RAS VAF threshold of 5% yielded the highest prognostic discrimination for OS (HR = 2.41; 95% CI 1.65–3.55; p < 0.0001; C-index = 0.601). ctRAS-high mutant tumors (VAF ≥ 5%) were associated with synchronous metastatic disease, multiple metastatic sites, higher blood tumor mutational burden, and elevated tumor fraction. ctRAS-low mutant tumors (VAF < 5%) were more frequently metachronous, presented with a single metastatic site, and showed liver involvement. High RAS VAF in ctDNA is a strong and independent prognostic marker for OS in mCRC. Quantitative ctDNA profiling may enhance risk stratification and guide personalized management strategies.

The Société française des jeunes radiothérapeutes oncologues (SFjRO, French society of young radiation oncologists) was founded in 2001 with three main objectives: to represent French residents in radiation oncology, to provide training and to promote research. Initially, the board consisted of only three members but has since expanded to over ten. Since its inception, the SFjRO has organized national in-person courses, which have evolved into projects aimed at standardizing training throughout the country. These national courses are now a compulsory part of residency for all radiation oncology residents in France. In terms of representation, the SFjRO has organized cross-sectional studies and meetings to provide up-to-date information on career development, well-being, and academic training, in order to help young radiation oncologists make informed decisions. The SFjRO represents French radiation oncology residents in various societies such as the Société française de radiothérapie oncologique (SFRO, French society of radiation oncologists), the Intersyndicale nationale des internes (Isni, national union of french residents) or the Collège national des enseignants en cancérologie (Cnec, national council of oncology teachers). The society's involvement in research has been strengthened through partnerships with national and international organizations, providing numerous opportunities for young residents. This article outlines both the major evolutions over time and the role of the SFjRO in representing residents, training and promoting research for young radiation oncologists.

Background: The Evaluation of Digital Addiction (EVADD) study investigates problematic smartphone use in the digital age, as global smartphone users reached 55.88 million in France in 2023. With increased screen time from digital devices, especially smartphones, the study highlights adult use issues and associated risks. Objective: The aim of the study is to assess the prevalence of compulsive smartphone use among French adults and identify patterns of problematic behaviors, including their impact on daily activities, sleep, and safety. Methods: The EVADD study used a cross-sectional, nonprobability sample design, conducted from May 3 to June 5, 2023. Participants were recruited through the French mutual insurance company PRO-BTP. Data were collected anonymously via a digital questionnaire, including the Smartphone Compulsive Use Test, capturing information on social network engagement, device ownership, and daily screen use. Results: A total of 21,244 adults (average age 53, SD 15 years; 9844 female participants) participated. Among 21,244 participants, 8025 of 12,034 (66.7%) respondents exhibited compulsive smartphone use (P<.001). Additionally, 7,020 (36.7%) participants scored >= 8 on the Smartphone Compulsion Test, indicating addiction. Younger participants (18-39 years) were significantly more likely to show signs of addiction (2504/4394, 57%; odds ratio 2.5, 95% CI 1.9-3.2) compared to participants aged >= 60 years. Problematic behaviors included unsafe smartphone use while driving (5736/12,953, 44.3%), frequent smartphone use before bedtime (9136/21,244, 43%), and using smartphones in the bathroom (7659/21,244, 36.1%). Sleep disturbances and risky behaviors correlated strongly with higher compulsion scores (P<.01). Conclusions: The EVADD study highlights the complex relationship between adults and smartphones, revealing the prevalence of compulsive behaviors and their impact on daily life, sleep, and safety. These findings emphasize the need for public awareness campaigns, preventive strategies, and therapeutic interventions to mitigate health risks associated with excessive smartphone use.

The EVADD study (EVAluation of Digital aDdiction) investigates problematic smartphone use in the digital age, as global users hit 55.88 million in 2023. It focuses on increased screen time from digital devices, especially smartphones, highlighting adult usage issues. Employing a cross-sectional, non-probability sample design, the EVADD study was conducted from May 3rd to June 5th, 2023 and utilized the Smartphone Compulsive Use Test to assess participants' compulsive smartphone use. Participants were recruited through the French mutual insurance company PRO-BTP. Anonymously collected data encompassed social network engagement, electronic device ownership, and daily leisure time spent on devices through an online questionnaire. In a study with 21,244 respondents (average age 53, 48% women), most were retirees or employees, predominantly married or in a couple, with over half owning 2 or 3 devices, primarily smartphones and laptops. A significant 70% considered smartphones indispensable. The Smartphone Compulsion Test revealed 66.7% exhibited compulsive use, and 38% showed clear addiction signs, especially younger participants. Leisure time on screens averaged 1-2 hours, with notable habits like using smartphones in the bathroom (36%) and before sleep (43%). Problematic behaviors included unsafe driving and high engagement with social networks, particularly Facebook, without active participation. The EVADD study illuminates the complex relationship between adults and smartphones, underscoring the risks of excessive use. It reveals how these behaviors affect daily life, sleep patterns, and driving safety. While identifying a spectrum of social network use from habitual to potentially addictive, the study aims to inform preventive strategies and therapeutic interventions rather than pathologize everyday activities. Ultimately, it advocates for heightened awareness and education to mitigate health risks associated with problematic smartphone usage.

Chemotherapy-induced neutropenia poses a significant risk to cancer patients, with pegfilgrastim being commonly used for its prevention. While pegfilgrastim can be administered via prefilled syringe or pen device, patient preferences and experiences with these delivery methods remain unclear. We conducted a prospective, open-label, randomized, observational trial (NCT05910164) at the Rafael Institute, France, comparing patient preferences for pegfilgrastim administration using a prefilled syringe versus a prefilled pen device. Patients undergoing chemotherapy and requiring pegfilgrastim were enrolled and randomized 1:1 to receive either syringe or pen first, with crossover administration. Questionnaires assessed patient preferences, learning experiences, autonomy, pain levels, emotional responses, satisfaction with nursing care, and empowerment. Among 150 randomized patients (mean age 58 years; 69

187 Background: Addressing tumor heterogeneity is one of the main advantage of liquid biopsy over tissue biopsy, as liquid biopsy is likely to better reflect the global molecular profile (primary tumor site and metastatic disease). Variant Allele Frequency (VAF) represents the fraction of sequencing reads in which a variant is observed. The aim was to evaluate the prognostic value of circulating tumor (ct) VAF for KRAS and NRAS genes in patients with ctRAS mutant metastatic colorectal cancer (MCRC). Methods: Circulating comprehensive genomic profiling using FoundationOne Liquid CDx (FO-Liq) was proposed to patients with histologically proven or highly suspected solid tumor whatever treatment line. FO-Liq is a next generation sequencing panel of 310 cancer related genes and 3 genomic signatures (blood tumor mutational burden (bTMB), microsatellite instability (MSI) and tumor fraction (TF)). The optimal threshold for ctVAF was determined by calculating Harrell’s C discrimination index extended for survival data. The primary endpoint was overall survival (OS). Results: From October 2020 to June 2023, 740 patients were screened for circulating molecular profiling. In the colorectal cohort (N=201), 198 (98.5%) patients had metastatic disease (ctRAS/BRAF wild-type, N=76 (38.4%) ; ctRAS mutant, N=106 (53.5%) and ctBRAF V600E mutant, N=16 (8.1%)). The optimal threshold for ctVAF RAS was 5% (C-index 0.67, 95% CI 0.62-0.73 ; P<0.0001). Among patients with ctRAS mutant MCRC, 43 (40.6%) were ctRAS mutant-Low (VAF RAS <5%) and 63 (59.4%) were ctRAS mutant-High (VAF RAS ≥5%). Median follow-up was 18.5 months (95% CI 15.3-34.5). There was a significant increase in the the risk of death for RAS mutant-High compared to RAS mutant-Low (HR 2.81, 95% CI 1.70-4.63; P<0.001). Patients with RAS mutant-low variants had the same prognosis that RAS/BRAF wild-type profile (HR 1.22 ; P=0.573), and patients with RAS mutant-high variants had the same prognosis that BRAF mutant profile (HR 0.82, P=0.563). The factors associated with RAS mutant-High profile were : bTMB-High, TF-High, RAS G12A and G13D variants. MAP kinase, TGFb and Wnt signaling pathways and BRCA1-2 genes were more frequently altered in patients with ctRAS mutant-High tumors. We observed a transient decrease of VAF RAS in second-line setting. Conclusions: The circulating VAF of RAS genes enables to split RAS mutant-Low (favorable prognosis similar to RAS/BRAF wild-type) from RAS mutant-High (poorer prognosis similar to BRAF mutant) metastatic colorectal cancer. These results provide further insights into prognostication and therapeutic strategies in patients with RAS mutant metastatic colorectal cancer.