Occupational lung cancer cases remain largely under-reported and under-compensated worldwide. In order to improve the detection and compensation of work-related lung cancers, we implemented a systematic screening of occupational exposures, combining a validated self-administered questionnaire to assess occupational exposures and a specialized occupational cancer consultation. After a pilot study, the present prospective, open-label, scale-up study aimed to assess this systematic screening of occupational exposures in lung cancer patients in five sites in France by associating university hospitals with cancer centers. Patients with lung cancer were sent a self-administered questionnaire to collect their job history and potential exposure to lung carcinogens. The questionnaire was assessed by a physician to determine if a specialized occupational cancer consultation was required. During the consultation, a physician assessed if the lung cancer was occupation-related and, if it was, delivered a medical certificate to claim for compensation. Patients were offered help from a social worker for the administrative procedure. Over 15 months, 1251 patients received the questionnaire and 462 returned it (37%). Among them, 176 patients (38.1%) were convened to the occupational cancer consultation and 150 patients attended the consultation. An exposure to occupational lung carcinogen was identified in 133 patients and a claim for compensation was judged possible for 90 patients. A medical certificate was delivered to 88 patients and 38 patients received compensation. Our national study demonstrated that a systematic screening of occupational exposures is feasible and will bring a significant contribution to improve the detection of occupational exposures in lung cancer patients.

We aimed to determine the pattern of isolated local recurrences (ILR) in women with stage II-III hormone receptor-positive and human epidermal growth factor receptor 2 breast cancer (HR + /HER2-BC) after 10-year follow-up. UNICANCER-PACS 01 and PACS 04 trials included 5,008 women with T1-T3 and N1-N3 to evaluate the efficacy of different anthracycline ± taxanes-containing regimens after modified mastectomy or lumpectomy plus axillary lymph node dissection. We analyzed the data from 2,932 women with HR + /HER2- BC to evaluate the cumulative incidence of ILR and describe the factors associated with ILR. After a median follow-up of 9.1 years (95% CI 9.0–9.2 years), the cumulative incidence of ILR increased steadily between 1 and 10 years from 0.2% to 2.5%. The multivariable analysis showed that older age (subhazard ratios [sHR] = 0.95, 95% CI 0.92–0.99) and mastectomy (sHR = 0.39, 95% CI 0.17–0.86) were associated with lower risk of ILR, and no adjuvant endocrine therapy (sHR = 2.73, 95% CI 1.32 7–5.67) with increased risk of ILR. In this population of high-risk patients with localized HR + /HER2- BC, the risk of ILR was low but remained constant over 10 years. Younger age at diagnosis, breast-conserving surgery, and adjuvant endocrine therapy were independent risk factors of ILR.

INTRODUCTION:In 2019, only 1,790 occupational cancers were recognized, i.e., less than 1% of estimated occupational cancers. Our study aims to expand the methodology of a French cancer center to improve the detection and compensation of occupational bronchopulmonary cancers.PATIENTS AND METHODS:Between November 2014 and December 2020, all patients diagnosed with primary bronchopulmonary cancer (including mesothelioma) received a free questionnaire (Curriculum Laboris) aimed at retracing their professional career but also socio-demographic data. After an initial analysis of the questionnaire, a consultation can be scheduled if exposures are suspected. They will then be confirmed or not, during a consultation of around 1hour 30minutes during which the patient's precise career path is explored.RESULTS:Among the 498 patient questionnaires received, 261 patients (52%) benefited from a consultation. Of all the patients seen in consultation, 198 (or 76%) had a proposal to declare an occupational disease. Among the 151 declarations of which the fate is known, 107 (i.e., 54% of the proposed declarations or 21% of the questionnaires concerning primary lung cancer) received an agreement of recognition.CONCLUSION:The massive underreporting of occupational cancers at present in France is a real public health problem. The two major issues in the recognition of occupational diseases are, on the one hand, reparation for the damage suffered by victims or their beneficiaries and, on the other hand, the adaptation of national prevention programs considering past, present and emerging.

Cite This Article Serin, D. (2022). Oncologie Issue 1, 2022. Oncologie, 24(1), 1–2.

Cite This Article Metges, J., Serin, D., Troussard, X., Blay, J., Campone, M. et al. (2021). ONCOLOGIE—Introduction Letter of Issue 1, 2021. Oncologie, 23(1), 1–2.

Background In 2013, the interim analysis of the Protocol for Herceptin as Adjuvant therapy with Reduced Exposure (PHARE) trial could not show that 6 months of adjuvant trastuzumab was non-inferior to 12 months. Here, we report the planned final analysis based on the prespecified number of occurring events. Methods PHARE is an open-label, phase 3, non-inferiority randomised trial of patients with HER2-positive early breast cancer comparing 6 months versus 12 months of trastuzumab treatment concomitant with or following standard neoadjuvant or adjuvant chemotherapy. The study was undertaken in 156 centres in France. Eligible patients were women aged 18 years or older with non-metastatic, operable, histologically confirmed adenocarcinoma of the breast and either positive axillary nodes or negative axillary nodes but a tumour of at least 10 mm. Participants must have received at least four cycles of a chemotherapy for this breast cancer and have started receiving adjuvant trastuzumab-treatment. Eligible patients were randomly assigned to either 6 months or 12 months of trastuzumab therapy duration between the third and sixth months of adjuvant trastuzumab. The randomisation was stratified by concomitant or sequential treatment with chemotherapy, oestrogen receptor status, and centre. The primary objective was non-inferiority in the intention-to-treat population in the 6-month group in terms of disease-free survival with a prespecified hazard margin of 1.15. This trial is registered with ClinicalTrials.gov, number NCT00381901. Findings 3384 patients were enrolled and randomly assigned to either 12 months (n=1691) or 6 months (n=1693) of adjuvant trastuzumab. One patient in the 12-month group and three patients in the 6-month group were excluded, so 1690 patients in each group were included in the intention-to-treat analysis. At a median follow-up of 7.5 years (IQR 5.3-8.8), 704 events relevant to disease-free survival were observed (345 [20.4%] in the 12-month group and 359 [21.2%] in the 6-month group). The adjusted hazard ratio for disease-free survival in the 12-month group versus the 6-month group was 1.08 (95% CI 0.93-1.25; p=0.39). The non-inferiority margin was included in the 95% CI. No differences in effects pertaining to trastuzumab duration were found in any of the subgroups. After the completion of trastuzumab treatment, rare adverse events occurred over time and the safety analysis remained similar to the previously published report. In particular, we found no change in the cardiac safety comparison, and only three additional cases in which the left ventricular ejection fraction decreased to less than 50% have been reported in the 12-month group. Interpretation The PHARE study did not show the non-inferiority of 6 months versus 12 months of adjuvant trastuzumab. Hence, adjuvant trastuzumab standard duration should remain 12 months. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

Abstract Since 2005, 12 months of trastuzumab added to chemotherapy alone is the standard of care in patients with HER2-positive breast cancer. PHARE ('Protocol for Herceptin® as Adjuvant therapy with Reduced Exposure') is the first trial comparing a reduction of adjuvant trastuzumab versus the standard 12 months. In 2012, the first analysis failed to prove that 6-months was non-inferior to 12-months of adjuvant trastuzumab (NCT00381901). The current presentation reports the final analysis. Methods: The trial was sponsored by the French National Cancer Institute (INCa) (www.e-cancer.fr), and approved by central Ethical Committee on May 15th 2006. Patients with HER2-positive early breast cancer were randomly assigned between 12 and 6 months of adjuvant trastuzumab duration. The randomization was stratified by concomitant or sequential trastuzumab administration with chemotherapy, estrogen receptor (ER) status and center. The primary objective was non-inferiority of 6- versus 12-months arms in the intent to treat population, in terms of disease-free survival (DFS) with a pre-specified hazard margin of 1.15. Overall Survival (OS) and metastasis free survival (MFS) were secondary endpoints. Results: A total of 3380 patients were randomized, their median age was 54 years (21-86). Patients and disease characteristics were well balanced between the two arms. No involved axillary node was observed in 54.5% of cases, 41.7% of tumors were ER negative. At a median follow-up of 7.5 years, 704 events counting for DFS were observed. Between the 12- and 6-months arms, the adjusted Hazard Ratio (HR) for DFS rates was 1.08 (95%CI: 0.93-1.25; p=0.39) favoring the longer exposure. The 1.15 margin of non-inferiority was included in the 95%CI. No heterogeneity in terms of treatment effect was observed, no significant difference for trastuzumab duration effects was found in any subgroups.For OS and MFS, the adjusted HR were 1.13 (95%CI 0.92-1.39) and 1.15 (95%CI 0.96-1.37), respectively. Conclusion: The choice of the non-inferiority margin will remain inherently a subject of controversy especially in the context of oncology trials where the primary outcome is survival and the least additional death could be considered unacceptable questioning the very feasibility of such trials. Nevertheless, PHARE failed to show that 6 months of adjuvant trastuzumab was non-inferior to 12 months. The standard of care should remain 12 months of adjuvant trastuzumab. Citation Format: Pivot X, Romieu G, Debled M, Pierga J-Y, Kerbrat P, Bachelot T, Espie M, Lortholary A, Fumoleau P, Serin D, Jacquin J-P, Jouannaud C, Rios M, Abadie-Lacourtoisie S, Venat-Bouvet L, Cany L, Catala S, Khayat D, Gambotti L, Pauporte I, Faure Mercier C, Paget-Bailly S, Henriques J, Grouin J-M. PHARE randomized trial final results comparing 6 to 12 months of trastuzumab in adjuvant early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS2-07.

Abstract Background Long term information on the risk/benefit ratio of currently available therapies remains crucial for treatment decisions. In the PACS04 phase III trial, patients (pts) with node-positive (N+) breast cancer (BC) were double-randomized to concomitant taxane-anthracycline versus standard FEC, as well as 1-year trastuzumab versus nill in the HER2+ subpopulation. Methods 3009 pts (20% HER2+, 12% triple negative (TNBC) BC) were randomly assigned to receive 6 cycles of fluorouracil 500 mg/m2, epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2 (FEC) or epirubicin 75mg/m2 and docetaxel 75 mg/m2 (ED). Pts with HER2+ tumors were randomized to either trastuzumab (TRA) for one year, or observation (OBS). The primary endpoint was disease-free survival (DFS). Results After a median 115-month follow-up, DFS was not different in the ED compared to the FEC arm (70% vs 68% respectively, HR = 0.88 [95% CI: 0.77-1.01]; p = 0.064), nor was OS: 80% with FEC and 81% with ED (HR = 0.97 [95% CI: 0.81-1.16]; p = 0.729). Subgroup analysis suggested better DFS with ED in non-TNBC pts [HR = 0.82 (0.71-9.96) p = 0.02]. In the 528 pts with HER2+ BC, there was trend for a higher DFS in the TRA arm (68%; [95% CI: 61-74]) versus the OBS arm (60%; [95% CI: 54-66]); HR = 0.77 [95% CI:0.57-1.03]; p = 0.079 (intent to treat population). In the per protocol population, DFS, but not OS, was significantly higher in the TRA arm (HR: 0.69 [95%CI: 0.51-0.94]; p = 0.0156). ED led to more neurological and hematological toxicities (31% vs 11% febrile neutropenia) and led to 5 versus 1 treatment-related deaths. During follow-up, 75 pts developed a second non-breast primary cancer (43 with FEC and 32 with ED); 12 were hematologic malignancies (7 with FEC and 5 with ED). Long term cardiac deaths were rare (3 with FEC and 1 with ED). Conclusions This study did not show superiority of the concomitant anthracycline-taxane arm, which was more toxic in high-risk N+ BC pts. Long-term results of the HER2+ subpopulation are in line with the other adjuvant TRA trials but less striking probably due to lack of power. Long term cardiac toxicity and second primary cancer rate are similar to what has been reported by others. Clinical trial identification NCT00054587. Legal entity responsible for the study UNICANCER. 101 rue Tolbiac, 75013 Paris, France. Funding Roche, Ligue Nationale Contre le Cancer. Disclosure All authors have declared no conflicts of interest.

PURPOSE:We conducted a double-randomised phase III trial to evaluate a concomitant taxane-anthracycline regimen in node-positive breast cancer and the efficacy of trastuzumab in the human epidermal growth factor receptor 2 (HER2)-positive subpopulation. METHODS:A total of 3010 patients with node-positive breast cancer were randomly assigned to receive 6 cycles of 500 mg/m2 of fluorouracil, 100 mg/m2 of epirubicin and 500 mg/m2 of cyclophosphamide (FEC) or 75 mg/m2 of epirubicin and 75 mg/m2 of docetaxel (ED). Patients with HER2-positive tumours were secondary randomly assigned to either trastuzumab or observation. The primary end-point was disease-free survival (DFS) in the two chemotherapy arms. RESULTS:After a 115-month median follow-up, DFS was not significantly better in the ED arm (DFS: 70%, 95% confidence interval [CI]: 67-72) than in the FEC arm (DFS: 68%, 95% CI: 65-70; hazard ratio [HR] = 0.88, 95% CI: 0.77-1.01; p = 0.064). The OS was not different between FEC (OS: 80%, 95% CI: 78-83) and ED (OS: 81%, 95% CI: 79-83); HR = 0.97, 95% CI: 0.81-1.16; p = 0.729). ED appeared more toxic. In the 528 HER2-positive subset, there was trend for a higher DFS, in the intention-to-treat population, in the trastuzumab arm (DFS: 68%, 95% CI: 61-74) than in the observation arm (DFS: 60%, 95% CI: 54-66; HR = 0.77, 95% CI: 0.57-1.03; p = 0.079). In the per-protocol population, DFS was significantly higher in the trastuzumab arm (DFS: 70%, 95% CI: 63-76) than in the observation arm (DFS: 59%, 95% CI: 53-65; HR = 0.69, 95% CI: 0.51-0.94; p = 0.0156). The OS was not different between these 2 arms. CONCLUSION:This study did not show superiority of the concomitant anthracycline-taxane arm which was more toxic in high-risk node-positive breast cancer patients. Long-term results of the HER2-positive subpopulation are in line with those of the other adjuvant trastuzumab trials but quantitatively less pronounced mostly because of lack of power.

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018.

Chère lectrice, Cher lecteur d'Oncologie, Vous tenez entre vos mains le numéro d'Oncologie consacré aux débats qui ont animé les 40 es Journées de la Société française de sénologie et de pathologie mammaire qui se sont tenues à Avignon en novembre 2018.Nous avions choisi pour ce congrès national un thème d'actualité : Cancer du sein : optimisation du parcours de soins.Ce sujet, très transversal, plus organisationnel que scientifique, plus santé publique que médical, a rencontré un très vif succès, et plus de 1 200 personnes ont fréquenté les salles du Palais des Papes.Ce bâtiment chargé d'histoire où se sont tenus tant de conciles historiques était sûrement le lieu le plus indiqué en France pour inviter tous les acteurs impliqués dans ce domaine à partager leurs expériences, leurs difficultés mais aussi leurs réalisations et leurs espoirs pour améliorer cette traversée de la maladie.Nous avons fait une large place aux représentantes des malades et de leurs proches, que ce soit la Ligue 84 de lutte contre le cancer, Europa Donna, Vivre Comme Avant.La pluridisciplinarité chère à la SFSPM s'est exprimée au travers des prises de parole des intervenants médicaux venant de toutes les spécialités concernées, mais nous avons élargi notre vision grâce à la parole issue d'autres métiers, d'autres responsables engagés dans l'optimisation de ce parcours de soins : HAS, ARS, Inca, Unicancer, hospitalisation privée Elsan, infirmière de pratique avancée, sociologue, et l'expérience européenne d'EUSOMA.Vous trouverez sur le site de la SFSPM (www.senologie.com) outre le programme un enregistrement de toutes les présentations faites en session plénière.Alors pourquoi ce numéro d'Oncologie « spécial SFSPM -Avignon 2018 » ?

Abstract Purpose:Incidence of LRs in patients (pts) treated for HR+ HER2- localized BC and distribution overtime have not been described in recent years after introduction of new generation of adjuvant therapies and more extensive use of radiotherapy. We evaluated the incidence and distribution overtime of LRs in pts with HR+ HER2- N+ BCs who entered PACS 01 and PACS04 trials. Patients and Methods: Data were analyzed from 2909 pts with HR+/HER2- BC out of 5008 included in both trials. Pts underwent mastectomy or lumpectomy plus axillary dissection for a localized N+ BC and, according to study design, were randomized to: 6 cycles of FE100C (standard arm) versus FE100C x 3 cycles followed by docetaxel 100 mg/m2 x 3 cycles (FEC-D) (PACS01) or 6 cycles of Epirubicin 75mg/m2 and Docetaxel 75 mg/m2 (ED75)(PACS04). Loco-regional radiotherapy was mandatory after lumpectomy and recommended in other cases. All pts received 5 years of hormone therapy (HT). A competing risk multivariate analysis was conduct using Fine and Gray model to identify risk factors associated to isolated LRs. Competing events were nodal recurrence, contralateral BC, distant metastasis and death. Cumulative incidence associated to each event was estimated by a Kablfleish-Prentice estimator. Results: Pts' median age was 50 (22-65); 67.2% underwent lumpectomy, 32.8% mastectomy; 67.6% had 1 to 3 N+, 32.4% more than 3 N+; 45.7% had lymphovascular invasion; 49.5% received FE100C, 35.8% ET75, 14.7% had FEC-D; while radiotherapy was given to 97.3% and HT to 92.2%, of whom 90.5% received tamoxifen. At a median follow-up of 9.1 years, 60 pts (2.1%) experienced LR as first event. The 5-year and 10-year cumulative incidence of LRs were 1.04% and 2.53%, respectively. The cumulative incidence of LRs increased from the 5th year, and the annual risk tended to remain constant over time. Multivariate analysis of competing risk showed that younger age, conservative surgery and omission of HT (not prescribed or non-adherence) were independently associated with risk of developing LRs. Table 1. Multivariate analysis on competing risk of predictors of LRsVariablesHR 95%CIP valueAge at entry (<35 years, ≥ 35)*0.95 [0.92; 0.99]0.009Mastectomy, lumpectomy0.39 [0.17; 0.86]0.020> 20mm, ≤20 mm0.68 [0.37; 1.24]0.203N+ >3, 1-31.73 [0.99; 3.02]0.055Grade II/III, I1.06 [0.50; 2.24]0.885PR+,PR-1.78 [0.70; 4.53]0.223Type of chemotherapy 3FEC-3D, 6FEC/6ET1.32 [0.65; 2.69]0.446Number of cycles 6, <60.71 [0.17; 0.75]0.630Hormone therapy Yes,No0.36 [0.17; 0.75]0.006*treated as continuous variable Conclusion: Our analysis showed that incidence of LRs in pts with HR+ N+ BCs treated within PACS trials were considerably lower as compared to earlier studies. These findings may reflect differences in treatment era, as the more extensive use of radiotherapy and new generation of adjuvant chemotherapy. Despite current adjuvant strategies, young age at diagnosis and omission of HT remain independent risk factors of LRs. Citation Format: Pistilli B, Filleron T, Mazouni C, Zingarello A, Lacroix-Triki M, Rivera S, Coudert B, Serin D, Canon J-L, Campone M, Bachelot T, Goncalves A, Levy C, Cottu P, Petit T, Eymard J-C, Tunon De Lara C, Roché H, Roca L, Lemonnier J, Delaloge S. Overtime distribution and predictors of local recurrences (LRs) in patients with hormone receptor positive (HR+) and node positive (N+) breast cancers (BCs): 10 -year follow-up analysis of UNICANCER-PACS 01 and PACS04 trials [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-07.

Advances in early detection and treatment have pushed in a few decades the management of cancers from a management model of the end of life to the management of a chronic disease. This evolution has accelerated the development of supportive care in two directions, firstly towards the best possible support to the end of life in advanced cancer patients (palliative care) and secondly to the limitation of treatment toxicities, the prevention of relapse and the return to life as "normal" as possible (core for after cancer). If palliative care now hos a legitimacy and a solid regulatory base, this is not yet the case of supportive care in France. The content and organization differ depending on the institution, the choice of clinicians and patient preferences. Social networks and media convey messages that blur evidence-based practices. This article aims to review the facilitators and obstacles of this perspective.

Le 3e plan cancer énonce l’objectif « améliorer l’identification des cancers d’origine professionnelle pour permettre leur reconnaissance en maladie professionnelle ». Nous avons obtenu une subvention de l’ARS-PACA pour rechercher des causes professionnelles de cancers bronchopulmonaires primitifs (et mésothéliome) et éventuellement de proposer aux patients une déclaration de maladie professionnelle indemnisable (MPI) et une aide au suivi de ces déclarations.Le « recrutement » des patients se fait au sein de l’ISC, spécialisé dans la radiothérapie et la chimiothérapie, environ 300 cas par an.Un questionnaire (curriculum laboris) est adressé aux patients, puis une consultation est proposée, durant de 1h à 1h30, par un binôme de médecins du travail, à la recherche des expositions à des cancérogènes pulmonaires.Puis un important travail de recherche d’informations sur les expositions (dans les dossiers médicaux de santé au travail, les entreprises, les matrices-emploi-exposition (Evalutil, Matgene, etc.) est effectué afin d’argumenter une éventuelle déclaration de MPI.Malgré l’autorisation signée par le patient, nous sommes parfois confrontés à des refus de transmission d’informations des dossiers médicaux de santé au travail en contradiction avec la loi Kouchner. Seuls 6 % des dossiers disposaient d’information ou fiches d’exposition.Les documents de déclaration sont adressés au patient. Une assistante sociale les aide dans les démarches administratives.Depuis 2017, cette consultation s’insère dans le dispositif national PRO-POUMON avec 8 consultations de pathologies professionnelles. Résultats Deux cent quatre cancers du poumons et mésothéliomes (9) ayant adressé le questionnaire.Parmi ces 204 répondants, nous avons constaté :– 67 consultations étaient inutiles en l’absence d’indices d’exposition ;– 42 cancers étaient non déclarables ;– 70 cancers étaient déclarables en MPI (dont 8 déclarations préalables et 7 refus de déclaration exprimés), certains au FIVA (exposition à l’amiante), soit 34 % de patients déclarables en MPI qui n’auraient pas fait de démarche de reconnaissance en l’absence de cette consultation ;– 29 reconnaissances, 4 refus avec contestation.Cette étude met en évidence :– la difficulté à obtenir des éléments documentaires sur les expositions professionnelles à des cancérogènes. Leur traçabilité, bien que prévue par plusieurs textes réglementaires, n’est pas efficiente ;– la sous-déclaration massive des cancers professionnels puisque seuls 4,5 % des patients avaient effectué une déclaration préalable.L’absence de traçabilité des expositions professionnelles participe à leur invisibilité, elle ampute la prévention primaire, la prévention médicale et la réparation. Elle annihile les droits à réparation des salariés.

Purpose: Optimal duration of adjuvant chemotherapy in the treatment of early-stage breast cancer remained to be investigated rigorously for the standard regimens in widespread use in North America (doxorubicin/cyclophosphamide, AC) and Europe (5-fluorouracil/epirubicin/cyclophosphamide, FEC). Whether six cycles of FEC 100 present an advantage, or not, compared with only four cycles was tested directly in a phase III prospective multicentre trial.Patients and methods: Between 2002 and 2006, 1515 women between 18 and 65 degrees years of age, with node negative N(-) high-risk early-stage breast cancer, were included in the study following breast surgery and axillary lymph node dissection or procedure by sentinel node technique. Inclusion in the study required tumour size T >= 1 cm and at least one of the high-risk factors: T > 2 cm, negative oestrogen receptor/progesterone receptor (ER- and PR-), Scarff-Bloom-Richardson (SBR) grade II or III and age <= 35 degrees years. Patients were randomly assigned to either six FEC 100 (Arm A) or four FEC 100 (Arm B). The trial was powered to detect an absolute difference >= 6% in disease-free survival (DFS) at 5 degrees years.Results: At 6.1 degrees years median follow-up, with 91 (12%) events recorded in Arm A versus 106 (14%) in Arm B, no statistically significant risk increase was associated with four versus six FEC 100: DFS (hazard ratio (HR) Z 1.18; CI 95% [0.89-1.56], P = .24) and overall survival (OS) (HR Z 1.39; CI 95% [0.91-2.13], P = .12).Conclusion: Differences in chemotherapy duration did not induce notably different outcomes in our cohort of high-risk patients. Clinical trial registry number: NCT00055679, Agence National de Securite du Medicament (ANSM) - France. (C) 2017 Elsevier Ltd. All rights reserved.

In case of a new breast symptom or an abnormal result of breast imaging, some women have a problem finding a quick answer to allay their anxiety. The Institut Sainte-Catherine in Avignon has set up a new form of accelerated disease management through the opening of a new dedicated consultation called SOS SEIN 84. We present the result of a prospective quality study of our first new patients.

Cardiovascular toxicity is a potentially serious complication that can result from the use of various cancer therapies and can impact the short- and long-term prognosis of treated patients as well as cancer survivors. In addition to their potential acute cardiovascular adverse events, new treatments can lead to late toxicity even after their completion because patients who survive longer generally have an increased exposure to the cancer therapies combined to standard cardiovascular risk factors. These complications expose the patient to the risk of cardiovascular morbi-mortality, which makes managing cardiovascular toxicity a significant challenge. Cardio-oncology programs offer the opportunity to improve cardiovascular monitoring, safety, and management through a better understanding of the pathogenesis of toxicity and interdisciplinary collaborations. In this review, we address new challenges, perspectives, and research priorities in cancer therapy-related cardiovascular toxicity to identify strategies that could improve the overall prognosis and survival of cancer patients. We also focus our discussion on the contribution of cardio-oncology in each step of the development and use of cancer therapies.

Les inhibiteurs des tyrosines-kinases (ITK) sont une classe thérapeutique en expansion, dont les prescriptions augmentent avec l’identification de nouvelles cibles moléculaires et la mise sur le marché constante de nouvelles substances. Les effets secondaires les plus connus sont digestifs et cutanés. Les effets cardiovasculaires sont moins bien identifiés, car le plus souvent sans traduction clinique, et leur prise en charge reste mal codifiée: dysfonction myocardique, hypertension artérielle (HTA) et allongement de l’intervalle QT. L’allongement de l’intervalle QT reste mal dépisté faute de réalisation systématique d’électrocardiogramme (ECG). Il est cependant potentiellement mortel avec la survenue de torsade de pointe pouvant dégénérer en fibrillation ventriculaire. Cette toxicité est certaine pour le vandétanib, le vémurafénib, le sunitinib, le sorafénib, le nilotinib et le crizotinib. Elle est probable pour le lapatinib, l’erlotinib, le dasatinib et le bosutinib. Elle est certainement nulle pour les autres ITK, mais le recul est sans doute insuffisant pour certains d’entre eux. Un ECG de référence est donc conseillé. De même, une attention particulière doit être portée aux autres médicaments prescrits en cancérologie, en premier lieu les nombreuses substances utilisées pour les soins de support qui peuvent allonger l’intervalle QT et dans une moindre mesure les autres molécules métabolisées par le cytochrome 3A4 qui modifient le taux plasmatique des ITK. Une coopération entre oncologues, hématologues et cardiologues est donc indispensable. C’est pourquoi une plateforme coeur vaisseaux cancer se met sur pied en région PACA afin d’optimiser la prise en charge des patients et de prévenir les complications cardiovasculaires.

The Breast JournalVolume 22, Issue 3 p. 363-365 Letter to the Editor Follow-up of Patients Treated for pT1aN0M0 Breast Cancer: 10-year Survival and Prognostic Factors Patrice Crochet MD, Corresponding Author Patrice Crochet MD Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille Université, FranceAddress correspondence and reprint requests to: Patrice Crochet, MD, 2 rue du rempart, 13007 Marseille, France, or e-mail: pcrochet.marseille@gmail.comSearch for more papers by this authorNicolas Molinari PhD, Nicolas Molinari PhD IMAG, Department of Biostatistics, University of Montpellier, CHU Montpellier, Montpellier, FranceSearch for more papers by this authorJean-Claude Darmon MD, Jean-Claude Darmon MD Clinique Urbain V, Avignon, FranceSearch for more papers by this authorBruno Cutuli MD, Bruno Cutuli MD Clinique Courlancy, Reims, FranceSearch for more papers by this authorDaniel Serin MD, Daniel Serin MD Institut Sainte Catherine, Avignon, FranceSearch for more papers by this author Patrice Crochet MD, Corresponding Author Patrice Crochet MD Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille Université, FranceAddress correspondence and reprint requests to: Patrice Crochet, MD, 2 rue du rempart, 13007 Marseille, France, or e-mail: pcrochet.marseille@gmail.comSearch for more papers by this authorNicolas Molinari PhD, Nicolas Molinari PhD IMAG, Department of Biostatistics, University of Montpellier, CHU Montpellier, Montpellier, FranceSearch for more papers by this authorJean-Claude Darmon MD, Jean-Claude Darmon MD Clinique Urbain V, Avignon, FranceSearch for more papers by this authorBruno Cutuli MD, Bruno Cutuli MD Clinique Courlancy, Reims, FranceSearch for more papers by this authorDaniel Serin MD, Daniel Serin MD Institut Sainte Catherine, Avignon, FranceSearch for more papers by this author First published: 02 March 2016 https://doi.org/10.1111/tbj.12587Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue3May/June 2016Pages 363-365 RelatedInformation