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Until June 4, tens of thousands of professionals will draw up the state of the art on cancer research at the congress of theAmerican Society of Clinical Oncology (ASCO). To navigate the plethora of presentations, two experts mobilized by Unicancer, Pierre Fumoleau, General Director of Institut Curie, in Paris, and François Ghiringhelli, Center for the fight against cancer Georges-François Leclerc, Dijon, have agreed to play the role of guide.
The highlights of Saturday 1st June 2019: spotlight on cancers of the digestive tract, lung (at an early stage) and living conditions after bad cancer.
Colorectal cancer is the second cancer in terms of frequency in women (after bad cancer) and third in men (after lung cancer and prostate cancer). According to the League Against Cancer, 43,336 new cases occurred in 2018 (24,035 men and 20,837 women). This cancer is the second leading cause of cancer deaths in France: 17,117 deaths from colorectal cancer estimated in 2018 (9,294 men and 8,390 women) Nearly 85% of cases occur after age 65, and its frequency seems stable.
The studies presented in Chicago distinguish early cases, where the tumor is still localized, from those where metastases have developed.
In the first case, the first line of treatment consists of the removal of the tumor and the search for possible tumor cells in the ganglia. If the presence is confirmed, then chemotherapy is prescribed, most often oxaliplatin combined with fluoropyrimidines. The treatment is heavy: 12 courses every 15 days, ie 6 months of treatment. Side effects are important, including neuropathies that hinder the proper functioning of the hands. Can we improve the lives of these patients?
It seems so, according to Ioannis Sougklakos, from the University of Heraklion, Greece. With her colleagues, in the framework of the IDEA study (she takes into account some 10,000 American, French, Italian, Greek patients …), they showed that, except when the tumors are bulky, three months are enough. Patient comfort is greatly increased. Thus, it is no longer necessary to install a constraining device in the arm, and the injections can be replaced by tablets. Neuropathies are attenuated.
A second study based on the same cohort, presented by Timothy Iveson of Southampton University Hospital in Great Britain, points in the same direction.
Another change in practice will come from the work of Matthew Seymour of the NIH in Leeds, UK. With his team, he highlighted the benefits of chemotherapy prescribed before the surgical option. This facilitates the surgical procedure and increases the chances of completely removing the tumor.
When colorectal cancer has reached a metastatic stage, physicians often advocate dual chemotherapy combining FOLFOX (folinic acid, Fluorouracil or 5-FU and oxaliplatin) and an antiangiogenic (which prevents the development of tumor-specific blood vessels). ), in this case, Bevacizumab (or Avastin). Javier Sastre of San Carlos Hospital, Madrid, and Chiara Cremolini of the University Hospital of Pie, Italy, propose adding a third product, Irinotecan. This molecule inhibits an enzyme (topoisomerase) and thus prevents the DNA of tumor cells from replicating.
The results of these two teams are positive, even in the case of aggressive tumors. Henceforth, the choice between bi and triple therapy offered to doctors no longer has to be in case of aggressive disease: the reluctance related to side effects should be lifted for a better chance of recovery if of course there is no contraindication to this treatment.
Lung cancer is one of the most common cancers in the world. In France, with nearly 37,000 new cases per year (27,000 men and 10,000 women), this cancer ranks fourth behind those of the prostate, bad and colorectal. On the other hand, in terms of mortality, he is the first.
Céline Mascaux, an oncologist at Strasbourg University Hospitals, recalls that, in addition to smoking, risk factors include diesel, asbestos, X-rays … On the basis of histological criteria, there are two main types of cancer. non-small cells (85% of cases) and those with small cells.
Long impossible to treat, since 2004, lung cancer has benefited from targeted therapies (targeting the oncogenes product) and since 2012 immunotherapies. Significant efforts are being made on early detection. Benjamin Moutier, of the AstraZaneca laboratory who made it one of its priority research axes in order to make, in the long term, "of the lung cancer a chronic and not more deadly disease", quotes the scanners low dose (to avoid the too strong irradiations ). He recalls the very positive results of the Nelson study, conducted in the Netherlands and Belgium of 16,000 people at risk: the risk of death from lung cancer among male participants was reduced by 26% in the group screened against the control group at 10 years of follow-up.
At ASCO, David Kwiatkowski, from the Dana-Farber Cancer Center in Boston, presented his findings on recent immunotherapy, atezolizumab (an antibody to the PDL1 gene), for early-stage lung cancer. In 20% of patients, the tumor cells have almost disappeared. Pierre Fumoleau highlights the change in practices: "we have recently had effective products. Today, immunotherapy is often prescribed in the first line, combined with chemotherapy or surgical treatment. This was not the case before. And to clarify: "The immunotherapy works all the better that the mutational load, which accounts for the number of mutations, increases"
Tina Cascone, of the University of Texas, Houston, and her group, highlight in a phase II study the effectiveness of nivolumad (it blocks the PD1 receptor, for Programmed cell death 1, tumor cells, which stimulates the immune system) badociated with ipilimumab. This antibody inhibits the CTLA-4 receptor of T cells, which results in the activation of these immune cells. The side effects are greater than with nivolumad alone, but the results are better.
Finally, let's finish with the results revealing the utility of artificial intelligence in oncology. This work was conducted on the CANTO cohort (for CANcer TOxicities), a group of 12,000 women followed by bad cancer in 26 centers in France, promoted by UNICANCER. Coordinated by Fabrice André of the Institut Gustave Roussy in Villejuif, this follow-up also involves the Léon Berard Center in Lyon, the Institut Curie in Paris …
More than a quarter of patients experience severe fatigue in the months following the end of bad cancer treatment. At the same time physical, cognitive and emotional, this exhaustion exhausts the patients, who feel exhausted. Can we anticipate and better take care of it? After selecting the non-fatigued patients before their treatment, the researchers sequenced their genome to identify the genetic differences (we speak of polymorphisms). Then, thanks to an artificial intelligence method, they highlighted a combination of genetic polymorphisms that could be responsible for post-treatment fatigue.
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