Efficacy of Pemetrexed as Second-Line Therapy in Advanced NSCLC after Either Treatment-Free Interval or Maintenance Therapy with Gemcitabine or Erlotinib in IFCT-GFPC 05-02 Phase III Study.

J Thorac Oncol. 2013 Apr 15;

Authors: Bylicki O, Ferlay C, Chouaid C, Lavolé A, Barlési F, Dubos C, Westeel V, Créquit J, Corre R, Vergnenègre A, Monnet I, Le Caer H, Fournel P, Vaylet F, Falchero L, Poudenx M, Linard P, Pérol D, Zalcman G, Pérol M

Abstract
INTRODUCTION:: Maintenance therapy in advanced non-small-cell lung cancer (NSCLC) might lead to resistance to subsequent treatments. IFCT-GFPC 0502 study showed a progression-free survival (PFS) benefit with gemcitabine or erlotinib maintenance compared with observation after cisplatin-gemcitabine chemotherapy. The trial included a pre-defined pemetrexed second-line therapy, allowing post-hoc assessment of its efficacy according to previous maintenance treatment or treatment-free interval. METHODS:: Stage IIIB/IV NSCLC patients were randomized after four cycles of cisplatin-gemcitabine chemotherapy to either observation or to receive maintenance therapy with gemcitabine or erlotinib. Pemetrexed was given as second-line treatment on disease progression in all arms. PFS and overall survival (OS) were assessed from the beginning of pemetrexed therapy according to randomization arm. RESULTS:: Of the 464 randomized patients, 360 (78 %) received second-line pemetrexed (130 [84%], 114 [74%], and 116 [75%] in observation, gemcitabine, and erlotinib arm, respectively). Median number of pemetrexed cycles was 3 (1-40) in all arms. Median PFS did not differ between gemcitabine and observation arms (4.2 versus 3.9 months, hazard ratio [HR] [95% confidence interval [CI] 0.81 [0.62-1.06]) or between erlotinib and observation arms (4.2 versus 3.9 months, HR 0.83 [0.64-1.09]). OS data showed a non-significant improvement with gemcitabine arm versus observation arm (8.3 versus 7.5 months, HR 0.81 [0.61-1.07]) or erlotinib arm versus observation arm (9.1 versus 7.5 months, HR 0.80 [0.61-1.05]). Results were similar for non-squamous patients. Grade 3 to 4 treatment-related adverse events (AEs) were comparable in all arms. CONCLUSIONS:: Maintenance therapy with gemcitabine continuation or erlotinib does not seem to impair efficacy of second-line pemetrexed comparatively to administration after a treatment-free interval.

PMID: 23591160 [PubMed - as supplied by publisher]

Rapid On-Site Evaluation Improves Needle Aspiration Sensitivity in the Diagnosis of Central Lung Cancers: A Randomized Trial.

Respiration. 2013 Apr 10;

Authors: Mondoni M, Carlucci P, Di Marco F, Rossi S, Santus P, D'Adda A, Sferrazza Papa GF, Bulfamante G, Centanni S

Abstract
Background: Few prospective studies have evaluated the role of endobronchial needle aspiration in diagnosing central airways neoplasms. Rapid on-site evaluation has long been used in transbronchial needle aspiration of adenopathies and peripheral lesions, but its role in sampling central malignancies has not been substantiated yet. Objectives: In this study we evaluated if endobronchial needle aspiration may increase the sensitivity of bronchoscopy for diagnosing central airways neoplasms when added to conventional diagnostic methods (forceps biopsy, brushing and bronchial washing), and if rapid on-site evaluation may be beneficial in patients undergoing endobronchial needle aspiration. Methods: 125 patients (77% males, aged 70 ± 7 years; mean ± SD) with central lung cancers were randomized to undergo bronchoscopy including conventional diagnostic methods and needle aspiration, with or without rapid on-site evaluation, stratifying the patients on the basis of the neoplasm growth pattern (exophytic and submucosal/peribronchial disease). Results: Needle aspiration significantly increased the sensitivity of bronchoscopy when added to conventional methods (from 76 to 91%; p < 0.001), primarily resulting from differences in submucosal/peribronchial diseases (68 vs. 90%; p < 0.001) and independently from the presence of rapid on-site evaluation; needle aspiration guided by rapid on-site evaluation guaranteed a higher improvement in bronchoscopy sensitivity than conventional needle aspiration (98 vs. 84%, respectively; p = 0.004). Needle aspiration guided by rapid on-site evaluation showed a significantly higher sensitivity than the conventional method (97 vs. 76%, respectively; p = 0.001). Conclusions: Needle aspiration increases the sensitivity of bronchoscopy in diagnosing central airways malignancies when added to conventional diagnostic methods, with a further significant improvement when guided by rapid on-site evaluation.

PMID: 23594935 [PubMed - as supplied by publisher]

Publication date: February 2013
Source:Revue de Pneumologie Clinique, Volume 69, Issue 1

Author(s): J. Delourme , X. Dhalluin , A.B. Cortot , J.-J. Lafitte , A. Scherpereel

Le mésothéliome pleural malin (MPM) est une tumeur rare et agressive développée au niveau des surfaces mésothéliales de la cavité pleurale. L’exposition antérieure à l’amiante représente le principal facteur de risque de MPM. Les signes cliniques sont le plus souvent tardifs et non spécifiques. Le scanner thoracique, examen d’imagerie clé, montre habituellement une pleurésie (unilatérale) associée à un épaississement pleural nodulaire circonférentiel. La tomographie par émission de positions couplée au scanner (TEP-TDM) pourrait aider à différencier le MPM des tumeurs pleurales bénignes mais son utilisation pour le diagnostic de MPM n’est pas recommandée, de même que l’imagerie par résonnance magnétique thoracique ou les biomarqueurs sanguins ou du liquide pleural dont la mésothéline soluble toujours en évaluation. Le diagnostic est donc apporté par l’histologie avec une étude immunohistochimique obligatoire des biopsies pleurales obtenues idéalement par thoracoscopie. Le traitement du MPM repose essentiellement sur la chimiothérapie. La chirurgie, qu’elle soit de type pleurectomie décortication ou pneumonectomie extrapleurale, n’est pas recommandée en dehors d’un essai thérapeutique de même que la radiothérapie thoracique adjuvante. L’irradiation prophylactique des orifices de drains et cicatrices thoraciques, validée par les recommandations francophones de 2005, est cependant discutée au niveau international. Enfin, de nombreux travaux de recherche évaluent actuellement la place de thérapies ciblées et de biomarqueurs dans le MPM, ouvrant de nouvelles perspectives dans la prise en charge de ce cancer. Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor issued from the mesothelial surface of the pleural space. A previous exposure to asbestos is the main risk factor of mesothelioma. Clinical signs are most of the time late and unspecific. Chest CT-scan, a key imaging procedure, usually shows a (unilateral) pleurisy associated with pleural nodular thickening. PET-scan associated with CT-scan may help to differenciate MPM from pleural benign tumors but it is not recommended for the diagnosis of MPM, as well as chest resonance magnetic imaging and blood or pleural fluid biomarkers, including soluble mesothelin still under investigation. The diagnosis of MPM is based on histology using essentially immunohistochemistry on pleural biopsies best obtained by thoracoscopy. The treatment of MPM relies mostly on chemotherapy. Surgery, pleurectomy/decortication or extrapleural pneumonectomy, is not recommended outside a clinical trial, as well as adjuvant chest radiotherapy. Prophylactic irradiation of chest scars and drains, validated by the French guidelines in 2005, is however highly discussed at the international level. Finally, numerous research studies presently assess the value of targeted therapies and biomarkers in MPM, opening new perspectives in the management of this cancer.

Publication date: Available online 3 April 2013
Source:Revue de Pneumologie Clinique

Author(s): R. Hernu , N. Eydoux , A. Peiretti , C. El-Khoury , D. Robert , L. Argaud , M. Armanet

Introduction La prise en charge des exacerbations aiguës de bronchopneumopathie chronique obstructive (EA BPCO) dans les services d’urgence français est mal connue, bien que des recommandations nationales existent. Méthodes Il s’agit d’une étude prospective réalisée sur une période de dix semaines (12/01 au 22/03/2009), de type audit de pratique, sur la prise en charge des EA BPCO dans les services d’urgence du Réseau des Urgences de la Vallée du Rhône (RESUVal). Résultats La participation de 16 établissements de santé a permis l’étude de la prise en charge de 221 EA BPCO. La mesure de la fréquence respiratoire et la description de l’expectoration n’étaient mentionnées que dans 99 (45 %) dossiers médicaux. Concernant la prise en charge thérapeutique, 215 (97 %) patients ont bénéficié de l’administration d’oxygène, 209 (95 %) ont reçu des aérosols de bêta-2-mimétique et 176 (80 %) des aérosols d’anti-cholinergique. Une corticothérapie systémique et une antibiothérapie ont été prescrites pour respectivement 116 (52 %) et 123 (56 %) patients. La ventilation non invasive (VNI) a été utilisée chez seulement 59 % des patients avec un pH inférieur à 7,35. Conclusions Ces résultats montrent que la prise en charge des EA BPCO aux urgences pourrait probablement être améliorée en recueillant de manière systématique la fréquence respiratoire et les caractéristiques de l’expectoration des patients ou en généralisant la pratique de la VNI aux urgences dans cette indication. Introduction Acute exacerbations of chronic obstructive pulmonary disease (COPD) patients are major events in the history of this chronic respiratory disease. Their management in French emergency services is unknown, although national guidelines exist. Methods This is a descriptive audit study, over a 10 weeks period (12/01–22/03/2009), of the management of COPD exacerbations in the RESUVal (Réseau des Urgences de la Vallée du Rhône, France) network emergency departments. Results The enrollement of 16 emergency units allowed the analysis of 221 exacerbations of COPD. Measurement of respiratory rate and description of the sputum were mentioned in only 99 (45%) medical records. The rest of the initial assessment was generally satisfactory. Regarding the therapeutic management, 215 (97%) patients received oxygen, beta-2-agonist aerosols were administrated for 209 (95%) patients and anticholinergic aerosols were used for 176 (80%) patients. A systemic corticosteroid and antibiotics were respectively prescribed for 116 (52%) and 123 (56%) patients. Non-invasive ventilation (NIV) was used in only 59% of patients presenting a pH&lt;7.35. Conclusions These findings demonstrate that management of exacerbations of COPD could be improved through systematic patients’ respiratory rate and sputum characteristics recording or NIV utilization reinforcement.