Infiltration de la plèvre viscérale par les adénocarcinomes bronchiques de stade IB (rôle pronostique ?)

La chimiothérapie adjuvante des CBNPC de stade II et IIIA est admise au vu de l'amélioration de la survie montrée dans plusieurs essais randomisés. Pour les stades IB, l'intérêt de ce traitement reste à établir. Cette étude a analysé le rôle pronostique de l'infiltration de la plèvre viscérale pour statuer sur son intérêt en tant que nouveau critère décisionnel de réalisation d une chimiothérapie adjuvante. Une série nantaise de 73 patients porteurs d adénocarcinomes de stades pT1 à pT3N0M0 réséqués entre le 01/01/1999 et le 01/01/2005 a été étudiée. La survie à 5 ans des stades pT2a (>3 et <=5cm) est statistiquement meilleure en l absence d infiltration de la plèvre viscérale (81,8% versus 37,5%, p<0,028). Les tumeurs pT2 <=3cm ont le même pronostic que les pT1 et doivent donc être traités comme tels. Ces résultats ouvrent la voie à une étude prospective testant, chez les patients porteurs d'adénocarcinomes classés pT2N0M0, l'impact d'une chimiothérapie adjuvante.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Routine detection of EGFR gene mutations in lung carcinomas: A 2-year single-center experience.

e21117 Background: Activating mutations in the tyrosine kinase domain of the EGFR gene in lung carcinoma has been associated with a dramatic response to tyrosine kinase inhibitors. Therefore, routine analysis of pathological specimens is mandatory in clinical practice to predict patient response. We have analyzed the results of the tests we performed during years 2010 and 2011. Methods: DNA was extracted from formalin-fixed paraffin-embedded tissues, following macrodisection, using an iPrep robot (Invitrogen). The p.L858R and p.L861Q substitutions (exon 21) were assessed by allele-specific PCR and exon 19 deletions by PCR amplification followed by DNA fragment analysis (polyacrylamide gel electrophoresis). These techniques allowed us to detect these mutations when present in at least 2% of the cells. Results: During these 2 years, we analyzed samples from 1,041 patients (including 907 adenocarcinomas, 71 large cell carcinomas and 28 squamous cell carcinomas). The EGFR mutational status could not be determined in 51 cases : DNA could not be amplified in 23 cases (2.2%), and 28 samples (2.7%) contained a limited percentage (&lt;10%) of cancer cells. The EGFR status could thus be successfully determined in 990 (95.1%) samples. EGFR mutations were detected in 142 (14.3%) patients : 74 exon 19 deletions, and 68 p.L858R mutation. The mutation rate was, as expected, higher in women (24.0%) than in men (7.2%), and mutated patients were significantly older than non mutated patients (median age : 71 y vs 63 y). Furthermore, the mutation rate was much higher in tumors expressing the TTF-1 antigen (117/638; 18.3%) than in TTF-1 negative tumors (5/228; 2.2%). Similar mutation rates were obtained with primary tumors (89/661; 13.5%) and metastases (40/274; 14.6%), and with surgical specimen (43/325; 13.2%), fiberoptic bronchial biopsies (36/250; 14.4%), CT-guided needle biopsies (25/181; 13.8%) and transbronchial needle aspirates (5/38; 13.2%). Conclusions: The results obtained through routine analysis of more than 1000 samples indicated that our procedure is very efficient. All types of samples can be analyzed without any significant bias. TTF-1 immunostaining might be used to predict for negative EGFR mutation status. </jats:p

Transient Vision Loss – A Rare Oxaliplatin-Induced Ophthalmologic Side Effect: A Report of Two Cases

Oxaliplatin, a platinum-based chemotherapeutic agent, is responsible for induced peripheral sensory neuropathy. Only a few cases of ophthalmologic toxicity have been reported. We report here two cases of sudden transient vision loss after oxaliplatin administration, in one case intraperitoneally. These symptoms likely reflect optic neuritis that could be included in the spectrum of oxaliplatin-induced neuropathy. </jats:p

BRAF Non-V600E Mutated Metastatic Colorectal Cancer in a Young Patient: Discussion from a Case Report

We report the case of a 32-year-old man with a caecal adenocarcinoma with major lymph node extension and peritoneal carcinomatosis, presenting a BRAF-K601E mutation. A triplet (5FU plus oxaliplatin plus irinotecan) combination with bevacizumab achieved tumor control but the disease progressed immediately after cessation and the patient died 8 months after the diagnosis. A short review of BRAF non-V600E mutations shows that outcome and clinical features depend on the mutation.</jats:p