ABSTRACT
Lung cancer is the leading cause of cancer deaths in France, with about 30,000 deaths per year. The overwhelming majority (90 %) are tobacco-related. The prognosis is dark but great therapeutic advances have been made with the development of targeted therapies first and then immunotherapy afterwards. These medications are conditioned to the expression of biomarkers that require specific tools in routine to measure them. We will detail in this chapter several techniques of anatomopathology, cytogenetics and molecular biology necessary for the detection of biomarkers in lung cancers, and their applications in thoracic oncology in 2018.
Subject(s)
Biomarkers, Tumor/analysis , Carcinoma, Non-Small-Cell Lung/diagnosis , Cytogenetic Analysis/methods , High-Throughput Nucleotide Sequencing/methods , In Situ Hybridization, Fluorescence/methods , Lung Neoplasms/diagnosis , Biomarkers, Tumor/metabolism , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/pathology , Chromatin Immunoprecipitation/methods , Cytogenetic Analysis/trends , Humans , Immunohistochemistry , Lung Neoplasms/genetics , Lung Neoplasms/metabolism , Lung Neoplasms/pathology , Sequence Analysis, DNA/methods , Translocation, GeneticSubject(s)
Carcinoma, Merkel Cell/therapy , Nivolumab/pharmacology , Pyrazoles/pharmacology , Skin Neoplasms/therapy , Aged, 80 and over , Carcinoma, Merkel Cell/genetics , Carcinoma, Merkel Cell/pathology , Chemoradiotherapy/methods , Drug Antagonism , Drug Synergism , Female , Humans , Janus Kinase 2/antagonists & inhibitors , Janus Kinase 2/genetics , Nitriles , Nivolumab/therapeutic use , Positron-Emission Tomography , Pyrazoles/therapeutic use , Pyrimidines , Skin Neoplasms/genetics , Skin Neoplasms/pathologySubject(s)
Carcinoma, Basal Cell/secondary , Liver Neoplasms/secondary , Skin Neoplasms/pathology , Aged , Female , HumansABSTRACT
PURPOSE: Carboplatin clearance is correlated with glomerular filtration rate (GFR) and usually estimated with creatinine clearance using Cockcroft-Gault (CG) formula. Because plasma creatinine level is highly correlated with muscle mass, we hypothesized that an abnormal body composition with a low lean body mass (LBM) percentage [(LBM/weight) × 100] may result in inadequate carboplatin dosing. Serum cystatin C is an alternative marker of GFR, not affected by muscle mass. We aimed to investigate the influence of total LBM and LBM percentage on GFR calculation, using creatinine (CrCl) or cystatin C (GFRcysC-creat) in cancer patients. METHODS: Pretreatment serum creatinine and cystatin C were prospectively measured in consecutive patients. CrCl (CG formula), GFRcysC-creat (CKD-EPI creatinine-cystatin equation), and LBM (CT scan) were calculated. Severe thrombocytopenia post-carboplatin were analyzed. RESULTS: In 131 patients without renal insufficiency, LBM was correlated with creatinine (r = 0.30, p < 0.005) but not with cystatin C (r = -0.07, p = 0.43). In patients with the lowest LBM percentage, the CrCl was significantly higher than GFRcysC-creat indicating an overestimation of GFR with creatinine (p = 0.0004). In 24 patients treated with carboplatin AUC 5 (mg/ml min) ± paclitaxel, the risk of severe thrombocytopenia was associated with lower LBM percentage (p = 0.0002) and higher CrCl/GFRcysC-creat ratio (p = 0.006). By ROC analysis, the CrCl/GFRcysC-creat ratio threshold predicting severe thrombocytopenia was 1.23. CONCLUSIONS: A low LBM percentage increases the risk of inadequate GFR calculation by CG formula, and carboplatin overdosage with severe thrombocytopenia. High CrCl/GFRcysC-creat ratio allows the identification of these patients.
Subject(s)
Antineoplastic Agents/administration & dosage , Body Composition/physiology , Carboplatin/administration & dosage , Glomerular Filtration Rate , Neoplasms/drug therapy , Aged , Antineoplastic Agents/adverse effects , Antineoplastic Agents/pharmacokinetics , Area Under Curve , Carboplatin/adverse effects , Carboplatin/pharmacokinetics , Creatinine/blood , Cystatin C/blood , Female , Humans , Male , Middle Aged , Neoplasms/pathology , Paclitaxel/administration & dosage , Prospective Studies , Thrombocytopenia/chemically induced , Thrombocytopenia/epidemiologySubject(s)
Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/pathology , Meningeal Carcinomatosis/drug therapy , Quinazolines/therapeutic use , Aged , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Antineoplastic Agents/blood , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Diarrhea/chemically induced , Female , Humans , Lapatinib , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Magnetic Resonance Imaging , Meningeal Carcinomatosis/diagnostic imaging , Meningeal Carcinomatosis/secondary , Quinazolines/administration & dosage , Quinazolines/adverse effects , Quinazolines/blood , Receptor, ErbB-2/metabolism , Trastuzumab/therapeutic use , Treatment OutcomeABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Salivary glands tumours are rare neoplasms for which there are few clinical trials. The most common malignant parotid tumour is the mucoepidermoid carcinoma. High-grade mucoepidermoid carcinomas are highly aggressive tumours. The initial therapy of localized disease is known, but when there is a recurrence, several options are possible and chemotherapy is generally reserved for palliative treatment. We comment on published guidelines and report a case of sustained remission with docetaxel. CASE SUMMARY: Our case concerns a 64-year-old woman with a high-grade mucoepidermoid carcinoma of the parotid gland with local recurrence treated with docetaxel 50 mg/m² every 15 days. After the sixth cycle, a complete remission was observed on CT-scan. The tolerability was excellent. After 2 years of docetaxel, the patient was still in complete remission. WHAT IS NEW AND CONCLUSION: Docetaxel is an active drug for the treatment of mucoepidermoid carcinoma of salivary glands. A prospective study should confirm these data.