Incidence and associated factors of cetuximab-induced hypersensitivity infusion reactions in 1392 cancer patients treated in four French areas: a possible association with Lyme disease?

BACKGROUND: Previous studies have observed an increased incidence of Cetuximab-induced hypersensitivity infusion reactions (CI-IRs) in the southeastern states of the USA. Tick's bites were suspected of generating cross-reactions between cetuximab and alpha-gal. This study aims was to describe the incidence and associated risk factors of CI-IRs, in the French areas chosen according to their Lyme disease incidence. PATIENTS AND METHODS: A retrospective chart review was conducted on patients that received cetuximab infusion from January 2010 to June 2019 in 4 French areas with different Lyme disease incidence rates. RESULTS: Of 1392 patients, 117 (8.4%) experienced a CI-IR, including 68 severe (grade 3 or 4) reactions (4.9%). This CI-IR incidence was significantly higher in the Lyme disease high-risk area than in the other areas (13.2% versus 7.1%, 8.1% and 6.4%; P = 0.016). Sex (P = 0.53), premedication (P = 0.91), primary cancer location (P = 0.46) and chemotherapy regimen type (P = 0.78) had no impact on CI-IR incidence in the overall population. In the head and neck squamous cell carcinoma (HNSCC) patient subgroup, CI-IRs were significantly more frequent in the high-risk area (16.4% versus 6.7%, 7.1% and 7.0%; P = 0.0015). CONCLUSION: This study suggests that patients treated in the French area with the highest incidence of Lyme disease are at a higher risk of CI-IRs.

Sternocleidomastoid muscle metastasis of breast cancer: case report.

The authors report a case of 84-year-old women, with dysphagia to liquids and solid foods, and with infiltration of right stemocleidomastoid muscle that compressed the upper third of the esophagus to the thoracic hull. The biopsy of sternocleidomastoid muscle permitted the diagnosis of metastatic breast cancer relapse after 22 years.

Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study.

PURPOSE: French 2008 treatment guidelines recommend low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) with treatment duration of at least 3 months and up to 6 months and beyond if cancer remains active. Our aim was to assess adherence to guidelines in hospital clinical practice. METHODS: The French hospital database (PMSI) was used to identify patients with CAT admitted to three hospitals of the Paris region to be included in a retrospective cohort study. Adherence to guidelines was assessed in patients included from different treatment periods following the venous thromboembolism (VTE) episode i.e. first 10 days (T1), day 10 to 3 months (T2), months 3 to 6 (T3) and beyond 6 months (T4) when applicable. RESULTS: A total of 240 patients with CAT were included from January 2012 to December 2012 of whom 204 were analyzable. Treatment was adherent to guidelines in 55, 31 and 34 % of patients in T1, T2 and T3 treatment periods, respectively, while overall treatment adherence was found in 52 % of patients. Adherence rates were the highest among patients with pulmonary embolism (PE, 60.5 %), catheter-related thrombosis (62.5 %), class III/IV extended cancer (58.0 %) and metastatic malignancy (60.3 %) while only 40 % with deep vein thrombosis (DVT) received a treatment consistent with guidelines. CONCLUSION: Adherence to guidelines appears insufficient since only half of patients received an appropriate treatment. Adherence dropped significantly across treatment periods T2 and T3. VTE diagnosis and cancer characteristics influenced the anticoagulant prescription. Management of patients with CAT requires further education and information of health care professionals.

mTOR-inhibitor treatment of metastatic renal cell carcinoma: contribution of Choi and modified Choi criteria assessed in 2D or 3D to evaluate tumor response.

PURPOSE: To determine whether 2D or 3D Choi and modified Choi (mChoi) criteria could assess the efficacy of everolimus against metastatic renal cell carcinoma (mRCC). METHODS: RECIST-1.1, Choi, and mChoi criteria were applied retrospectively to analyse baseline and 2-month contrast-enhanced computed tomography (CECT) images in 48 patients with mRCC enrolled in the everolimus arm of the French randomized double-blind multicentre phase III trial comparing everolimus versus placebo (RECORD-1). The primary endpoint was centrally reviewed progression-free survival (PFS) calculated from the initial RECORD-1 analysis. Mean attenuation was determined for 2D target lesion regions of interest drawn on CECT sections whose largest diameters had been measured, and for the 3D whole target lesion. RESULTS: The median PFS was 5.5 months. The median PFS for everolimus responders defined using 3D mChoi criteria was significantly longer than for non-responders (7.6 versus 5.4 months, respectively), corresponding to a hazard ratio for progression of 0.45 (95 % CI: 0.22-0.92), with respective 1-year survival rates of 31 % and 9 %. No other 2D or 3D imaging criteria at 2 months identified patients who would benefit from everolimus. CONCLUSIONS: At 2 months, only 3D mChoi criteria were able to identify mRCC patients with a PFS benefit from everolimus. KEY POINTS: Choi criteria could not identify everolimus-treated patients with significantly prolonged PFS. mCHOI enabled identification of everolimus-treated mRCC patients with a PFS benefit. 3D attenuation measurement criteria appeared to perform better than single-slice measurement.

Peritoneal tuberculosis associated with adrenocorticol primitive neoplasm mimicking a peritoneal carcinosis: a case report.

The authors report a case of women, 51-year-old that presented with peritoneal tuberculosis, with concomitant adrenocortical primitive neoplasm, mistaken as peritoneal carcinomatosis, due to the failure of correct histological analysis. In fact, the critical life status, associated to increases of CA 125, typical imaging of peritoneal carcinomatosis, and presence of 75% atypical cells in ascitic fluid, induced to begin chemotherapy.

Erectile dysfunction and alcohol intake.

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association. Materials and Methods. In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment. RESULTS. The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R2=0.4). CONCLUSIONS. The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.

Role of contrast-enhanced color Doppler ultrasonography and dynamic flow in the evaluation of hepatic tumors treated with radiofrequency.

The contribution of contrast-enhanced color Doppler ultrasonography (CDUS) and dynamic flow (DF) (Toshiba) in the evaluation following treatment of hepatic tumors with radiofrequency (RF) is discussed. Twenty-seven patients with 34 hepatic tumors were included in this prospective study. The treated tumors measured 10-58 mm in diameter (mean diameter 29 mm). Two tumors were treated twice and one three times, comprising a total of 38 target lesions treated with RF and evaluated by 127 contrast-enhanced CDUS. The results of CDUS follow-up were compared to those of the dynamic MRI at 2 months, 4 months, 6 months and 1 year. Before RF, the injection of Levovist raised the number of vascularized lesions seen with unenhanced Doppler from 44% to 79%. All the non-vascularized lesions were metastases. Twenty-four hours after RF, four tumors presented an enhancement with Levovist, in which two were insufficiently treated lesions. Twenty-one treated tumors have been followed-up jointly by CDUS and MRI at the same time at 2 months, 20 at 4 months, 12 at 6 months and nine at 1 year. Compared to the MRI and the evolution, the CDUS presented a sensitivity of 100% and a specificity of 90% for the detection of progressive recurrence. The preliminary results show that the CDUS is useful to confirm the absence of detectable vascularity after treatment with RF ablation, whereas the presence of enhancement must be confirmed by MRI.

Doppler US with perfusion software and contrast medium injection in the early evaluation of isolated limb perfusion of limb sarcomas: prospective study of 49 cases.

BACKGROUND: The aim of this study was to prospectively evaluate the use of Doppler ultrasonography with perfusion software and contrast agent injection (DUPC) during isolated limb perfusion (ILP) with high-dose chemotherapy and TNF-alpha(biochemotherapy) in patients with locally advanced extremity soft tissue sarcoma (STS). PATIENTS AND METHODS: Fifty-two patients were prospectively included in this monocentric imaging trial. Three were excluded because the study was incomplete in two patients and one tumour did not exhibit any contrast uptake. DUPC was performed before ILP and on days 1, 7, 15, 30 and 60 after ILP. A total of 292 DUPC were performed on 55 target lesions in 49 evaluable patients. The percentage of contrast uptake was evaluated at each tumour site by two radiologists. The criterion tested was a decrease of more than 50% in intra-tumour contrast uptake compared to the pre-ILP examination. Results were compared with both MRI and histological analysis after resection of residual disease. RESULTS: According to MRI and the histological analysis, 25 (51%) patients were good responders (no difference between the four treatment arms) with tumour necrosis exceeding 90% and 24 (49%) were poor responders. As of day +1, the accuracy of DUPC in predicting tumour response was 82% (18/25 good responders and 22/24 poor responders) increasing to 91% at day +7, 95% at day +15 and 96% at day +30. At day +15, DUPC was predictive of a good response in 100% of the cases. CONCLUSION: DUPC is a simple technique, allowing early prediction of tumour response after ILP. A new treatment planning scheme can be proposed based on the results of this study.

[Functional and early evaluation of treatments in oncology: interest of ultrasonographic contrast agents]. / Evaluation fonctionnelle et précoce des traitements en cancérologie: intérêt des produits de contraste ultrasonores.

The early and functional evaluation of new treatments in oncology is a main goal. At present, technical advances in Doppler-ultrasonography allow the detection of neovascularization for superficial and deep malignant tumors in order to evaluate the efficiency of new treatments as Treatment response can be early predicted according to modifications of this vascularization before Volume modification. Contrast agents injection improves the efficiency of this technique and developments in perfusion softwares optimize this detection.

Tracheal resection and reconstruction: indications, surgical procedure, and postoperative care.

Nursing management of the patient undergoing tracheal resection and reconstruction is not well described in the literature. Over the last 25 years, nurses in the respiratory surgical intensive care unit at Massachusetts General Hospital in Boston have cared for more than 600 patients who have undergone this procedure. Using a diagnostic format, we have developed a plan of care for this patient population. In this article, the etiology of tracheal obstruction, its diagnosis and surgical correction, and nursing care of the patient after tracheal resection and reconstruction are presented.