[Therapeutic cancer vaccines: challenges and perspectives]. / Vaccins thérapeutiques anticancéreux : défis et perspectives.

For over a decade, immunotherapy has been transforming cancer treatment and prognosis. Tumor therapeutic vaccines trigger new immune responses and enhance existing immunity to more effectively combat cancer. These vaccines aim to curb the established disease or prevent recurrence, unlike conventional preventive vaccines. There are four categories of therapeutic vaccines: cellular, viral/bacterial, peptide, and nucleic acid, each with its own benefits and challenges. Advances in the understanding of anti-tumor immunity and advanced technologies such as mRNA vaccines support the development of this new treatment option. Currently in clinical trials, they could lead to promising and personalised anti-cancer therapies.

Depuis plus d'une décennie, l'immunothérapie améliore le traitement et le pronostic des patients atteints de cancer. Les vaccins thérapeutiques tumoraux activent de nouvelles réponses immunitaires et amplifient l'immunité existante pour combattre le cancer plus efficacement. Ces vaccins visent à freiner la maladie établie ou à éviter les récidives, à la différence des vaccins préventifs classiques. Il existe quatre catégories de vaccins thérapeutiques : cellulaire, viral/bactérien, peptidique et à acide nucléique, chacun avec des bénéfices et des défis spécifiques. Les avancées dans la compréhension de l'immunité antitumorale et dans les technologies de pointe, comme les vaccins à ARNm, favorisent le développement de cette nouvelle option de traitement. Actuellement en essais cliniques, ils pourraient aboutir à des thérapies anticancéreuses prometteuses et personnalisées.

[Nutritional support for individuals with advanced oncological pathology]. / Soutien nutritionnel aux personnes atteintes de pathologie oncologique avancée.

Cachexia increases the risk of therapeutic failure and reduces the quality of life for cancer patients. Patients with nutritional risks should be referred to a dietitian. Nutritional interventions primarily include meal adaptation and oral nutritional supplements. When cachexia is more severe, artificial nutrition is indicated for patients with a KPS (Karnofsky Performance Status) of 40 or above and a life expectancy of more than 6 weeks. When the digestive system is functional, enteral nutrition is recommended. Parenteral nutrition shows the same benefits but requires close monitoring. The decision to stop artificial nutrition is influenced by the medical condition, the patient's wishes, and the socio-cultural context.

La cachexie augmente le risque d'échec thérapeutique et diminue la qualité de vie des patients atteints de cancer. Ceux présentant un risque nutritionnel doivent être adressés à un diététicien. Les interventions nutritionnelles comprennent en premier lieu l'adaptation des repas et les suppléments nutritionnels oraux. Lorsque la cachexie est plus sévère, une nutrition artificielle est indiquée chez les patients avec un score de performance de Karnofsky (KPS) égal ou supérieur à 40 et une espérance de vie de plus de 6 semaines. Quand le système digestif est fonctionnel, la nutrition entérale est recommandée. La nutrition parentérale montre les mêmes bénéfices mais nécessite une surveillance étroite. La décision de stopper la nutrition artificielle est influencée par la condition médicale, les souhaits du patient et le contexte socioculturel.

Precision Oncology in Gastrointestinal Stromal Tumors.

GIST (gastrointestinal stromal tumors) represent 20% of sarcomatous tumors and 1-2% of primary gastrointestinal cancers. They have an excellent prognosis when localized and resectable, though their prognosis is poor in the metastatic setting, with limited options after the second line until recently. Four lines are now standard in KIT-mutated GIST and one in PDGFRA-mutated GIST. An exponential growth of new treatments is expected in this era of molecular diagnostic techniques and systematic sequencing. Currently, the main challenge remains the emergence of resistance linked to secondary mutations caused by selective pressure induced by TKIs. Repeating biopsies to tailor treatments might be a step in the right direction, and liquid biopsies at progression may offer a non-invasive alternative. New molecules with wider KIT inhibition are under investigation and could change the catalog and the sequence of existing treatments. Combination therapies may also be an approach to overcome current resistance mechanisms. Here, we review the current epidemiology and biology of GIST and discuss future management options, with an emphasis on genome-oriented therapies.

Home-deliverable antitumoral treatments in the age of COVID-19: the Portsmouth experience and a narrative review.

Background and Objective: During the coronavirus disease 2019 (COVID-19) pandemic, risks and priorities of oncologic care have required a thorough reassessment. The chance that fragile patients have exposure to infection during frequent hospital visits is an additional consideration for all therapeutic decisions. Patients with cancer, particularly those with lung cancer, have a greater chance of developing a severe form of COVID-19. Their increased risk is due to the immunosuppression associated with the chemotherapy itself, the underlying pulmonary compromise, which often accompanies lung malignancy or their general poor health. Oncology societies have given precise recommendations on the treatment modalities to be favoured, such as giving up specific palliative or adjuvant treatments, preferring shorter and less cytopenic therapies. In this review, we discussed how some of these curative treatments could be given by administering them at home. In this narrative review, we aim to see if it is safe and feasible to deliver home-administered oncologic intravenous treatments. Methods: By narrative review, we looked for all the articles written in English describing home delivery chemotherapy or immunotherapy programs since 2019 that emerged or evolved during the COVID-19 pandemic. We added real-life data regarding the initiation of home immunotherapy in Portsmouth. Key Content and Findings: There is a growing body of evidence supporting the safety and feasibility of home-administered chemotherapy and immunotherapy treatments. Conclusions: Home-administered chemotherapy and immunotherapy treatments are safe and feasible despite financial challenges, particularly about reimbursement by insurance companies and the loss of earnings for hospitals. Home treatments also require the careful selection of eligible patients and the training and organisation of specialised teams capable of managing the expected complications. It would be interesting to assess the risk-reduction in terms of infections and potential survival gains obtained by these programmes during the COVID pandemic.

Primary Extra-Osseous Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature.

Extra-osseous Ewing sarcoma (ES) is a rare and aggressive malignant tumor found in a variety of organs. Primary ES of the thyroid is exceedingly rare and few cases have been documented to date. We describe the case of a 54-year old woman with a history of breast carcinoma in whom a unique hypermetabolic left thyroid nodule was identified during a follow-up PET-CT scan. An ultrasound examination showed a hypoechogenic nodule of 3.7 cm. A cytological diagnosis of poorly differentiated thyroid carcinoma was made, and a total thyroidectomy was performed. The surgical specimen revealed a poorly differentiated neoplasm composed of medium-sized cells with scant cytoplasm, expressing pancytokeratin, CD99 and NKX2.2 but lacking p63 and p40 expression. Molecular analysis revealed a EWSR1-FLI1 fusion transcript supporting the diagnosis of a primary extra-osseous ES of the thyroid. The patient received adjuvant chemotherapy and has no evidence of recurrent disease.

[Metastatic hormone-sensitive prostate cancer: more than just androgen-deprivation therapy]. / Cancer de la prostate métastatique hormonosensible: l'hormonothérapie, oui, mais pas seulement !

For decades, androgen deprivation was the standard of care for metastatic prostate cancer. Chemotherapy, then novel anti-androgen therapies, changed the treatment paradigm. Large phase III randomized clinical trials were conducted over the course of the last decade, first among patients with castration resistant prostate cancer, then among those with hormone-sensitive disease. Today, androgen deprivation therapy alone is no longer the gold standard and should be associated either with chemotherapy in high-volume disease, or novel anti-androgen therapy. As such, each case should be discussed with a specialist to choose the most appropriate treatment.

Pendant plusieurs décennies, la suppression androgénique seule a été le traitement standard du cancer de la prostate métastatique. La chimiothérapie puis les hormonothérapies de nouvelle génération ont bouleversé ce paradigme, avec d'importantes répercussions thérapeutiques. De grands essais randomisés de phase III ont été conduits ces dernières années, ciblant d'abord les cancers prostatiques métastatiques résistant à la castration puis les cancers prostatiques métastatiques hormonosensibles. Aujourd'hui, la déprivation seule n'est plus le traitement standard; elle est désormais associée soit à une chimiothérapie en cas de maladie à haut volume, soit à une hormonothérapie de nouvelle génération. Ainsi, chaque cas mérite d'être discuté avec un spécialiste, afin de choisir le traitement le plus adapté.