Journal Title
Title of Journal: Oncologie
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Authors: J P Metges M A Lebot R Faroux F Riaud E Gamelin O Capitain V Guérin Meyer P Leynia J Y Douillard H Senellart S Rochard C Louvigné L Campion O Dupuis C Grollier N A Achour B Person J L Raoul E Boucher C Bertrand J F Ramée L Guivarch P L Etienne S Roussel H Desclos M N Julien M I Labarre V Klein R Bessard C Stampfli F Royet J Faycal S Gouva G Le Bihan M Couturier A Gourlaouen C Bertholom M Porneuf E Jobard E Peguet D Grasset J F Bouret V Bicheler A Ulvoas L Miglianico C Chouzenoux P Deguiral L Derenne D Martin P Michel Langlet C Bodin V Rossi S Barré O Cojocarasu C Naveau Ploux A M Vidal I Cumin J Egreteau A Brouard T Matysiak Budnik P Thomaré A S Le Bris Michel G Piriou R Largeau C Elhannani E Crespeau F Suberville H Bourgeois C Riche D Déniel Lagadec F Marhuenda F Grudé
Publish Date: 2014/12/21
Volume: 16, Issue: 5, Pages: 267-276
Abstract
En 2006 bevacizumabFOLFIRI représente la thérapie ciblée administrable dès la première ligne chez les patients porteurs d’un cancer colorectal métastatique non opérable Une série homogène de 111 patients colligés en région Bretagne et Pays de la Loire ayant reçu du bevacizumab FOLFIRI en première ligne en 2006 révèle les résultats suivants 51 réponses 29 stabilités 21 progressions et 10 toxicités avant évaluation La médiane de survie globale OS est de 251 mois et la médiane de survie sans progression PFS de 102 mois Dans le cas d’une chirurgie secondaire l’OS médian triple de 188 mois chez les patients non réséqués versus 592 mois ceux réséqués En comparant les sujets âgés de plus et de moins de 70 ans aucune différence n’a été mise en évidence en termes de bénéfice ou de risque BevacizumabFOLFIRI pourrait être administré en pratique courante chez les personnes âgées sous couvert d’une évaluation gériatrique et d’une approche multidisciplinaireA study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumabFOLFIRI as firstline treatment in 2006 showed the following results 51 responses 29 stabilisations 21 progressions and 10 cases of toxicity prior to assessment Median overall survival OS was 251 months and median progressionfree survival was 102 months Surgery secondary to treatment tripled median OS which reached 592 months in resected patients versus 188 months in unresected patients Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risksManagement of patients with metastatic colorectal cancer mCRC is evolving continuously Use of conventional chemotherapy and targeted agent combinations has become the standard treatment and option of choice for these patients Treatment options are essentially based on multicenter international phase III studies whose main objectives include progressionfree survival PFS and even overall survival OS 1 2 3 4 5 6 7 Bevacizumab cetuximab and more recently panitumumab were successively studied for this purpose A regimen combining bevacizumab with irinotecanbased chemotherapy is more effective than a protocol without bevacizumab 4 which led to the granting of the first label for bevacizumab in 2005 However the combination tested was IFL Irinotecan Fluorouracil Leucovorin protocol which was found to be dramatically toxic 7 8 9 Given a lack of data on the FOLFOX protocol the French teams resorted to use the FOLFIRI protocol reputed less toxic than the IFL protocol As the American teams had access to the results of the Goldberg study demonstrating the superiority of the FOLFOX protocol compared with the IFL protocol they started combining bevacizumab with FOLFOX right away 710 11 12 The German teams use the weekly AIO regimen irinotecan 80 mg/m2 leucovorin 500 mg/m2 followed by 5FU 2600 mg/m2 administered continuously for a period of 22 hours but the results of this regimen have not been compared with those of the bevacizumab—FOLFIRI combinationThe inclusion criteria in prospective studies exclude generally elderly patients more than 75 years old However large numbers of elderly patients are treated on a daily practice with targeted agent therapy It therefore became necessary to obtain information on patients receiving routine care and not included in clinical trials The available cohort studies predominantly included NorthAmerican patients In the routine care series the reference chemotherapy in the United States was found to be FOLFOX and XELOX capecitabine and oxaliplatin or capecitabine administered as monotherapy rather than FOLFIRI 1112Studies published on patients falling in the oncogeriatrics category and receiving bevacizumab treatment generally concern patients over age of 65 years 13 14 15 Seventyfive years and above seems to be a better age for oncogeriatric considerations Studies of patients over 75 years and even over 80 years are recently published 16 Moreover the importance of studying response rates PFS and OS in routine care cohorts is now being associated with assessment of side effects and particularly the safety monitoring of the combinations pharmacovigilance review Given that management has become global it seems important to determine how many patients underwent liver metastasis resection secondary to treatment However in most cases this mainly consists in collecting information on the healthcare centres of the patient including any potential medicalsurgical management and multipleline therapy instituted successive chemotherapy lines used following disease progression depending on the patient’s general condition
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