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The incidence of cancer has been steadily increasing in the elderly population. Indeed, it has been found that more than sixty percent of the cancers recently diagnosed in western countries occurred in people aged 65 or more. Care for these patients must be individualized, focusing primarily on the geriatric evaluation, comorbidities, but also on the biological and evolutionary characteristics of the disease. The potential differences in evolution of the disease in a young and an old subject, both from a clinical point of view, and because of predictive and prognostic biological factors, such as shorter life expectancy, greater expected vulnerability of the old subject and the great heterogeneity found in populations obviously require the development of several possible therapeutic strategies for a given case. This remains true even considering the availability of new and better-tolerated medicines that can be administered orally or on a weekly basis, together with supportive therapies (nutrition, stimulating agent, and so on). If the main prognostic factor remains the tumoral stage, it is the physiological status of the individual, much more than his actual age that will help choose a therapeutical course of action. The fragile nature of some elderly people may lead to toxic shocks, and even, in some cases, to death. We must take all those components in our strategies of care giving of elderly patient moreover on clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: Breast cancer is often an estrogen-dependent disease. The primary goals of the treatment of breast carcinomas are multiple, depending on the situation in which the patients are treated. In adjuvant setting, the aims are to delete the time of relapse, to increase the overall survival, and to offer to the patients the best quality of life they may expect. Tamoxifen is the standard hormonal agent for premenopausal women with receptor-positive breast cancer. Recent data show an increasing role for aromatase inhibitors in postmenopausal women. In metastatic setting, the primary goals are improved quality of life and prolonged survival; effective therapies with minimal toxicity, such as endocrine therapy, are highly desirable and should be considered a primary option over chemotherapy for selected estrogen-receptor positive patients. Ovarian ablation has been worldwide used. Methods of irreversible ovarian ablation include surgical oophorectomy and ovarian irradiation. Potentially reversible castration can be medically accomplished using luteinizing hormone releasing hormone analogues (LHRH agonists). In the metastatic setting, ovarian ablation (induced by the use of LHRH agonists or by surgical ovarian ablation) and tamoxifen monotherapies produce comparable outcomes, and may be more effective when used together (combined estrogen blockade). In advanced breast cancer, the combination prolongs the progression-free survival and increases response rates and duration of response rate relative to the use of LHRH agonist alone. In the adjuvant setting, data suggest that ovarian ablation followed by tamoxifen produces similar results to those obtained with adjuvant chemotherapy in hormone-receptor positive breast cancer women. The value of combining these modalities remains unclear, but the addition of the LHRH analogue goserelin to standard treatment results in a significant benefit in terms of relapse-free and overall survival, especially for estrogen-receptor positive patients. Finally, considering the efficacy of the new aromatase inhibitors, the interest of combining these drugs with the LHRH analogues has yet to be defined, both for pre- and post-menopausal patients. [Copyright &y& Elsevier]

Les patients présentant un cancer sont particulièrement à risque de dénutrition, ce qui impacte directement leur prise en charge thérapeutique. Les recommandations préconisent une évaluation de l'état nutritionnel dès la consultation d'annonce, néanmoins, ceci est peu réalisé en pratique courante et le nombre de prise en charge diététique est nettement limité. L'objectif de ce travail est donc d'améliorer la prise en charge nutritionnelle des patients en hôpital de jour d'oncologie. Pour cela, deux actions ont été menées de façon concomitantes. La première porte sur la remise au patient d'un programme personnalisé de soins (PPS) incluant un onglet diététique. Ce dernier permet au patient de s'autoévaluer en devenant acteur de sa prise en charge mais également de faciliter les transmissions et la visibilité de son état nutritionnel par l'équipe soignante. La seconde porte sur la sensibilisation des médecins à la dénutrition et notamment à la gestion de l'alimentation artificielle via la rédaction de protocoles communs à l'établissement. Il s'agit d'une étude prospective monocentrique. La comparaison de 2 groupes de patients a été réalisée en amont (session 1, n = 66) et en aval (session 2, n = 41) des deux travaux de sensibilisation. Les critères d'évaluation de l'état nutritionnel étudiés comprenaient pour le critère phénotypique : le poids, la taille, l'indice de masse corporel (IMC) ainsi que la cinétique de perte de poids par rapport au poids habituel du patient. Le critère étiologique sélectionné était, systématiquement et à minima, une situation d'agression. La classification de la sévérité reposait sur la cinétique de perte de poids ou l'IMC. Les patients de chaque session étaient comparables en prenant en considération leur âge, sexe et la localisation de la tumeur primitive. Les résultats montrent une augmentation significative du pourcentage de patients non dénutris de plus de 25 % ainsi qu'une diminution de celui des personnes dénutries modérément de 24 % (session 2 vs session, p < 0,05). Indépendamment de leur statut nutritionnel, le nombre d'interventions diététiques est accru de 22,4 % (session 2 vs session 1, p < 0,05). Il n'y a pas de corrélation significative entre la distribution du PPS aux patients et l'augmentation du nombre d'interventions diététiques constaté. De plus, le nombre de prise en charge nutritionnelle à la demande du patient est inchangé, les soignants restant proactifs. Concernant les personnes présentant une dénutrition sévère, la stratégie de prise en charge diététique montre une nette diminution de la mise en place de compléments nutritionnels oraux et d'alimentation parentérale au profit de l'alimentation entérale (session 2 vs session 1 ; p < 0,05). En conclusion, l'action conjointe de sensibilisation des médecins et des patients à la dénutrition a permis, à la fois de majorer le nombre de prise en charge diététique, mais également de favoriser la thérapeutique nutritionnelle adéquate dans les cas de dénutrition sévère. [ABSTRACT FROM AUTHOR]

Primary therapy for high-risk gestational trophoblastic neoplasia (GTN) includes a multi-agent, methotrexate-based regimen, named EMA/CO. In France, the guidelines recommend the use of either a platinum-based protocol when methotrexate is contra-indicated or a highdose EMA/CO once brain metastases are diagnosed. For patients who are resistant to the initial therapy, different salvage approaches have been developed or adapted from treatments already used for germ cell tumors. Currently, the most frequently used protocol is a combination of etoposide and platinum-based therapy (EMA/EP). In the EMA/EP protocol, etoposide and cisplatin are used in place of cyclophosphamide and vincristine (CO in the EMA/CO regimen) with the goal of reversing resistance mechanisms of previously used drugs. Although, new approaches for improving the management of high-risk patients who are resistant or refractory to the initial therapy are now available, new molecules are still awaited to optimize patient's care. [ABSTRACT FROM AUTHOR]

Background: It can be hypothesised that inherited polymorphisms in the drug-transporter ABCB1 gene may interfere with interindividual variations in drug response in breast cancer patients. Docetaxel is a substrate for ABCB1 whose function has been shown to be modulated by oestrogen and progesterone.Methods: Whether ABCB1 polymorphisms including T-129C, A61G, C1236T, G2677T/A and C3435T polymorphisms could account for variations in the disposition of docetaxel and whether menopausal status at the time of diagnosis might interact with this effect were analysed in women receiving neoadjuvant chemotherapy for breast cancer (n=86).Results: A highly significant association was observed, but restricted to premenopausal women (n=53), between the pharmacokinetics of docetaxel and C3435T polymorphism, as patients with CC genotype had lower mean values of the area under the plasma concentration-time curve (AUC) of docetaxel than patients with CT and TT genotypes (P<0.0001). Comparison between pre- and postmenopausal women with the same C3435T genotype yielded a significant difference in docetaxel AUC only for CC genotype (P<0.0001).Conclusion: These results suggest that C3435T polymorphism genotyping and menopausal status at the time of diagnosis might be useful when considering chemotherapy regimens including docetaxel in breast cancer patients. [ABSTRACT FROM AUTHOR]