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Le pyoderma gangrenosum (PG) est une affection rare, essentiellement dermatologique, dont l'atteinte pulmonaire inhabituelle et peu connue, constitue un défi diagnostique et thérapeutique. Un homme, âgé de 66 ans, suivi depuis 6 ans pour une gammapathie monoclonale IgA de signification indéterminée et un PG corticodépendant initialement cutané, avait une pneumonectomie pour une masse suspecte de néoplasie se révélant être une localisation pulmonaire du PG. Lors des pneumopathies successives parfois dyspnéisantes et excavées, plusieurs hypothèses, parfois associées, sont évoquées. Diverses explorations infectieuses et immunologiques, et diverses thérapeutiques anti-bactériennes/fongiques ou immunosuppressives sont conduites, pour finalement conclure à des récidives pulmonaires et/ou cutanées du PG. L'évolution à 14 mois semble finalement favorable sous tofacitinib. La reconnaissance de l'atteinte cutanée du PG, essentielle au diagnostic de son atteinte pulmonaire, en constitue probablement le miroir évolutif sous traitement. Seules des confrontations multidisciplinaires des cas rapportés permettront l'élaboration de recommandations diagnostiques et thérapeutiques. Pyoderma gangrenosum (PG) is a rare, mainly dermatological condition, whose unusual and little-known lung involvement presents a diagnostic and therapeutic challenge. A 66-year-old man, followed for 6 years for an IgA monoclonal gammopathy of undetermined significance and an initially cutaneous corticosteroid-dependent PG, received a pneumonectomy for a mass suspected of neoplasia, that turns out to be a PG pulmonary localisation. During successive pneumopathies, sometimes dyspneic and excavated, several hypotheses are discussed. Various infectious and immunological explorations, and various antibacterial/fungal or immunosuppressive therapies are conducted, to finally conclude to pulmonary and/or cutaneous recurrences of PG. The outcome at 14 months seems finally favourable with tofacitinib. The recognition of cutaneous involvement of PG, which is essential for the diagnosis of its lung involvement, is probably the mirror of its evolution under treatment. Only multidisciplinary confrontation of reported cases will allow the elaboration of diagnostic and therapeutic recommendations. [ABSTRACT FROM AUTHOR]

Malignant pleural mesothelioma (MPM) is a rare tumour, secondary to professional asbestosis exposure. MPM incidence is rising since the late sixties and this increase will continue till 2020–2030, with curently 800 to 1000 new cases in France. Molecular carcinogenesis of MPM is still poorly understood but gene alterations of NF2, c-met, WT1 RASSF1, and p16, have been described. These genes are involved in cell invasion and motility, cell division and apoptosis control. The histological diagnosis remains critical since the morphology of this neoplasm is extremely variable, but immunohistochemical analyses have been precisely described by the French Mesopath Group. The clinical diagnosis relies on thoracos-copy and large pleural biopsy. The therapeutic strategy always includes the irradiation of drainage channels or pleural punctures with 3 × 7 Grays within the four weeks following these procedures. Rarely, in carefully selected patients, extensive extra-pleural pneumonectomy can be performed. The recommended first-line chemotherapy is based on a doublet of pemetrexed and cisplatin that has demonstrated in a phase III setting, an overall increase in survival and improvement of quality of life when compared to a cisplatin-based monotherapy. Antiangiogenic agents such as bevacizumab could be of interest but they have to be tested in randomized phase III trials. [ABSTRACT FROM AUTHOR]

Concurrent chemotherapy and thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is the standard treatment in limited-disease small-cell lung cancer (LD-SCLC), with 5-year overall survival (OS) of only 25% to 33%. STIMULI is a 1:1 randomised phase II trial aiming to demonstrate superiority of consolidation combination immunotherapy versus observation after chemo-radiotherapy plus PCI (protocol amendment-1). Consolidation immunotherapy consisted of four cycles of nivolumab [1 mg/kg, every three weeks (Q3W)] plus ipilimumab (3 mg/kg, Q3W), followed by nivolumab monotherapy (240 mg, Q2W) for up to 12 months. Patient recruitment closed prematurely due to slow accrual and the statistical analyses plan was updated to address progression-free survival (PFS) as the only primary endpoint. Of the 222 patients enrolled, 153 were randomised (78: experimental; 75: observation). Among the randomised patients, median age was 62 years, 60% males, 34%/65% current/former smokers, 31%/66% performance status (PS) 0/1. Up to 25 May 2020 (median follow-up 22.4 months), 40 PFS events were observed in the experimental arm, with median PFS 10.7 months [95% confidence interval (CI) 7.0-not estimable (NE)] versus 42 events and median 14.5 months (8.2-NE) in the observation, hazard ratio (HR) = 1.02 (0.66-1.58), two-sided P = 0.93. With updated follow-up (03 June 2021; median: 35 months), median OS was not reached in the experimental arm, while it was 32.1 months (26.1-NE) in observation, with HR = 0.95 (0.59-1.52), P = 0.82. In the experimental arm, median time-to-treatment-discontinuation was only 1.7 months. CTCAE v4 grade ≥3 adverse events were experienced by 62% of patients in the experimental and 25% in the observation arm, with 4 and 1 fatal, respectively. The STIMULI trial did not meet its primary endpoint of improving PFS with nivolumab-ipilimumab consolidation after chemo-radiotherapy in LD-SCLC. A short period on active treatment related to toxicity and treatment discontinuation likely affected the efficacy results. • First randomised trial comparing nivolumab/ipilimumab versus observation after standard chemo-radiotherapy and PCI in LD-SCLC. • Period on active treatment was short with a median time to nivolumab/ipilimumab discontinuation <2 months. • No improvement for PFS and OS for immunotherapy consolidation over observation. • Higher OS benefit observed for patients on twice daily radiotherapy schedule (versus once daily), female sex and ECOG PS 1. [ABSTRACT FROM AUTHOR]