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Objective: Treatment of high-grade serous ovarian carcinomas relies on surgery and chemotherapy, potentially followed by bevacizumab and/or poly (ADP-ribose) polymerase inhibitors (PARPi). The modeled CA-125 ELIMination rate constant K (KELIM) is a pragmatic indicator of tumor primary chemosensitivity. Although it is well established that BRCA mutations are associated with platinum sensitivity, the relationship between BRCA status and KELIM score has yet to be elucidated. This study aimed to evaluate the interactions between BRCA and KELIM, and their respective prognostic values., Methods: We retrospectively collected data from 743 patients with high-grade serous ovarian carcinomas included in a French nationwide registry (NCT03275298) treated with neoadjuvant platinum-based chemotherapy followed by surgery. We analyzed the interactions between BRCA and KELIM, and their impacts on progression-free survival and overall survival., Results: BRCA -mutated (BRCA m) patients had higher standardized KELIM than BRCA -wild type ( BRCA wt) tumors (median 1.16 vs 1.06, respectively; p=0.001). The prognostic value of the KELIM score was independent of BRCA in multivariate analyses. KELIM score and BRCA could be combined to define three prognostic groups: (1) an unfavorable prognostic group with both BRCA wt and unfavorable KELIM (median progression-free survival 12.0 months); (2) an intermediate prognostic group with either BRCA m and unfavorable KELIM, or BRCA wt and favorable KELIM (median progression-free survival of 16.0 and 18.8 months, respectively; HR 0.64 compared with the unfavorable group, p<0.001); and (3) a favorable prognostic group with both BRCA m and favorable KELIM (median progression-free survival 28.8 months; HR 0.37 compared with the unfavorable group, p<0.001)., Conclusions: The KELIM score provides complementary prognostic information with respect to BRCA, and discriminates different prognoses within BRCA m or BRCA wt patients. Patients with both BRCA wt/unfavorable KELIM have a poor prognosis, underscoring the urgent need for novel therapeutic strategies., Competing Interests: Competing interests: J-MC: reports personal fees from AstraZeneca, Roche, Vifor, Clovis, GlaxoSmithKline, and Merck Sharp and Dohme, outside the submitted work. LC: reports non-financial support from Pharmamar and GSK, outside the submitted work. P-EC: reports personal fees from Merck Sharp and Dohme, AstraZeneca, and GlaxoSmithKline, outside the submitted work. AD: reports non-financial support from Monaco Age Oncologie, outside the submitted work. TMR: reports personal fees from Pfizer, AstraZeneca, GlaxoSmithKline, Clovis Oncology, Roche, Merck Sharp and Dohme, Mylan, Tesaro, and Norvartis; grants from Pfizer, Merck Sharp and Dohme, and Seagen; a non-financial advisory role for the French National Cancer Institute, Arcagy, and Unicancer, outside the submitted work. LG: reports personal fees from Viatris, Roche, Merck Sharp and Dohme, Clovis, GlaxoSmithKline, and AstraZeneca, outside the submitted work. FJ: reports personal fees from Amgen, Astellas, AstraZeneca, Byaer, EISAI, GlaxoSmithKline, Ipsen, Janssen, Merck Sharp and Dohme, Novartis, Novocure, Pfizer, Seagen, and Viatris; non-financial support from Astellas, AstraZeneca, Bristol-Meyer Squibb, GlaxoSmithKline, Janssen, Merck Sharp and Dohme, Ipsen, EISAI, and Chugai, outside the submitted work. EL: reports personal fees from Strycker, outside the submitted work. PP: reports personal fees from GlaxoSmithKline, Merck Sharp and Dohme, PharmaMar, and Roche, outside the submitted work. CP: reports personal fees from Roche, GlaxoSmithKline, Pharmamar, and Merck Sharp and Dohme, outside the submitted work. RS: reports grants from AstraZeneca; personal fees from GlaxoSmithKline, EISAI, Seagen, and Novartis; non-financial support from Merck Sharp and Dohme, GlaxoSmithKline, and Novartis, outside the submitted work. IR-C: reports personal fees from Agenus, Amgen, AstraZeneca, Clovis, Deciphera, GlaxoSmithKline, Macrogenics, Merck Sereno, Mersena, Novartis, Oxnea, Roche, Bristol-Meyer Squibb, and Merck Sharp and Dohme, outside the submitted work. MR: reports non-financial support from AstraZeneca; grants from Merck Sharp and Dohme, Daiichi Sankyo, and Bristol-Meyer Squibb; personal fees from AstraZeneca, Immunocore, Merck Sharp and Dohme, and GlaxoSmithKline, outside the submitted work. BY: reports personal fees from Merck Sharp and Dohme, AstraZeneca, GSK-TESARO, Bayer, Roche-Genentech, ECS Progastrine, Novartis, LEK, Amgen, Clovis Oncology, Merck Serono, Bristol-Meyer Squibb, Seagen, Myriad, Menarini, Gilead, and EISAI, outside the submitted work. EB, OB, LB, MCa, MCh, OC, HC, CG, FM, TP, BS, and A-MS have nothing to disclose., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To evaluate the feasibility of a same day breast cancer diagnosis and management protocol, consequently decreasing time to treatment and immediately reassuring patients with benign diagnosis., Materials and Methods: A total of 60 women underwent breast exam during SENODAY in our cancer center between January 2020 and December 2022. Patients are first seen by a breast surgeon who mentions whether the patient's history and physical exam are suspicious of malignancy. Patients are then sent to the radiologist who performs a complete radiologic assessment, classifies the lesions, and performs a biopsy when necessary. The specimen is sent to the pathologist who uses the imprint cytology technique to obtain a preliminary diagnosis. Effective counseling is established in case of breast cancer diagnosis., Results: Among 60 women, 25 patients were reassured by breast imaging and 35 underwent histopathological analysis (17 patients with a 1-day protocol and 18 with the standard definitive technique). Clinical examination was found to have a sensitivity of 100% and a specificity of 89.47%. The positive predictive value was 80 % and the negative predictive value was 100%. However, we did not find a strong correlation between imaging and definitive pathology. Moreover, on imprint cytology, sensitivity, specificity, PPV, and NPV were 100%. Finally, the mean time-to-treat was 28.6 days., Conclusions: SENODAY reassured 68.3% of patients. It also offered effective counseling and a treatment plan to newly diagnosed breast cancer patients within 1 day. Same day histological diagnosis by imprint cytology is effective and feasible with an excellent accuracy., Competing Interests: Disclosure The authors have stated that they have no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: RUBY is a tool for extracting clinical data on breast cancer from French medical records on the basis of named entity recognition models combined with keyword extraction and postprocessing rules. Although initial results showed a high precision of the system in extracting clinical information from surgery, pathology, and biopsy reports (≥92.7%) and good precision in extracting data from consultation reports (81.8%), its validation is needed before its use in routine practice., Methods: In this work, we analyzed RUBY's performance compared with the manual entry and we evaluated the generalizability of the approach on different sets of reports collected on a span of 40 years., Results: RUBY performed similarly or better than the manual entry for 15 of 27 variables. It showed similar performances when structuring newer reports but failed to extract entities for which changes in terminology appeared. Finally, our tool could automatically structure 15,990 reports in 77 minutes., Conclusion: RUBY can automate the data entry process of a set of variables and reduce its burden, but a continuous evaluation of the format and structure of the reports and a subsequent update of the system is necessary to ensure its robustness.

Background/aim: The COVID-19 pandemic introduced drastic containment measures, which had a direct impact on breast cancer management. During the first wave, a delay in care and a decrease in new consultation numbers was observed. It would be interesting to study the resulting long-term consequences on breast cancer presentation and time to first treatment., Patients and Methods: This retrospective cohort study was conducted at the surgery Department of the Anti-Cancer Center of Nice, France. Two periods of 6 months were compared: a pandemic period from June to December 2020 (after the end of the first wave), and a control period one year earlier. The primary endpoint was to measure the time to care access. The patients and cancer characteristics and the management type were also compared., Results: A total of 268 patients underwent diagnosis for breast cancer in each period. The time from biopsy to consultation was shortened after the containment was lifted (16 days vs. 18 days, p=0.024). The time between first consultation and treatment was unchanged between the two periods. The tumor size was larger in the pandemic period (21 mm vs. 18 mm, p=0.028). The clinical presentation was different: 59.8% of patients consulted for a palpable mass in the pandemic period, vs. 49.6% in the control period (p=0.023). There was no significant change in therapeutic management. The use of genomic testing was significantly increased. The number of breast cancer cases diagnosed decreased by 30% during the first COVID-19 lockdown. Even though a rebound was expected after the first wave, the number of consultations for breast cancer remained constant. This finding shows the fragility of screening adherence., Conclusion: It is necessary to reinforce education in the face of crises that may be repeated. Management of breast cancer did not change, which is a reassuring aspect regarding the care pathway in anticancer centers., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: Chemotherapy for high-grade serous ovarian cancers in platinum-sensitive relapse includes carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin. According to in vitro data, BRCA mutated patients are sensitive to replicative stress agents but BRCA status is not yet used for the choice of chemotherapy at relapse. Our aim was to assess these doublets according to BRCA status in first platinum-sensitive relapse., Methods: The ESME ovarian cancer database comprises a multicenter retrospective cohort of patients with ovarian cancer treated in French cancer centers between January 2011 and December 2017. Patients with high-grade serous ovarian cancers at first platinum-sensitive relapse who received one of these doublets were included. The objective was to compare progression-free survival of each chemotherapy doublet according to BRCA status., Results: Among the 10 263 patients in the database, 1539 patients had a first platinum-sensitive relapse: 825 BRCA wild type patients (53.6%) and 304 BRCA mutated patients (19.8%) (7 patients had a homologous recombination mutation and BRCA status was unkown for 403 patients). Median progression-free survival was longer in BRCA mutated patients than in BRCA wild type patients when receiving carboplatin/pegylated liposomal doxorubicin without maintenance treatment (15.8 vs 11.8 months; p<0.001). In contrast, we observed no difference in patients treated with carboplatin/paclitaxel (14.6 vs 14.3 months, respectively; p=0.70) or in those treated with carboplatin/gemcitabine (12.0 vs 9.8 months, respectively; p=0.18). In BRCA wild type patients without maintenance, better progression-free survival occurred with carboplatin/paclitaxel (median progression-free survival 14.3 months) than with carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin (9.8 and 11.8 months, respectively; p=0.017). In BRCA mutated patients without maintenance, there was no difference between the three doublets (median progression-free survival of 14.6, 12.0, and 15.8 months with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin, respectively; p=0.40)., Conclusion: While treatment with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin shows comparable efficacy in BRCA mutated patients, treatment with carboplatin/paclitaxel appears to be more effective than carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin in BRCA wild type patients with high-grade serous ovarian cancers at first platinum-sensitive relapse., Competing Interests: Competing interests: MR received honoraria from AstraZeneca, MSD, GSK, Immunocore and grant support from Bristol-Myers Squibb and Merck. RS received honoraria from GSK, EISAI, and Novartis and declares research grants from AstraZeneca. TD declares advisory boards from Pfizer, AstraZeneca, GSK, Clovis Oncology, Roche, MSD, Mylan, and Tesaro, research grants from Novartis, Pfizer, MSD, abd Seagen and local PI from Roche, AstraZeneca, GSK, MSD, Pfizer, Netris Pharma, and Seagen. The other authors have no conflicts of interest to declare., (© IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Breast intra operative radiation therapy has been evaluated with different systems delivering 20-21 Gy with treatment times around 30 min. Papillon + TM Contact X-ray machine was designed to produce a 50 kVp beam with a high dose rate ≥ 15 Gy/minute. A pilot study with the first prototype was conducted in Nice., Materials and Methods: The inclusion criteria were age ≥ 60 years, unifocal ductal breast adenocarcinoma ≤ 2.5 cm, grade 1-2. Surgical local excision with sentinel node dissection was performed and the applicator was placed in the tumor bed after excision with a prescribed dose of 20 Gy. The main end point of the study was the doses measured with the Gafchromic films; two were located at the skin surface and two in the excision cavity. Secondary endpoints were early toxicity and relapse free survival., Results: Between 10/2018 and 09/2019, 26 patients were included. Mean Gafchromic doses were 18.8 Gy ± 2 Gy at the south pole, 15.6 Gy ± 2.81 Gy at the equator and 2.5 Gy ± 1.67 Gy at the skin. With a median follow-up time of 12 months, no skin or subcutaneous toxicity > grade 2, no local relapse and no metastasis were observed., Conclusion: This is the first phase II study testing the Papillon + tm system for breast IORT with in vivo dosimetry measurements and reassuring clinical data., Competing Interests: Pr J-P Gérard declares he is medical advisor without any financial conflict for Ariane and Clerad. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.)

Purpose: The French National Cancer Institute has developed, in partnership with the French National Authority for Health, breast cancer-specific Care Quality, and Safety Indicators (BC QIs). With regard to the most common form of cancer, our aim is to support local and national quality initiatives, to improve BC pathways and outcomes, reduce heterogeneity of practice and regional inequities. In this study, we measure the BC QIs available in the French National medico-administrative cancer database, the French Cancer Cohort, for 2018., Materials and Methods: BC QIs are developed according to the RAND method. QIs are based on good clinical practice and care pathway recommendations. QI computation should be automatable without any additional workload for data collection. They will be published annually for all stakeholders, and especially hospitals., Results: Finally, ten feasible and pertinent QIs were selected. In France, BC care was found to be close to compliance with most QIs: proportion of patients undergoing biopsy prior to first treatment (94.5%), proportion of patients undergoing adjuvant radiotherapy after breast-conserving surgery for BC (94.5%), proportion of women undergoing radiotherapy within 12 weeks after surgery and without chemotherapy (86.2%), proportion of DCIS patients undergoing immediate breast reconstruction (54.3%) and proportion of women with NMIBC undergoing breast reintervention (14.4%). However, some are still far from their recommended rate. In particular, some QIs vary considerably from one region, or one patient, to another., Conclusion: Each result needs to be analyzed locally to find care quality leverage. This will strengthen transparency actions aimed at the public., Competing Interests: Disclosure The authors declare that they have no conflict of interest., (Copyright © 2022. Published by Elsevier Inc.)

Objective: Interval debulking surgery is recommended after 3-4 cycles (standard IDS) of neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer (EOC) not able to received upfront complete debulking surgery. However, real world practices frequently report performing IDS after ≥5 NAC cycles (delayed IDS). The aim of this work was to evaluate the impact on survival of the number of NACT cycles before IDS., Methods: We identified from a French national database, women with newly diagnosed EOC who underwent IDS from January 2011 to December 2016. Progression free survival (PFS) and overall survival (OS) were compared using Cox model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched-pair analysis., Results: 928 patients treated by IDS for which our propensity score could be applied were identified. After a median follow-up of 49.0 months (95% CI [46.0;52.9]); from the IPTW analysis, median PFS was 17.6 months and 11.5 months (HR = 1.42; CI 95% [1.22-1.67]; p < 0.0001); median OS was 51.2 months and 44.3 months (HR = 1.29; CI 95% [1.06-1.56]; p = 0.0095) for the standard and delayed IDS groups. From the matched-pair analysis (comparing 352 patients for each group), standard IDS was associated with better PFS (HR = 0,77; CI 95% [0.65-0.90]; p = 0.018) but not significantly associated with better OS (HR = 0,84; CI 95% [0.68-1,03]; p = 0.0947)., Conclusions: Carrying IDS after ≥5 NACT cycles seems to have a negative effect on patients survival. The goal of IDS surgery is complete resection and should not be performed after >3-4 NACT cycles., Competing Interests: Declaration of Competing Interest All the authors declare that they have no conflicts of interest to disclose related to this work., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: In spite of the frequency and clinical impact of BRCA1/2 alterations in high-grade epithelial ovarian cancer (HGEOC), real-world information based on robust data warehouse has been scarce to date., Methods: Consecutive patients with BRCA -mutated HGEOC treated between 2011 and 2016 within French comprehensive cancer centers from the Unicancer network were extracted from the ESME database. The main objective of the study was the assessment of clinicopathological and treatments parameters., Results: Out of the 8021 patients included in the ESME database, 266 patients matching the selection criteria were included. BRCA1 mutation was found in 191 (71.8%) patients, while 75 (28.2%) had a BRCA2 mutation only; 95.5% of patients received a cytoreductive surgery. All patients received a taxane/platinum-based chemotherapy (median = six cycles). Complete and partial response were obtained in 53.3% and 20.4% of the cases, respectively. Maintenance therapy was administered in 55.3% of the cases, bevacizumab being the most common agent. After a median follow up of 51.7 months, a median progression-free survival of 28.6 months (95% confidence interval (CI) [26.5; 32.7]) and an estimated 5-year median overall survival of 69.2% (95% CI [61.6; 70.3]) were reported. Notably, BRCA1 - and BRCA2 -mutated cases exhibited a trend towards different median progression-free survivals, with 28.0 (95% CI [24.4; 32.3]) and 33.3 months (95% CI [26.7; 46.1]), respectively ( p -value = 0.053). Furthermore, five-year OS for BRCA1 -mutated patients was 64.5% (95% CI [59.7; 69.2]), while it was 82.5% (95% CI [76.6; 88.5]) for BRCA2 -mutated ones ( p -value = 0.029)., Conclusions: This study reports the largest French multicenter cohort of BRCA -mutated HGEOCs based on robust data from the ESME, exhibiting relevant real-world data regarding this specific population.

Purpose: Electronic medical records are a valuable source of information about patients' clinical status but are often free-text documents that require laborious manual review to be exploited. Techniques from computer science have been investigated, but the literature has marginally focused on non-English language texts. We developed RUBY, a tool designed in collaboration with IBM-France to automatically structure clinical information from French medical records of patients with breast cancer., Materials and Methods: RUBY, which exploits state-of-the-art Named Entity Recognition models combined with keyword extraction and postprocessing rules, was applied on clinical texts. We investigated the precision of RUBY in extracting the target information., Results: RUBY has an average precision of 92.8% for the Surgery report, 92.7% for the Pathology report, 98.1% for the Biopsy report, and 81.8% for the Consultation report., Conclusion: These results show that the automatic approach has the potential to effectively extract clinical knowledge from an extensive set of electronic medical records, reducing the manual effort required and saving a significant amount of time. A deeper semantic analysis and further understanding of the context in the text, as well as training on a larger and more recent set of reports, including those containing highly variable entities and the use of ontologies, could further improve the results., Competing Interests: Jean-Marc FerreroConsulting or Advisory Role: Pfizer, Daichi, NovartisNo other potential conflicts of interest were reported.

Background: Delays in initiating adjuvant chemotherapy after breast cancer surgery seems to have an impact on patients' risk of relapse and their survival rate. The aim of this retrospective study was to identify factors delaying initiation of adjuvant chemotherapy after breast surgery., Material and Methods: All patients undergoing surgical treatment for mammary cancer between June 2014 and June 2015 and receiving adjuvant chemotherapy were selected retrospectively., Results: In multivariate analysis, 3 factors significantly delay initiation of adjuvant chemotherapy: a secondary procedure (odds ratio [OR], 6.67; P = .00012), inclusion in a therapeutic trial (OR, 8.46; P = .0013), and a positive HER2 status (OR, 3.02; P = .063 [statistically significant])., Discussion: This study provides a brief overview of the population most likely to experience a delay in the initiation of their adjuvant chemotherapy after cancer surgery. Our findings should assist interventions during initial management., Competing Interests: Disclosure None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation., Design: The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted., Methods: The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities., Results: The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±)., Conclusion: There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the value of performing a risk-reducting mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer., Design: The CNGOF Commission of Senology, composed of 26 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted., Methods: The Commission of Senology considered 8 questions on 4 topics, focusing on histological, familial (no identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's disease) risk. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival., Results: The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1±) and 5 with a low level of evidence (GRADE 2±)., Conclusion: There was significant agreement among the Commission of Senology members on recommendations to improve practice for performing or not performing RRM in the clinical setting., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)