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Purpose: Immune Checkpoints Inhibitors (ICI) have changed the therapeutic landscape of metastatic renal cell carcinoma first-line treatment with complete response (CR) at metastatic sites observed in 10 to 15% of cases. Delayed nephrectomy could be discussed for patients having a clinical benefit from immunotherapy-based treatment. However, it is unclear whether prior immunotherapy exposure adversely influences the complexity of surgery. The aim of this study was to assess oncological outcomes of differed nephrectomy after immunotherapy, and to identify predictive factors associated with surgical complexity., Methods: This is a multicenter retrospective study from a national cohort of 102 patients treated between March 2015 and March 2023 by differed nephrectomy after complete response (CR) or major partial response (mPR defined as > 80% according to RECIST criteria) on metastatic sites following immunotherapy-based combination treatment. Tumor downsizing was assessed by calculating the percentage reduction from the largest measured tumor diameter, comparing before and after immunotherapy., Results: A total of 102 patients (median age 63.3 years) were included. ICI was administered as first-line in 84.3% of cases, with an ICI-ICI (74.5%) or ICI-TKI combination (25.5%), and with a median duration of treatment of 10 [1-57] months. The majority of procedures are radical nephrectomies (n = 85, 83.3%) with an open approach performed in 52.9% of cases (n = 54). Median operative time was 180 [90-563] minutes and median blood loss was 300 cc [0-4000] cc. Surgeons experienced difficulties due to adhesions and inflammatory reactions at the kidney and the surrounding tissue in 65.7% of cases (n = 67), more frequently in case of partial nephrectomy compared to radical surgery (85% vs. 61%, p = 0.04). In 15 cases (14.7%), the surgical approach changed during the procedure due to these intraoperative difficulties (including 10 patients with open conversion and 3 partial nephrectomies finally converted to radical). We highlighted a relationship between primary renal tumor downsizing and intraoperative complexity. Tumor downsizing > 10% is more likely to induce surgical difficulties (76.1% vs. 45.7%, p = 0.002), but without any impact on postoperative complications rate. Pathology reports show a complete response in 13.7% (n = 14), a pT1-pT2 stage in 29.4% (n = 30) and a pT3-pT4 stage in 56.9% (n = 58), a median ISUP grade 3 and a clear cell carcinoma histology in 95.1% (n = 97). After a median follow-up of 29.6 months, 48% of patients were free from progression and without systemic treatment. Patients with a complete response at the metastatic sites had a better prognosis in terms of recurrence-free survival (82.1% vs. 37.9% at 3 years, p = 0.001)., Conclusion: Delayed nephrectomy after immunotherapy could be a challenging surgical procedure but offers encouraging oncological outcomes., Competing Interests: Declarations. Research involving human participants and/or animals: N/A. Informed consent: N/A. Financial interests: None. Non-financial interests: None. Conflicts of interest: The authors have no conflicts of interest to disclose., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The aim of this study was to analyse the impact of adjuvant trastuzumab on fatigue, emotional status, and quality of personal and work life of patients treated for localised breast cancer., Methods: In a prospective setting, we recruited age-matched localised breast cancer patients, treated by adjuvant chemotherapy with (group 1) or without IV trastuzumab (group 2), between September 2011 and May 2014. Patients completed questionnaires on quality of life (FACT-G, FACT-B), fatigue (FACIT-F, ICQ), anxiety-depression (HADS), and work life (dedicated self-questionnaire) at inclusion then at 3, 6, 9, and 15 months., Results: We included 35 patients in each group. No significant difference was found between the two groups concerning return to work, fatigue, and quality of life scores at each phase of the study. In total, 39 patients (72.2%) reported having returned to work at T15, with no significant difference between the two groups (p = 0.53). Significantly higher scores for'helplessness' outcomes were observed in group 1, 9, and 15 months (6.138 and 5.731; p = 0.047 and 0.048, respectively). Patients in group 1 reported higher score of anxiety-depression than group 2 at 3 months (p = 0.027) then no significant difference was observed at the other times of the study., Conclusion: Trastuzumab does not appear to affect fatigue and return to work in patients with localised breast cancer. The emotional well-being could be affected in patients treated by trastuzumab, with a more pronounced 'helplessness' feeling which could be more related to the additional follow-up imposed by the prescription of trastuzumab., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC)., Methods: In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain., Results: OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836)., Conclusion: We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)