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1. Economics of the clinical management of lung cancer in France: an analysis using a Markov model

Author

Laurent Molinier, Christophe Combescure, Bruno Housset, Jean-Pierre Daurès, Christos Chouaid, A. Vergnenegre, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), C Chouaïd, Molinier L, C Combescure, JP Daurès, B Housset, and SCHILLER A .

Subjects
Male, Oncology, Cancer Research, Lung Neoplasms, Palliative care, medicine.medical_treatment, MESH: Health Care Surveys, MESH: Aged, 80 and over, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Antineoplastic Combined Chemotherapy Protocols, Economic analysis, 030212 general & internal medicine, Carcinoma, Small Cell, Stage (cooking), health care economics and organizations, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Palliative Care, Respiratory disease, MESH: Carcinoma, Small Cell, Health Care Costs, Middle Aged, Markov Chains, 3. Good health, MESH: Antineoplastic Combined Chemotherapy Protocols, Models, Economic, 030220 oncology & carcinogenesis, Costs and Cost Analysis, Female, MESH: Palliative Care, France, management, medicine.medical_specialty, Locally advanced, MESH: Health Care Costs, MESH: Costs and Cost Analysis, economic analysis, Clinical, 03 medical and health sciences, MESH: Markov Chains, Internal medicine, medicine, Carcinoma, Humans, Lung cancer, Aged, MESH: Models, Economic, Chemotherapy, MESH: Humans, business.industry, medicine.disease, Markov model, MESH: Male, MESH: Lung Neoplasms, respiratory tract diseases, Surgery, MESH: France, lung cancer, Health Care Surveys, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, MESH: Carcinoma, Non-Small-Cell Lung
Abstract

International audience; To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20 691 (95% CI: 5777-50 380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31 833 (95% CI: 15 866-64 455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.

Published
2004
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2. Lung cancer risk among bricklayers in a pooled analysis of case-control studies

Author

Consonni, Dario, De Matteis, Sara, Pesatori, Angela C, Bertazzi, Pier Alberto, Olsson, Ann C, Kromhout, Hans, Peters, Susan, Vermeulen, Roel Ch, Pesch, Beate, Brüning, Thomas, Kendzia, Benjamin, Behrens, Thomas, Stücker, Isabelle, Guida, Florence, Wichmann, Heinz-Erich, Brüske, Irene, Landi, Maria Teresa, Caporaso, Neil E, Gustavsson, Per, Plato, Nils, Tse, Lap Ah, Yu, Ignatius Tak-Sun, Jöckel, Karl-Heinz, Ahrens, Wolfgang, Pohlabeln, Hermann, Merletti, Franco, Richiardi, Lorenzo, Simonato, Lorenzo, Forastiere, Francesco, Siemiatycki, Jack, Parent, Marie-Élise, Tardón, Adonina, Boffetta, Paolo, Zaridze, David, Chen, Ying, Field, John K, 't Mannetje, Andrea, Pearce, Neil, McLaughlin, John, Demers, Paul, Lissowska, Jolanta, Szeszenia-Dabrowska, Neonila, Bencko, Vladimir, Foretova, Lenka, Janout, Vladimir, Rudnai, Peter, Fabiánová, Eleonóra, Stanescu Dumitru, Rodica, Bueno-de-Mesquita, Bas, Schüz, Joachim, Straif, Kurt, Risk Assessment, Infection & Immunity, dIRAS RA-2, dIRAS RA-I&I RA, LS IRAS EEPI EXAS (Arb.hyg+bl.st.kar.), LS IRAS EEPI GRA (Gezh.risico-analyse), Consonni, D. and De Matteis, S. and Pesatori, A.C. and Bertazzi, P.A. and Olsson, A.C. and Kromhout, H. and Peters, S. and Vermeulen, R.C.H. and Pesch, B. and Brüning, T. and Kendzia, B. and Behrens, T. and Stücker, I. and Guida, F. and Wichmann, H.-E. and Brüske, I. and Landi, M.T. and Caporaso, N.E. and Gustavsson, P. and Plato, N. and Tse, L.A. and Yu, I.T.-S. and Jöckel, K.-H. and Ahrens, W. and Pohlabeln, H. and Merletti, F. and Richiardi, L. and Simonato, L. and Forastiere, F. and Siemiatycki, J. and Parent, M.-É. and Tardón, A. and Boffetta, P. and Zaridze, D. and Chen, Y. and Field, J.K. and Mannetje, A. and Pearce, N. and McLaughlin, J. and Demers, P. and Lissowska, J. and Szeszenia-Dabrowska, N. and Bencko, V. and Foretova, L. and Janout, V. and Rudnai, P. and Fabiánová, E. and Dumitru, R.S. and Bueno-De-Mesquita, H.B. and Schüz, J. and Straif, K., Courcelles, Michel, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano = University of Milan (UNIMI), Imperial College London, Centre International de Recherche contre le Cancer - International Agency for Research on Cancer (CIRC - IARC), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), The Institute of Environmental Medicine [Stockholm] (IMM), Karolinska Institutet [Stockholm], Institute for Risk Assessment Sciences, Utrecht University [Utrecht], The University of Western Australia (UWA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), National Cancer Institute [Bethesda] (NCI-NIH), National Institutes of Health [Bethesda] (NIH), The Chinese University of Hong Kong [Hong Kong], University Hospital Essen, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Leibniz Association, University of Bremen, Unit of Cancer Epidemiology, Université de Turin-CERMS and Centre for Oncologic Prevention, Università degli Studi di Padova = University of Padua (Unipd), Azienda Sanitaria Locale [ROMA] (ASL), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), CIBER de Epidemiología y Salud Pública (CIBERESP), International Prevention Research Institute (IPRI), Icahn School of Medicine at Mount Sinai [New York] (MSSM), Institute of Carcinogenesis, Russian Cancer Research Centre, Keele University [Keele], University of Liverpool, London School of Hygiene and Tropical Medicine (LSHTM), Samuel Lunenfeld Research Institute, Mount Sinai Hospital [Toronto, Canada] (MSH), Cancer Care Ontario, The M Sklodowska-Curie Cancer Center and Institute of Oncology, The Nofer Institute of Occupational Medicine, Institute of Hygiene and Epidemiology, Charles University [Prague] (CU)-First Faculty of Medicine, Masaryk University [Brno] (MUNI), Department of Optics [Univ Palacký], Faculty of Science [Univ Palacký], Palacky University Olomouc-Palacky University Olomouc, National Institutes of Environmental Health Sciences, Regional Authority of Public Health [Slovaquia] (RAPH), Ministry of Health of the Slovak Republic [Slovaquia], Institute of Public Health, National Institute for Public Health and the Environment [Bilthoven] (RIVM), Grant sponsor: German Social Accident Insurance (DGUV), Grant number: FP 271, Grant sponsors: Canadian Institutes for Health Researchand Guzzo-SRC Chair in Environm ent and Cancer, National Cancer Institute of Canada, Canadian Cancer Society, Occupational Cancer ResearchCentre, Workplace Safety and Insuranc e Boar d, Canadian Cancer Society, and Cancer Care Ontario, Grant sponsor: European Commission’s INCO Copernicus program, Grant number: IC15-CT96-0313, Grant sponsor: European Union Nuclear Fission Safety Program, Grant number:F14P-CT96-0055, Grant sponsors: French Agency of Health Security (ANSES), Fondation de France, French National Research Agency (ANR),National Institute of Cancer (INCA), Fondation pour la Recherche Medicale, French Institute for Public Health Surveillance (InVS), Health Ministry (DGS), Organization for the Research on Cancer (ARC), and French Ministry of work, solidarity, and public function (DGT), Grant sponsor: Federal Ministry of Education, Science, Research, and Technology, Grant number: 01 HK 173/0), Grant sponsor: Federal Ministry of Science, Grant number:01 HK 546/8, Grant sponsor: Ministry of Labour and Social Affairs, Grant number: IIIb7-27/13, Grant sponsor: Research Grants Council of the Hong Kong Special Administrative Region, China, Grant number: CUHK4460/03M, Grant sponsors: Environmental Epidemiology Program of the Lombardy Region, INAIL, Italian Association for Cancer Research, Region Piedmont, Compagnia di San Paolo, Lazio Region, Health Research Council of New Zealand, New Zealand Department of Labour, Lottery Health Research, Cancer Society of New Zealand, Grant sponsor: Polish State Committee for Scientific Research, Grant number: SPUB-M-COPERNICUS/P-05/DZ-30/99/2000, Grant sponsors: Instituto Universitario de Oncologia, Universidad de Oviedo, Asturias, Fondo de Investigacion Sanitaria (FIS) and Ciber de Epidemiologia y Salud Publica (CIBERESP), Swedish Council for Work Life Research and Swedish Environmental Protection Agency, Dutch Ministry of Health, Welfare and Sports, National Institute of Public Health and the Environment, and Europe Against Cancer Program, Roy Castle Foundation, and Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, Risk Assessment, Infection & Immunity, dIRAS RA-2, dIRAS RA-I&I RA, LS IRAS EEPI EXAS (Arb.hyg+bl.st.kar.), LS IRAS EEPI GRA (Gezh.risico-analyse), Università degli Studi di Milano [Milano] (UNIMI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Universita degli Studi di Padova, Charles University and General University Hospital-First Faculty of Medicine, and Masaryk Memorial Cancer Institute and Medical Faculty of Masaryk University

Subjects
Male, Epidemiology, control studies, cancer risk, bricklayer, middle aged, occupation, CARCINOGENS, blue collar worker, POPULATION, comparative study, education.field_of_study, MESH: Middle Aged, risk assessment, WORKERS, MEN, MESH: Carcinoma, Squamous Cell, clinical trial, MESH: Follow-Up Studies, Prognosis, MESH: Case-Control Studies, 3. Good health, Occupational Diseases, [SDV] Life Sciences [q-bio], OCCUPATIONAL-EXPOSURE, hospital based case control study, Oncology, priority journal, risk factor, Adenocarcinoma, Carcinoma, Squamous Cell, case, Human, MESH: Occupational Diseases, medicine.medical_specialty, national cancer institute of, additional supporting information may, case–control studies, employment statu, MESH: Prognosis, Article, Follow-Up Studie, MESH: International Agencies, [SDV.CAN] Life Sciences [q-bio]/Cancer, carcinogen, adult, Humans, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, research and guzzo-src chair, education, CRYSTALLINE SILICA DUST, fp 271, Science & Technology, MESH: Humans, Occupational health, MORTALITY, health care facility, Construction Industry, Case-control study, bricklayers, Odds ratio, case control study, medicine.disease, dguv, lung adenocarcinoma, major clinical study, Lung neoplasm, occupational hazard, MESH: Lung Neoplasms, Occupational Disease, occupational cancer, multicenter study, age, Relative risk, small cell lung cancer, Occupational medicine, MESH: Female, population research, Cancer Research, online version of this, [SDV]Life Sciences [q-bio], canada, Medizin, medicine.disease_cause, MESH: Occupational Exposure, grant number, Risk Factors, MESH: Risk Factors, Carcinoma, Small Cell, Medicine (all), international cooperation, grant sponsor, article, canadian institutes for health, MESH: Carcinoma, Small Cell, be found in the, MESH: Construction Industry, female, NORDIC COUNTRIES, International Agencie, canadian cancer society, epidemiology, grant sponsors, Gustavsson, in environment and cancer, Case-Control Studie, Life Sciences & Biomedicine, lifespan, prognosi, Population, UNITED-STATES, [SDV.CAN]Life Sciences [q-bio]/Cancer, lung neoplasms, Asbestos, smoking, building industry, occupational health, Internal medicine, Occupational Exposure, medicine, follow up, controlled study, occupational, Lung cancer, population based case control study, Plato, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, adenocarcinoma, business.industry, case-control studies, Risk Factor, Carcinoma, MESH: Adenocarcinoma, International Agencies, Small Cell, Confidence interval, MESH: Male, human tissue, Surgery, lung cancer, german social accident insurance, Squamous Cell, Bricklayers, Case-control studies, Lung neoplasms, Adenocarcinoma, Case-Control Studies, Female, Follow-Up Studies, Lung Neoplasms, Middle Aged, business, CONSTRUCTION-INDUSTRY, squamous cell lung carcinoma
Abstract

Bricklayers may be exposed to several lung carcinogens, including crystalline silica and asbestos. Previous studies that analyzed lung cancer risk among these workers had several study design limitations. We examined lung cancer risk among bricklayers within SYNERGY, a large international pooled analysis of case–control studies on lung cancer and the joint effects of occupational carcinogens. For men ever employed as bricklayers we estimated odds ratios (OR) and 95% confidence intervals (CI) adjusted for study center, age, lifetime smoking history and employment in occupations with exposures to known or suspected lung carcinogens. Among 15,608 cases and 18,531 controls, there were 695 cases and 469 controls who had ever worked as bricklayers (OR: 1.47; 95% CI: 1.28–1.68). In studies using population controls the OR was 1.55 (95% CI: 1.32–1.81, 540/349 cases/controls), while it was 1.24 (95% CI: 0.93–1.64, 155/120 cases/controls) in hospital-based studies. There was a clear positive trend with length of employment (p < 0.001). The relative risk was higher for squamous (OR: 1.68, 95% CI: 1.42–1.98, 309 cases) and small cell carcinomas (OR: 1.78, 95% CI: 1.44–2.20, 140 cases), than for adenocarcinoma (OR: 1.17, 95% CI: 0.95–1.43, 150 cases) (p-homogeneity: 0.0007). ORs were still elevated after additional adjustment for education and in analyses using blue collar workers as referents. This study provided robust evidence of increased lung cancer risk in bricklayers. Although non-causal explanations cannot be completely ruled out, the association is plausible in view of the potential for exposure to several carcinogens, notably crystalline silica and to a lesser extent asbestos. WHAT'S NEW?: In their work, bricklayers can be exposed to various airborne carcinogens, including crystalline silica and asbestos. Previous studies of cancer risk have not accounted for full employment history or smoking status, and failed to establish a firm relationship between bricklaying and lung cancer. In this study, the authors used data from the largest collection of case-control studies on lung cancer with complete occupational and smoking history existing today, the SYNERGY project. They found clear evidence that lung cancer risk increases in proportion to the length of time spent working as a bricklayer, paving the way for better protection and compensation for those in this occupation.

Published
2015
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3. Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies

Author

Bruno Housset, Christos Chouaid, Jean-Paul Tillement, K. Atassi, Isabelle Monnet, Claire Fuhrman, Jean-Claude Duché, I Abd Alsamad, Annesi-Maesano, Isabella, Unité fonctionnelle de pharmacologie-toxicologie, CHI Créteil, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche sur les Ions, les MAtériaux et la Photonique (CIMAP - UMR 6252), Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Fuhrman C, Duche JC, C Chouaid, Abd je Alsamad, K Atassi, je Monnet, JP Tillement, B Housset ., Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche sur les Matériaux Avancés (IRMA), Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), and Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Mesothelioma, Pathology, Lung Neoplasms, Pleural effusion, MESH: Keratin-19, Tissue Polypeptide Antigen, Clinical Biochemistry, MESH: Antigens, Neoplasm, Gastroenterology, 0302 clinical medicine, Carcinoembryonic antigen, Malignant pleural effusion, Prospective Studies, Carcinoma, Small Cell, Hyaluronic Acid, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, biology, MESH: Carcinoma, Small Cell, MESH: Carcinoma, Squamous Cell, General Medicine, Middle Aged, respiratory system, 3. Good health, Area Under Curve, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, Keratins, Female, MESH: Pleural Effusion, MESH: Carcinoembryonic Antigen, medicine.medical_specialty, Pleural Neoplasms, Adenocarcinoma, Sensitivity and Specificity, MESH: Pleural Neoplasms, Diagnosis, Differential, 03 medical and health sciences, MESH: Tissue Polypeptide Antigen, MESH: Diagnosis, Differential, Antigens, Neoplasm, Internal medicine, Biomarkers, Tumor, medicine, Thoracoscopy, Humans, Aged, Tumor marker, Keratin-19, MESH: Humans, MESH: Hyaluronic Acid, MESH: Mesothelioma, business.industry, MESH: Adenocarcinoma, MESH: Keratins, MESH: ROC Curve, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: Sensitivity and Specificity, MESH: Lung Neoplasms, Carcinoembryonic Antigen, respiratory tract diseases, Pleural Effusion, ROC Curve, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Tumor Markers, Biological, biology.protein, MESH: Area Under Curve, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Differential diagnosis, business, MESH: Female
Abstract

International audience; STUDY OBJECTIVE: The aim of the study was to assess diagnosis value of tumor markers for differential diagnosis between mesothelioma and other pleural tumors. DESIGN AND METHODS: Prospective study of 85 patients attending our hospital with malignant pleural effusion. The diagnostic approach involved routine pleurocentesis followed by pleural needle. When precise diagnosis was not achieved, thoracoscopy with pleural biopsies was performed. Carcinoembryonic antigen (CEA), hyaluronic acid, tissue polypeptide antigen and cyfra 21 to 1 were measured in serum and pleural fluid. RESULTS: By using receiver operating characteristics curves and area under curves, the best diagnostic characteristics were obtained with pleural and serum CEA concentrations. The area under the curve was larger for pleural ACE than for serum ACE. The sensitivity and specificity of a pleural CEA level exceeding 3 ng/mL for ruling out the diagnosis of mesothelioma were 100% and 77%, respectively. CONCLUSION: A CEA level above 3 ng/mL in pleural fluid eliminated the diagnosis of mesothelioma, whereas the other markers were not sufficiently discriminant. However, despite a negative predictive value of 100% at a cutoff of 3 ng/mL, CEA assay in pleural fluid only avoids a small number of diagnostic thoracoscopies.

Published
2000
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4. Phase III double-blind, placebo-controlled study of thalidomide in extensive-disease small-cell lung cancer after response to chemotherapy: an intergroup study FNCLCC cleo04 IFCT 00-01

Author

Jean Luc Breton, Virginie Westeel, Elisabeth Quoix, Dominique Maraninchi, Sabine Gameroff, Radj Gervais, Jean-Louis Pujol, H. Janicot, Philippe David, Jean Genève, Marie-Laure Tanguy, Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de pneumologie, CHU Strasbourg-Hopital Civil, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC), Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre François Baclesse, Service de biostatistiques et information médicale [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO)

Subjects
Male, Cancer Research, Lung Neoplasms, medicine.medical_treatment, Placebo-controlled study, Gastroenterology, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Proportional Hazards Models, 0302 clinical medicine, MESH : Female, MESH: Double-Blind Method, Carcinoma, Small Cell, Etoposide, 0303 health sciences, MESH: Middle Aged, MESH: Thalidomide, MESH: Carcinoma, Small Cell, Middle Aged, MESH : Survival Rate, Thalidomide, 3. Good health, Survival Rate, Oncology, 030220 oncology & carcinogenesis, MESH : Disease-Free Survival, Female, medicine.drug, medicine.medical_specialty, Cyclophosphamide, MESH: Survival Rate, MESH : Male, [SDV.CAN]Life Sciences [q-bio]/Cancer, Placebo, Disease-Free Survival, MESH : Thalidomide, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Humans, MESH : Double-Blind Method, MESH : Middle Aged, MESH : Lung Neoplasms, Lung cancer, Survival rate, Proportional Hazards Models, 030304 developmental biology, Chemotherapy, MESH: Humans, business.industry, MESH : Humans, medicine.disease, MESH : Proportional Hazards Models, MESH: Male, Surgery, MESH : Carcinoma, Small Cell, MESH: Lung Neoplasms, MESH: Disease-Free Survival, business, MESH: Female
Abstract

Purpose This randomized, double-blind, placebo-controlled phase III study aimed to determine whether thalidomide prolongs survival of patients with extensive-disease small-cell lung cancer (SCLC). Patients and Methods One hundred nineteen patients received two courses of etoposide, cisplatin, cyclophosphamide, and 4′-epidoxorubicin (PCDE). Responder patients who had recovered from chemotherapy toxicity were randomly assigned to receive four additional PCDE cycles plus thalidomide (400 mg daily) or placebo. Results After the first two PCDE cycles, objective response rate was 81.5%, and 92 patients were randomly assigned to placebo (n = 43) or thalidomide (n = 49). Median exposure duration to placebo was 4.5 months, and median exposure to thalidomide was 4.9 months. Patients treated with thalidomide had a longer survival compared with patients who received placebo, although the difference was not statistically significant (minimal follow-up, 3 years; median survival time, 11.7 v 8.7 months, respectively; log-rank test: hazard ratio [HR] = 0.74; 95% CI, 0.49 to 1.12; P = .16). Patients with a performance status (PS) of 1 or 2 who received thalidomide had a significantly longer survival (HR = 0.59; 95% CI, 0.37 to 0.92; P = .02). The disease also progressed slower in patients with PS of 1 or 2 receiving thalidomide (HR = 0.54; 95% CI, 0.36 to 0.87; P = .02), whereas the difference did not reach statistical significance for the whole population (HR = 0.74; 95% CI, 0.49 to 1.12; P = .15). Neuropathy occurred more frequently in the thalidomide group compared with the placebo group (33% v 12%, respectively). Conclusion Treatment with thalidomide was not associated with a significant improvement in survival of SCLC patients. There was pronounced heterogeneity in survival outcomes between groups of patients. Some benefit was observed among patients with a PS of 1 or 2 (exploratory analyses), deserving further studies targeting angiogenesis in this disease.

Published
2007
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5. Prognosis of lung cancer patients with life-threatening complications

Author

Jorge I. F. Salluh, Elie Azoulay, Nelson Spector, Guillaume Thiery, Michael Darmon, Carlos Gil Ferreira, Benoît Schlemmer, Marcio Soares, Intensive Care Unit, Instituto Nacional de Câncer, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Clinical Research, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), and Vesin, Aurélien

Subjects
Male, Lung Neoplasms, MESH: Comorbidity, Comorbidity, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, MESH: Cause of Death, 0302 clinical medicine, Risk Factors, law, MESH: Risk Factors, Carcinoma, Non-Small-Cell Lung, Cause of Death, Hospital Mortality, Carcinoma, Small Cell, MESH: Respiration, Artificial, MESH: Multiple Organ Failure, MESH: Cohort Studies, Cause of death, MESH: Aged, MESH: Middle Aged, Respiratory disease, MESH: Carcinoma, Small Cell, Middle Aged, Prognosis, Shock, Septic, Intensive care unit, 3. Good health, Intensive Care Units, 030220 oncology & carcinogenesis, MESH: Survival Analysis, MESH: Critical Illness, Disease Progression, Female, MESH: Disease Progression, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, Brazil, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Illness, Multiple Organ Failure, MESH: Shock, Septic, MESH: Prognosis, 03 medical and health sciences, Intensive care, Internal medicine, medicine, Humans, MESH: Hospital Mortality, Lung cancer, Intensive care medicine, Aged, MESH: Humans, business.industry, Cancer, medicine.disease, Respiration, Artificial, Survival Analysis, MESH: Male, MESH: Lung Neoplasms, 030228 respiratory system, Respiratory failure, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Brazil, MESH: Female, MESH: Respiratory Insufficiency, MESH: Carcinoma, Non-Small-Cell Lung
Abstract

International audience; BACKGROUND: The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients. METHODS: Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil. RESULTS: Of the 143 patients (mean age, 61.6 +/- 9.9 years [+/- SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality. CONCLUSIONS: The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancer per se was not associated with mortality and, therefore, should not be factored into ICU triage decisions.

Published
2007
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6. [Pemetrexed development in oncology]

Author

Chaigneau, Loïc, Villanueva, Christian, Thierry-Vuillemin, Antoine, Legat-Fagnoni, Christine, N'Guyen, Thierry, Maurina, Tristan, Lorgis, Véronique, Pivot, Xavier, Saas, Philippe, Service d'Oncologie Médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Pôle pharmaceutique [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])

Subjects
Male, Mesothelioma, Antimetabolites, Antineoplastic, Guanine, Lung Neoplasms, [SDV.IMM] Life Sciences [q-bio]/Immunology, Pleural Neoplasms, Pemetrexed, Digestive System Neoplasms, MESH: Pleural Neoplasms, MESH: Glutamates, Glutamates, Carcinoma, Non-Small-Cell Lung, Humans, Carcinoma, Small Cell, Enzyme Inhibitors, MESH: Guanine, MESH: Antimetabolites, Antineoplastic, MESH: Humans, MESH: Mesothelioma, MESH: Digestive System Neoplasms, MESH: Carcinoma, Small Cell, MESH: Respiratory Tract Neoplasms, Respiratory Tract Neoplasms, MESH: Male, MESH: Lung Neoplasms, MESH: Enzyme Inhibitors, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, MESH: Urogenital Neoplasms, MESH: Female, Urogenital Neoplasms, MESH: Carcinoma, Non-Small-Cell Lung
Abstract

International audience; The pemetrexed disodium (Alimta), LY231514) is the first antifolate able to inhibit at the same time the synthesis of purins and pyrimidins. Many therapeutic tests were carried out in clinical situations where the methotrexate and the fluorouracil had been the proof of their effectiveness. It then showed an interesting activity in a great number of tumours but with very different profiles of tolerance according to the studies and pathologies. The explanation will come in 2001 by the description from the relation between the vitamin deficiencies among treated patients and occurred from toxicities. The two randomized studies carried out in the malignant pleural mesothelioma and the non small cell lung cancer made it possible to establish its utility and to record the pemetrexed in these clinical situations. Others axes of development remain possible, but the results are stanby or to confirm as in squamous-cell cancer in the head and neck and breast, digestive or urinary tracts cancer. In all the cases, the optimization of the pemetrexed in terms of amount/methods of administration and associations possible because of its profile of tolerance makes of it a molecule of chemotherapy with a future.

Published
2007

7. [The progression of lung cancer incidence in France (1978-2000)]

Author

Molinié, F., Velten, M., Remontet, L., Bercelli, P., Réseau Francim, Danzon, Arlette, Département d'Ingénierie des Systèmes (ex SIS) (DIS), Institut de Recherches sur les lois Fondamentales de l'Univers (IRFU), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Registre des cancers du Bas-Rhin, CRLCC Paul Strauss, Hospices Civils de Lyon, Service de Biostatistique, Université de Lyon, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département d'Ingénierie des Systèmes (ex SIS) ( DIS ), Institut de Recherches sur les lois Fondamentales de l'Univers ( IRFU ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay, Laboratoire Biostatistique-Santé ( LBS ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre National de la Recherche Scientifique ( CNRS ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO)

Subjects
MESH: Smoking, MESH: Registries, MESH : Male, MESH : Risk, MESH : Mortality, MESH : Age Distribution, MESH : Aged, MESH : Cohort Studies, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Morbidity, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Adenocarcinoma, MESH: Aged, 80 and over, MESH : Middle Aged, MESH : Female, MESH : Lung Neoplasms, MESH: Incidence, MESH : Carcinoma, Squamous Cell, MESH : France, MESH : Aged, 80 and over, MESH : Sex Distribution, MESH: Age Distribution, MESH: Cohort Studies, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: Risk, MESH: Mortality, MESH : Humans, MESH: Adenocarcinoma, MESH: Sex Distribution, MESH: Adult, MESH: Carcinoma, Small Cell, MESH: Carcinoma, Squamous Cell, MESH : Adult, MESH : Incidence, MESH: Male, MESH : Carcinoma, Small Cell, MESH: Lung Neoplasms, MESH : Smoking, MESH: France, MESH: Morbidity, MESH : Carcinoma, Large Cell, MESH: Carcinoma, Large Cell, MESH: Female, MESH : Registries
Abstract

International audience; INTRODUCTION: Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000. METHODS: National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type. RESULTS: In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply. CONCLUSIONS: The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

Published
2006

8. Economic analyses and lung cancer

Author

Vergnenegre, A., Molinier, L., christos chouaid, Annesi-Maesano, Isabella, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), SCHILLER A, Molinier L, and C Chouaïd .

Subjects
Male, Canada, MESH: Humans, Lung Neoplasms, Cost-Benefit Analysis, MESH: Health Care Costs, MESH: Carcinoma, Small Cell, Health Care Costs, MESH: Cost of Illness, MESH: Male, MESH: Lung Neoplasms, MESH: France, Cost of Illness, MESH: Canada, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Carcinoma, Non-Small-Cell Lung, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, France, Carcinoma, Small Cell, MESH: Female, MESH: Carcinoma, Non-Small-Cell Lung, MESH: Cost-Benefit Analysis
Abstract

International audience; The economic assessment of treatments or medical strategies has been the subject of an increasing number of publications. The elevated costs and relative lack of efficacy of many treatments of chronic diseases such as lung cancer are an added impetus to such analyses. In the first part of this review, we summarise the theoretical basis of economic assessment, the tools available and the limitations of these methods. In the second part, we examine their application to the treatment of lung cancer. We discuss the evaluation of the cost of these cancers to society, economic assessment of new chemotherapeutic drugs, and the place of cost-effectiveness analysis in randomized trials. In the last part, we outline the interest and future of such considerations for clinicians. These methods, which provide complementary data for clinicians when making decisions on therapeutic options, will be adopted more widely in coming years.

Published
2002

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