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Resume En France, en 2010, le cout du cancer est tres eleve, 17 milliards € en incluant les couts indirects. En 2014, les depenses remboursees par l’Assurance Maladie sont de l’ordre de 13,5 milliards € (1 % pour le cancer du poumon). Le cout moyen de ce cancer est passe de 20 000€ en 1998 a 40 000€ en 2009 par an. L’apparition de nouvelles molecules pourrait representer au niveau mondial, en 2030, une depense de 47 milliards $ pour le nivolumab et 84 milliards $ pour le pembrolizumab. Au Canada, la probabilite d’etre cout-efficace avec le nivolumab en deuxieme ligne etait de 45 % (seuil de 150 000 CAN$). Le meme produit a ete considere comme non cout-efficace en Suisse. Pour le pembrolizumab, la probabilite (au seuil de 200 000$ par QALY) d’etre cout-efficace etait de 75 %. En France, les simulations montrent que, pour le cout des produits, le ratio est de 1 a 13 entre le pembrolizumab et le docetaxel, de 1 a 3,5 avec le pemetrexed. Les ratios sont legerement inferieurs avec le nivolumab. L’introduction d’etudes medico-economiques sur l’immunotherapie est imperative. Seule la prescription du bon produit au bon malade, correctement selectionne, pourra se reveler cout-efficace.

Resume Introduction Cet article presente un etat des lieux et les tendances evolutives des donnees epidemiologiques, cliniques et microbiologiques de la tuberculose en 2010. Etat des connaissances Avec un taux de 8,2 cas de tuberculose pour 100 000 habitants en 2009, la France appartient aux pays a faible incidence de tuberculose. Cependant, ce taux d’incidence masque des disparites puisque l’incidence de la tuberculose est encore tres elevee dans certains groupes de population et dans certaines zones geographiques. Le taux de declaration est eleve chez les personnes sans domicile fixe et chez les personnes nees a l’etranger, particulierement parmi celles recemment arrivees en France. L’Ile-de-France et la Guyane ont egalement des taux d’incidence nettement plus eleves par rapport aux autres regions. Les cas de tuberculose pulmonaires representent 72 % des tuberculoses et 49 % sont positives a l’examen microscopique des crachats. Perspectives-conclusions Sauf en 2007 et 2008, depuis vingt ans, l’incidence de la tuberculose en France baisse regulierement. C’est de nouveau le cas en 2009. Ces resultats incitent neanmoins a la vigilance et les mesures visant a reduire les disparites au sein de certaines populations devront etre evaluees dans les annees a venir en termes d’impact sur l’epidemiologie de la tuberculose.

Resume Les cancers bronchiques a petites cellules (CPC) representent aujourd’hui moins de 15 % de l’ensemble des cancers du poumon. Le pronostic est lie a la dissemination de la maladie. Lorsqu’elle est facilement accessible et qu’elle ne retarde pas la realisation du traitement, la realisation d’une scintigraphie a emission de positons permet d’affirmer le caractere localise de la maladie et de justifier une attitude plus agressive. Les progres recents portent essentiellement sur les modalites de la radiotherapie (administration concomitante avec la chimiotherapie, nombres de doses et fractionnement des doses). L’irradiation prophylactique cerebrale est un standard chez les patients en reponse. Il est recommande de traiter en deuxieme et de troisieme lignes par chimiotherapie. Il n’y a pas de nouvelle molecule prometteuse en dehors peut-etre de l’amburicine. Les therapies ciblees se sont toutes montrees decevantes. Tres peu d’essais cliniques concernent aujourd’hui le CPC, qui devient une maladie « orpheline ».

Objectif de l’etude Depuis 2014, plusieurs essais randomises ont montre la superiorite des inhibiteurs de checkpoint immunitaires, et notamment des anti PD-1, dans le traitement des cancers bronchiques non a petites cellules metastatiques, par rapport a la chimiotherapie. Ces patients recoivent souvent de maniere sequentielle rapprochee ou concomitante du nivolumab, un inhibiteur de PD-1, et une radiotherapie, souvent a visee symptomatique. Neanmoins, meme si les etudes precliniques suggerent une potentielle synergie entre les deux traitements, la tolerance de cette association est meconnue. Materiel et methode Nous avons analyse retrospectivement une large serie de patients atteints d’un cancer bronchique non a petites cellules metastatiques, traites dans trois centres francais et ayant recu une radiotherapie dans les six mois precedents et une injection de nivolumab les trois mois suivant ou en concomitance. Resultats Parmi les 104 patients inclus (37 femmes, 67 hommes, d’âge median 60,3 ans, 67 % d’indices de performance inferieur a 2, 93 % de fumeurs actifs ou sevres) et les 144 cibles irradiees incluses, des effets secondaires ont ete observes chez 62 patients (59,6 %), dont dix souffrant au moins d’une toxicite de grade III-IV. Pour neuf de ces dix patients, cette toxicite severe etait immuno-induite, en rapport avec les injections de nivolumab. Les taux de survie globale a 1 et 2 ans etaient respectivement de 48,8 % et 29,1 % et ceux de survie sans progression de 20,9 % et 10,1 %. Le delai d’administration de la radiotherapie avant ou pendant/apres le nivolumab, n’influencait pas les taux de survie ou la frequence des effets indesirables. La survie sans progression etait significativement plus longue pour les patients souffrant d’effets secondaires induits par le nivolumab (p = 0,038). Conclusion Il s’agit a ce jour de la serie retrospective la plus large evaluant specifiquement l’association de nivolumab et de radiotherapie chez les patients atteints de cancer bronchique non a petites cellules metastatiques. Cette combinaison therapeutique est bien toleree et ne semble pas etre associee a un surcroit d’effets indesirables.

Les cancers broncho-pulmonaires (CBP) ont fait l'objet du plus grand nombre de publications dans le domaine medico-economique au cours de cette annee. Les BPCO sont egalement un theme riche en publications dans ce domaine.

Erlotinib can be prescribed in the treatment of locally advanced or metastatic non-small lung cancer cell (NSCLC) after failure of at least one prior chemotherapy regimen on the basis of the BR-21 study. Several publications have recently questioned these results. The metabolic imaging of solid tumours by positron emission tomography is a research field that could help customize the treatment of NSCLC and so complement the treatment approaches allowed by genetic analyses. This strategy is part of an innovative "early metabolic look" approach. The primary objective of this study is to determine if metabolic progression observed between the 7th and 14th day after initiation of treatment with erlotinib by 3'-Deoxy-3'-[18F]-Fluorothymidine PET in patients with EGFR naive NSCLC is predictive for morphological progression after 6 to 8 weeks of treatment. A health economic analysis will be conducted. This study is particularly innovative because it begins the exploration of the era of metabolic evaluation of therapeutic response in NSCLC.

International audience; Failure Mode, Effects, and Criticality Analysis (FMECA) is used in industry to prevent process or product failures. We studied the feasibility of this method in hospital organizations. FMECA was used to improve drug prescription in two medical wards. Failure modes were identified and classified hierarchically. Corrective actions were taken. Involvement of all the professionals concerned in this process was obtained, and has resulted in real acceptance of the proposed changes and in their effective realization.

EPO’s biosimilars in oncology. After a reminder on general conditions for prescribing EPOs and international recommendations, the more specific prescription of biosimilars, their interchangeability, guidelines, traceability, are considered.

Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population.A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total.We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed.

This article presents recent data and trends on the epidemiology, clinical presentation and microbiology of tuberculosis in France during 2010.In 2009, a total of 5759 cases were notified in France, representing a rate of 8.2 cases per 100,000. The notification rate was below 10 per 100,000 in all French regions, except in Île-de-France and French Guyana. Notification rates were higher in some population groups such as people born abroad, especially those born in Sub-Saharan Africa, and those recently arrived in France, as well as in homeless people. Pulmonary tuberculosis accounted for 72% of notified cases, 49% of which were contagious (positive direct examination of sputum, positive culture). PERSPECTIVES-CONCLUSIONS: Except in 2007 and 2008 the incidence of tuberculosis (TB) has fallen consistently in France for the last 20 years and this was again the case in 2009. These results support the maintenance of a vigilant approach to the control of the disease and call for the enhancement of public health activities in population groups at higher risk of the disease.

International audience; CONTEXT: Erlotinib therapy for non small-cell lung cancer (NSCLC) has mainly been evaluated in randomized trials. METHOD: OBSTAR was a multicenter, retrospective, observational study involving all patients treated with erlotinib in 18 French centers between June 2005 and September 2007. The analyses focused on the patients' characteristics, previous treatments, and treatment efficacy during a three-year follow-up period. RESULTS: 534 patients were included in this study. The median survival times were respectively 5.2 [3.7-7.4] and 4.7 [4.1-5.7] months, depending to whether erlotinib was used as second- (n=190), or ≥third-line treatment (n=305). The disease control rate were 39.1% [30.2-48.7] and 29.9% [29.6-36.9] according to the line of treatment. Factors predictive of an objective response were gender, age, and smoking status. Factors predictive of progression were age, sex, smoking status, the line of treatment, and the number of metastases. Treatment had to be interrupted for toxicity in 8.5% of cases. CONCLUSION: This study of erlotinib therapy in 2005-2007 confirms, in the general NSCLC patient population, the results of pivotal trials.

La prevalence de l’anemie en cancerologie dans une population de 870 000 personnes, est de 38 % sans traitement et de 62 % pour les anemies induites par la chimiotherapie (1). Les causes de l’anemie en cancerologie peuvent se classer en quatre grandes categories : peripheriques (hemorragie, hemolyse, deficit nutritionnel); inflammation (diminution de la survie des hematies, diminution de l’utilisation du fer); insuffisance medullaire (infiltration de la moelle osseuse par la tumeur, anemies de maladies chroniques); traitements (chimiotherapies et radiotherapie).

International audience; There has been an increasing number of publications dealing with the assessment of treatments or medical strategies. Chronic diseases like lung cancer require such an analysis, in relation to their costs and their poor efficacy. In its first part, this review shows the theoretical basis of economic assessment, the available tools and the limits of these methods. The second part points out their use in lung cancer: cost evaluation of these cancers for the society, economic assessment of new chemotherapic drugs, cost-effectiveness analysis in randomized trials. These methods give to the clinicians complementary results for their final decision.

The mechanisms controlling erythropoietin (EPO) synthesis by the kidney in patients with chronic obstructive lung disease (COLD) or congestive left heart failure (CLHF) remain incompletely understood. Renal dysfunction occurs as a consequence of decreased renal blood flow (RBF) in these diseases. Because alterations in renal haemodynamics may affect EPO synthesis and red blood cell production, we investigated the potential relationships between renal function and plasma EPO synthesis in patients with COLD or CLHF. Thirty-two patients with COLD and 13 with CLHF underwent determination of renal physiology parameters, plasma EPO levels and haemoglobin levels. Plasma EPO concentrations were increased in patients with COLD or CLHF as compared to normal subjects, and were inversely correlated to haemoglobin concentrations. In patients with COLD or CLHF, plasma EPO was negatively correlated with both RBF and renal oxygen delivery (ROD) and positively correlated with filtration fraction. Plasma EPO was not correlated with glomerular filtration rate, fractional excretion of sodium, PO2 or PCO2. Among the patients with COLD, those with polycythemia (haemoglobin150 g L-1) had lower plasma EPO and higher RBF and ROD values than those with normocythemia (haemoglobinor = 150 g L-1). Taken together, our data suggest that in patients with COLD or CLHF the critical determinant for EPO production is impairment of renal haemodynamics.