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Brain metastases (BM) are a common occurrence of systemic cancers. Technical improvements in neuroimaging offer additional tools for an early detection of BM, to target them precisely and differentiate these lesions from other cerebral pathologies. The therapeutic tools have also evolved from neurosurgery and whole brain therapy to include stereotactic radiosurgery, targeted and immune therapies. Given the numerous treatment options available, a multidisciplinary approach is essential to offer the patient a personalized approach to optimize the sequence and combination of treatments to offer the best outcome possible. This article aims to review key elements of diagnosis, risk stratification and modern treatment paradigms in the diagnosis and management of BM.Les métastases cérébrales (MC) sont une manifestation fréquente des cancers systémiques. Les améliorations des techniques de radiologie offrent des options supplémentaires pour détecter de manière précoce les MC, les cibler avec précision et les différencier d’autres pathologies. Les outils thérapeutiques se sont également élargis pour inclure des techniques de radiothérapie stéréotaxiques, des thérapies ciblées et des immunothérapies. Au vu des nombreuses options de traitement pour les patients souffrant de MC, une approche multidisciplinaire doit impérativement être favorisée pour personnaliser le traitement de chaque patient et améliorer le pronostic. Cet article décrit les éléments clés du diagnostic, de la stratification du risque et les paradigmes modernes de la prise en charge et des traitements des patients avec MC.

In recent years, new therapeutic strategies for non-small cell lung cancer (NSCLC) have been developed, stemming from a better understanding of oncogenic signaling pathways. The analysis of the alterations of genes involved in NSCLC oncogenesis is now an integral part of the diagnostic approach and opens the way to so-called "targeted" therapies. In this article, we will share the latest therapeutic advances by focusing on alterations of HER2, MET, EGFR and KRAS genes, for which new dedicated treatments have become available.Au cours de ces dernières années, de nouvelles stratégies thérapeutiques pour le cancer du poumon non à petites cellules (CPNPC) se sont développées, découlant d’une meilleure compréhension des voies de signalisation oncogéniques. L’analyse des altérations de gènes impliqués dans le développement de ce sous-type de maladie oncologique fait désormais partie intégrante de la démarche diagnostique et ouvre la voie à des thérapies dites « ciblées ». Nous partagerons dans cet article les dernières avancées thérapeutiques en nous intéressant aux altérations des gènes

Despite COVID-19 pandemic, which is still deeply affecting world economy and global health, medical oncology specialists keep pursuing their effort for the identification of new therapeutic options to improve patients' life expectancy and quality of life. 2021 confirms the immunotherapy efficacy, alone or in combination with other modalities, across several indications. This year, we are summarizing the new approaches in the following sectors: lung, breast, melanoma, gynecological, digestive, urological and ENT areas.En dépit de la pandémie de Covid-19 qui continue à grandement impacter l’économie mondiale et la santé, l’oncologie médicale poursuit sa quête d’identification de nouvelles options thérapeutiques ayant pour buts la prolongation de l’espérance de vie et l’amélioration de la qualité de vie de ses patients, en nombre croissant. L’année 2021 confirme également l’efficacité de l’immunothérapie, seule ou en combinaison à d’autres modalités, dans de nombreuses indications. Cette année, nous vous résumons les nouvelles approches dans les domaines suivants: poumon, sein, mélanome, sphères gynécologique, digestive, urologique et ORL.

Introduction For patients with corticosteroid (CS)-refractory immune checkpoint inhibitor–related cholangiohepatitis (irCH), no consensus exists regarding treatment, and outcomes remain poor. We evaluated the possibility of personalized treatment according to the patient’s cytokine profile and the immunohistopathologic assessment of the predominant immune infiltrate type of liver tissue. Methods NSCLCs with CS-refractory irCH were analyzed by immunohistochemistry of liver biopsy specimen, serum cytokine panel, and assessment of peripheral blood mononuclear cell immune cell monitoring by mass cytometry. Results A total of three consecutive patients with irCH were identified. We found a predominant T-cell infiltrate and an interferon-gamma or T helper 1 proinflammatory cytokine profile. Here, we report for the first time that a T-cell–targeted therapy with the interleukin (IL)-6 receptor-neutralizing antibody tocilizumab, which inhibits signaling downstream of interferon-gamma and several other Janus kinase–dependent cytokines, is an effective single cytokine-directed therapy for CS-refractory irCH. Three patients with severe, CS-refractory irCH who were treated with tocilizumab were found to have persistent clinical and biological remission. Conclusions Dysregulation of the IL-6/T-cell axis may contribute to the pathogenesis of CS-refractory irCH. Our observations suggest that IL-6 blockade seems to have promise in the treatment of CS-refractory irCH. The results from our three patients need to be confirmed in a larger patient population.

Small cell lung cancer is a recalcitrant malignancy with 5-year survival rates of less than 20%. In the majority of cases, patients have metastatic disease at diagnosis despite the new screening method by low-dose CT-scan. The high throughput sequencing has deepened our understanding of its biology. While the treatment of localized disease has changed little, the arrival of immune checkpoint inhibitors have revolutionized the management of extensive disease. At the same time, new strategies involving certain potential genetic targets are being analyzed on a large scale that could become valuable therapeutic alternatives in the future. Radiation therapy remains a very useful therapeutic modality in all stages of the disease. This article aims to review the epidemiology, molecular pathology, management and innovative therapies in small-cell lung cancer.Le cancer pulmonaire à petites cellules (CPPC) est une tumeur récalcitrante avec une survie à 5 ans de moins de 20 %. Il est fréquemment découvert à un stade métastatique malgré le nouveau dépistage par

Driven by highly specialized medicine, research and the quest for personalization of treatments, oncology witnessed substantial advances in 2019. This year numerous treatments have consolidated their importance and broadened their indications. Multiple innovative treatments, currently under study, brought hope for future advances, while biomarkers, such as PD-L1, microsatellite instability (MSI), tumor mutational burden (TMB), BRCA1/2 gene mutations, and homologous recombination deficiency (HRD) allowed better selection and customization of available treatments. This article provides an overview of this year's advances in oncology.Sous l’égide de la médecine hautement spécialisée, de la personnalisation des traitements et secondée par une recherche énergique, l’oncologie a connu en 2019 des avancées considérables. Cette année, de nombreux traitements ont consolidé leur importance et élargi leurs indications. L’annonce d’une pléthore de traitements novateurs, en étude, est source d’espoir pour l’avenir. Des biomarqueurs simples ou composites, tels que l’expression PD-L1, l’instabilité de microsatellite (MSI), la charge mutationnelle tumorale (TMB), les mutations des gènes

Lung cancer remains the leading cause of cancer-related deaths worldwide in women and men. In incidence, lung cancer ranks second, surpassed by breast cancer in women and prostate cancer in men. However, the historical differences in mortality and incidence rate between both sexes have changed in the last years. In the last decades, we have also witnessed an increased number of lung cancer in female never-smokers. These disparities have grown our interest in studying the impact of the gender and sex in the presentation of lung cancer. The aetiology is yet to be fully elucidated, but the data are clear so far: there is a growing divide between lung cancer presentation in women and men that will change our management and study of lung cancer. This article aims to review the sex and gender differences in lung cancer.

The primary treatment of ovarian cancer consists in a complete surgical debulking followed by adjuvant chemotherapy combining platinum with taxanes. Despite this treatment, patient survival has remained stable over the last 20 years. Recently, advances in the sequence, regimens, and route of administration of treatment have enhanced effectiveness and reduced toxicity. Targeted anti-angiogenic therapy and recently PARP inhibitors are now complementing standard treatment and have improved patient progression-free survival. The development of immunotherapy, alone or in combination, brings new perspectives for the future treatment of ovarian cancer.Le traitement initial du cancer de l’ovaire consiste en une cytoréduction chirurgicale maximale, associée à une chimiothérapie adjuvante combinant les sels de platine aux taxanes. Malgré ce traitement, la survie sans récidive des patientes est restée stable ces 20 dernières années. Récemment, les avancées dans la séquence, les schémas et la voie d’administration des traitements ont permis d’optimiser leur efficacité et réduire leur toxicité. Les traitements ciblés anti-angiogéniques et récemment les inhibiteurs PARP (poly-ADP-ribose-polymérase) sont venus compléter les traitements standards et ont permis l’amélioration de la survie sans progression des patientes. Le développement de l’immunothérapie, seule ou en association avec d’autres traitements, ouvre des nouvelles perspectives pour le traitement du cancer de l’ovaire.

A recent meta-analysis of 11,107 patients with non-small cell lung cancer who had undergone surgical resection showed that the 5-year survival benefit of adjuvant chemotherapy was 4%, and that of adjuvant chemoradiotherapy was 5%. Two trials have shown a trend toward improved survival with adjuvant paclitaxel plus carboplatin. However, the benefit of adjuvant treatment remains suboptimal. We must distinguish between patients who will not relapse-and who can thus be spared adjuvant treatment-and those who will-for whom adjuvant treatment must be personalized. Several gene expression signatures, generally containing nonoverlapping genes, provide similar predictive information on clinical outcome, and a model combining several signatures did not perform better than did each of the signatures separately. The invasiveness gene signature, containing 186 genes, includes genes involved in the nuclear factor κB pathway, the RAS-mitogen-activated protein kinase pathway, and epigenetic control of gene expression. A 15-gene signature has identified JBR.10 patients who are more sensitive to adjuvant chemotherapy.

Background Metastatic non-small-cell lung cancer (NSCLC) has a dismal prognosis. EGFR is overexpressed or mutated in a large proportion of cases. Downstream components of the EGFR pathway and crosstalk with the NF-κB pathway have not been examined at the clinical level. We explored the prognostic significance of the mRNA expression of nine genes in the EGFR and NF-κB pathways and of BRCA1 and RAP80 in patients in whom EGFR and K-ras gene status had previously been determined. In addition, NFKBIA and DUSP22 gene status was also determined. Methods mRNA expression of the eleven genes was determined by QPCR in 60 metastatic NSCLC patients and in nine lung cancer cell lines. Exon 3 of NFKBIA and exon 6 of DUSP22 were analyzed by direct sequencing. Results were correlated with outcome to platinum-based chemotherapy in patients with wild-type EGFR and to erlotinib in those with EGFR mutations. Results BRCA1 mRNA expression was correlated with EZH2, AEG-1, Musashi-2, CYLD and TRAF6 expression. In patients with low levels of both BRCA1 and AEG-1, PFS was 13.02 months, compared to 5.4 months in those with high levels of both genes and 7.7 months for those with other combinations (P = 0.025). The multivariate analysis for PFS confirmed the prognostic role of high BRCA1/AEG-1 expression (HR, 3.1; P = 0.01). Neither NFKBIA nor DUSP22 mutations were found in any of the tumour samples or cell lines. Conclusions The present study provides a better understanding of the behaviour of metastatic NSCLC and identifies the combination of BRCA1 and AEG-1 expression as a potential prognostic model.