Bulletin du cancer
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The treatment of metastatic melanoma is presently in complete revolution. Two molecules have recently been authorized for this indication. These treatments have a very different mechanism of action compared to previous chemotherapies. ⋯ With ipilimumab, the objective responses are less frequent than with vemurafenib but are more prolonged over time. Two phases III have demonstrated that ipilimumab treatment is effective on the overall survival of patients with metastatic melanoma. New combination therapies and additional targeted and immunotherapy agents are exciting perspectives that make us more optimistic for the future of metastatic melanoma treatment.
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Sleep disorders and more particularly insomnias are very frequently found in cancer patients. We notice a growing interest for this subject in the current literature. ⋯ Nevertheless, these insomnias represent a real discomfort for these patients, with not insignificant repercussions on their quality of life. It is important to be able to screen these disorders with a detailed and precised interview allowing a global patient care including pharmacologic and non-pharmacologic treatment.
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Anemia in oncology is no longer seen only as a side effect of chemotherapies. This comorbidity may be multifactorial, clinically and, for example, may be rather chronic when the patient has chronic renal failure associated, resulting in renal anemia. Similarly, the presence of iron deficiency, which can be solely responsible or contributing factor of anemia, is also a factor to be taken into account in both the diagnosis and exploration of anemia and in its treatment, requiring the use of injectable iron complexes for treatment, if necessary in combination with an erythropoiesis agent stimulating.
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Randomized Controlled Trial Multicenter Study
SALTO: a randomized, multicenter study assessing octreotide LAR in inoperable bowel obstruction.
This phase II, multicenter, randomized, double-blind, non-comparative study assessed the efficacy and safety of immediate-release octreotide and octreotide LAR, in combination with corticosteroids and standard medical care, on the symptoms of inoperable malignant bowel obstruction (MBO) due to peritoneal carcinomatosis. The primary efficacy endpoint was "success" at day 14 defined as a composite endpoint including the absence of a nasogastric tube, and vomiting less than twice per day and no use of anticholinergic agents. Patients in the octreotide arm received octreotide LAR 30 mg intramuscular (im) on days 1, 29 and 57, as well as daily immediate-release octreotide 600 μg per day plus methylprednisolone on days 1 to 6. ⋯ An intention-to-treat analysis showed that in the octreotide and placebo arms, 12 (38%) and nine (28%), respectively, patients were successfully treated at day 14, which increased to 9/15 (60%) and 7/25 (28%), respectively, among patients with a baseline Karnofsky score greater or equal to 50. Octreotide-treated patients reported three drug-related adverse events (AEs), and no drug-related serious AEs or deaths. Octreotide LAR may have a key role in treating patients with a MBO due to peritoneal carcinomatosis, particularly in those with moderately severe disease.
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The treatment strategy for hormone receptor-positive (ER+) HER2-positive (HER2+) metastatic breast cancer has been modified since several randomized trials have proven the effectiveness of anti-HER2 targeted therapy. Previously validated clinical practice guidelines recommending the use of endocrine therapy alone in first line might be changed. ⋯ Our result suggests that first-line endocrine therapy is a viable therapeutic option for a selected population of metastatic breast cancer patients with HER2-positive tumors. Genomic and transcriptomic signature could help to identify tumors that remain dependant of estrogen-signaling pathway.