Bulletin du cancer最新文献

Metastatic castration-sensitive prostate cancer (mCSPC) has undergone major therapeutic advances with the introduction of next-generation androgen receptor pathway inhibitors (ARPI). Two treatment strategies have demonstrated clinical benefit at this stage: doublet therapy, combining androgen deprivation therapy (ADT) with one of the four currently available ARPI, and triplet therapy, integrating abiraterone or darolutamide with docetaxel. The choice of therapeutic strategy is based on a personalized assessment that considers both tumor aggressiveness and the patient's overall profile, particularly cardiovascular and cognitive comorbidities, regardless of age, frailty, or level of activity. Optimal management of mCSPC requires a multidisciplinary approach, including a baseline cardiovascular workup, systematic geriatric assessment, non-pharmacological interventions (such as tailored physical activity and cognitive stimulation programs), calcium and vitamin D supplementation, structured sexual health support, and a comprehensive medication review conducted in collaboration with a pharmacist. Ongoing trials are exploring treatment de-escalation strategies, notably intermittent ADT, to preserve antitumor efficacy while improving quality of life. This review highlights the importance of a personalized, multidisciplinary approach, integrating therapeutic innovations with individualized supportive care, in a context marked by emerging differentiations of therapeutic options for mCSPC.

Introduction: Advance directives (AD) are rarely used although they have been enshrined in law since 2005. Health establishments have a duty to inform patients regarding AD. However, studies have shown little awareness of this law in the healthcare environment. Our study analyzes the perception of AD by oncohematology caregivers.

Methods: This is an observational, descriptive and prospective study conducted with a 12-item questionnaire distributed to oncohematology nurses and nursing assistants. Statistical analyses were carried out using a significance threshold of 0.05 and using the Chi², Fisher or Kruskal-Wallis tests.

Results: The questionnaire was completed by 138 caregivers. Among them, 63.8% felt they had "very weak" or "weak" knowledge of ADs. The level of training was considered insufficient by 83.8% of respondents. Those with a good level of knowledge of ADs approached them more often (P=0.003) and felt more comfortable doing so (P<0.001). More than 90% of caregivers were "convinced" or "very convinced" by ADs but less than half understood their impact in clinical practice.

Discussion: ADs remain little known among caregivers who do not feel comfortable approaching them. Training in ADs is an improvement clue because it allows you to approach them more often and to feel more comfortable. ADs are well-received by caregivers but their impact is little perceived in practice. The involvement of caregivers in end-of-life decisions through multidisciplinarity should be strengthened in oncohematology based on the palliative care model.

Ewing sarcoma (ES) is an aggressive sarcoma with a peak incidence in adolescents and young adults. Current therapy involves multiagent chemotherapy and local therapy but despite intensification of treatment patients with metastases at diagnosis and recurrent disease have poor prognosis. Improved understanding of ES biology has identified novel targets with promising activity in ES patients. Tyrosine kinase inhibitors are currently being evaluated as combination and maintenance therapy. Other emerging therapies include those that target the EWSR1:FLI1 fusion oncoprotein, cell cycle, apoptotic and DNA-repair pathways. Immunotherapeutic approaches are also being investigated, particularly CAR-T and CAR-NK cell therapy. Close collaboration between clinicians and biologists has also highlighted the importance of biomarkers that are still being validated prospectively and might be incorporated into standard of care in the future.

Introduction: Sickle cell disease affects approximately 30,000 people in France. Between 1988 and 2022, 700 patients underwent allogeneic hematopoietic stem cell transplantation (HSCT), mainly children, but the procedure is increasingly offered to adults. The medical and psychological complexities of transplantation in this population require specific attention to optimize care.

Methods: Our work was based on a literature review and team experience, following the standard methodology of the SFGM-TC. Our focus was on pre-transplant evaluation, transfusion preparation, fertility preservation, post-transplant medical follow-up, psychological support, and pain management.

Results: Transplantation for sickle cell disease requires comprehensive assessment of organ damage, transfusion preparation, and close interdisciplinary collaboration. Fertility is a major concern, with tailored protocols based on the patient's sex and age. Post-transplant pain, often complex, necessitates multidisciplinary follow-up and team awareness. Psychologically, the post-transplant transition is marked by a loss of bearings, requiring personalized psychological support.

Conclusion: Interdisciplinary collaboration, meticulous preparation, and long-term follow-up are essential to improving transplant outcomes in sickle cell patients. Enhanced team awareness and the involvement of expert patients are also recommended.

The Francophone-African Group of Pediatric Oncology (GFAOP), active for over 25 years across 18 French-speaking African countries, aims to strengthen local capacity to improve the care of children with cancer. In alignment with the WHO Global Initiative for Childhood Cancer (GICC), which targets a 60% survival rate by 2030, the GFAOP has revised its strategic plan around five key pillars: training, therapeutic guidelines, capacity building for pediatric oncology units, family support, and advocacy. This article outlines priority actions to address persistent challenges, including shortages of trained personnel, delayed diagnoses, treatment abandonment, and limited political recognition of pediatric cancer. It emphasizes the need to balance early diagnosis efforts with the capacity of care structures and to integrate all actions into national pediatric cancer control plans. A key challenge ahead is strengthening GFAOP's governance and progressively professionalizing its operations, while preserving the spirit of volunteerism that has been the foundation of its success.

Although childhood cancer is rare, it remains a major cause of mortality in low-and middle-income countries (LMICs), where survival rates are significantly lower than those observed in high-income countries. To address this disparity, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer (GICC) in 2018, aiming to achieve at least a 60% survival rate by 2030 through the "CureAll" approach. This article aims to raise awareness of the GICC in the French-speaking world and to share an interim assessment of its implementation in two pilot countries, Morocco and Senegal. With four decades of experience in paediatric oncology, Morocco was selected in 2019 as a pilot site for the GICC. A national study, serving as the first step in defining measurable targets for 2030, revealed a 5-year survival rate of 65% for the six priority paediatric cancers, enabling the establishment of an ambitious 80% survival goal by 2030 and the development of a national road map encompassing access to care and essential medicines, supportive care, governance, and training. In Senegal, the launch of the CureAll program in 2021 marked a major milestone in a context where childhood cancer had previously been neither structured nor prioritized. This initiative mobilized stakeholders, conducted a national situational analysis, and developed an action plan tailored to local realities, focusing on early diagnosis, quality of care, and research, alongside the opening of a second treatment center to strengthen access to specialized paediatric care. These initiatives have repositioned paediatric cancers, historically considered as an orphan diseases embedded within adult cancer programs, as a public health priority clearly supported by the government and the WHO. Their success relies on the coordination and pooling of efforts and resources among national and international partners, enabling rapid and effective implementation of actions to improve clinical outcomes in paediatric oncology.

In recent years, there have been significant changes in the way cancer patients are treated. The use of oral anti-tumour therapies has accelerated outpatient treatment. In response, healthcare professionals have organised themselves to design multidisciplinary information and support pathways for the initiation of treatment. Pharmacists, as drug experts, are involved to detect and analyse drug interactions. By taking control of their illness, patients are encouraged to seek their own solutions, sometimes using complementary and alternative medicines. The use of cannabidiol in a patient suffering from chronic myeloid leukaemia in 4th line treatment illustrates this problem. High-dose cannabidiol is a strong inhibitor of cytochrome 3A4 and P-gP protein, and a weak inhibitor of cytochromes 2C19, 2B6, 2D6, 2C9, 2C8 and 1A2, as well as UGT1A9 and 2B7. Case reports complement these elements by reporting clinically significant inhibition when lower doses are used. According to current recommendations, the first four lines of treatment for chronic myeloid leukaemia are major substrates of cytochrome 3A4. There is a risk of drug-drug interaction/herb-drug interaction, even at low doses. The use of cannabidiol is strongly discouraged. Pharmacists, through their participation in multidisciplinary interviews for the initiation of oral anti-cancer therapies, contribute their expertise in the detection and analysis of potentially clinically significant interactions.

Telemonitoring in oncology has developed in recent years, significantly improving the quality of life and overall survival of patients being treated for any type of cancer (Basch and al., 2016). In France, its growth in hospital has been strengthened by the two decrees of December 2022 (n°2022-1767, n°2022-1769) establishing a common law model and reimbursement by the Social Security from July 2023. We thought it was necessary to create French guidelines for all healthcare professionals wishing to carry out telemonitoring activity within their oncology center. We therefore propose clarifying the indications for telemonitoring, exploring the regulations surrounding digital medical device, how it works, and the role of the various healthcare professionals involved in the practice. We also address ethical considerations before outlining the approach to be followed by professionals to follow for optimal implementation. This article focuses particularly on this last part to facilitate the application of the recommendation by healthcare professionals wishing to integrate a telemonitoring activity.

International organizations FACT and the Joint Accreditation Committee ISCT-Europe & EBMT (JACIE) have developed a reference framework that provides a safe structure for the management of cellular therapies. This framework (FACT-JACIE v8.2) is organized according to a quality management approach. During the annual workshops of the Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC), we aimed to enable medical directors to build an effective human resource management system that complies with JACIE standards. To this end, we designed a competency validation system, including an annual cycle for physicians and a three-year cycle for paramedical staff, structured around three key domains. By clearly distinguishing the training pathway and integrating digital tools, this model ensures real-time updating of competencies and can be extended to other specialties or healthcare professions, as well as reproduced at the national level with international perspectives. This article lays the foundations of a collaboratively developed skills enhancement program. It describes the necessary steps to fully involve each professional category in its design, details the mechanisms that foster their engagement, and identifies the essential elements to define and implement in order to achieve an operational competency matrix. The entire approach is carried out in compliance with FACT-JACIE requirements, ensuring its robustness and international alignment.