Bulletin du cancer最新文献

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.

Objectives: To evaluate patient and pharmacist satisfaction with two information systems using QR codes to access information about oral cancer treatments.

Methods: THERANOVA-LIM (NCT04931329) was a prospective, descriptive, single-centre study of cancer patients receiving oral treatment. Patients were divided into two groups: one group using the information card and the other using the standard prescription with QR code. Patient satisfaction was assessed at 3 months using questionnaires.

Results: In all, 128 patients were included: 55 received a 'drug information card' and 73 a 'prescription with QR code'. The median age was 69 (37-90). The three most common cancers were breast (37.5%), prostate (14.1%) and brain (10.9%). The vast majority of patients had metastatic cancer (90%). The three most prescribed drugs were capecitabine (21.1%), ribociclib (11.7%) and temozolomide (11.7%). Patients presented the QR codes during medical consultations (25.0%), pharmacy visits (100%) and during home visits by nurses (25.0%). Both patients and professionals were satisfied with these new systems. Pharmacists felt that the prescription with a QR code was more useful for their daily practice in the pharmacy (P=0.02).

Conclusions: QR code systems proved effective in providing information to patients and healthcare professionals. The QR code prescription appeared to be the most practical for pharmacy activities.

Trial registration number and the date of registration: ClinicalTrials.gov, NCT04931329. 2021-05-10.

Low-grade serous ovarian carcinoma is a rare subtype of epithelial ovarian cancer, accounting for less than 10% of serous malignancies. Compared to high-grade serous ovarian carcinoma, it follows an indolent course, often affects younger women, and demonstrates resistance to conventional cytotoxic chemotherapy. Low-grade serous ovarian is characterized by recurrent MAPK pathway alterations (KRAS, BRAF, NRAS) and frequent expression of functional hormone receptors, supporting the rationale for targeted and endocrine strategies. Optimal management relies on complete surgical cytoreduction. Endocrine therapy has shown promise, particularly in maintenance settings, and is being investigated in frontline strategies. MEK inhibitors, especially trametinib and avutometinib in combination with defactinib, have recently demonstrated improved outcomes in recurrent disease, while new combination strategies are under active evaluation to overcome resistance mechanisms. Immunotherapy remains of limited efficacy, though biomarker-driven combinations are explored. Ongoing biomarker-guided trials are expected to refine treatment paradigms.

Background: While the gut microbiome is known to modulate systemic immunity and response to immune checkpoint inhibitors, the role of tumor-resident microbiota remains underexplored. Recent evidence suggests that these local microbial communities may influence intratumoral immunity and therapeutic outcomes.

Methods: A systematic review compliant with PRISMA guidelines was conducted to evaluate the impact of tumor-associated bacteria on anti-tumor immune responses. Four databases (PubMed, Scopus, Web of Science and EMBASE) were searched for studies published between January 2010 and April 2025. Eligible studies characterized non-intestinal microbiota within tumor tissue and assessed immune endpoints such as T cell infiltration, cytokine profiles, PD-L1 expression, or immune checkpoint inhibitors responsiveness. Due to endpoint heterogeneity, no meta-analysis was performed. Seventeen studies met inclusion criteria.

Results: In tumors including melanoma, pancreatic, esophageal, gastric, breast, lung, and colorectal cancers, intratumoral bacteria modulated immune responses and immune checkpoint inhibitors efficacy. Three recurring mechanisms emerged: immune activation via antigen presentation and Th1 polarization; immune suppression through regulatory T cell recruitment and stromal remodeling; and checkpoint modulation and T cell exhaustion via microbial signaling. These effects were spatially structured and tumor-context dependent.

Conclusion: Tumor-local microbiota represents a distinct and actionable component of the tumor-immune microenvironment. Incorporating microbial profiling into immuno-oncology strategies may enhance biomarker discovery, patient stratification, and development of microbiome-based therapies. Further research is warranted to map spatial microbial heterogeneity, validate functional mechanisms, and translate findings into clinical applications in precision immunotherapy.

Background: PRRT showed promising potential in the management of patients with pNETs. However, there is still a lack of evidence on its relative efficacy and safety compared with other treatment options. This review aims to synthesize the existing evidence on the efficacy and safety of PRRT (without SSA in key comparisons) for pNETs compared to different treatments.

Method: An electronic search was conducted from inception to December 2024. Comparative studies including RCTs, cohorts and case-control studies focused on using PRRT in the treatment of pNETs were included. Efficacy outcomes included DCR, CR, PR, SD, PFS, and OS. Safety outcomes were grade 3-4 hematological and renal toxicity and overall AEs.

Results: Nine studies met the inclusive criteria. Among them, only one (11.1%) study is an RCT. Meta-analysis between full and reduced dosages of 177Lu-DOTATATE for G1-G2 pNETs revealed no significant differences in DCR, CR, PR, SD, and PFS between the groups. However, the full dosage group suggested potential for improved OS in some studies, though not statistically significant. When PRRT was compared to other treatments such as surgery, chemotherapy, and targeted agents, it was associated with longer PFS and potentially OS. Additionally, PRRT combined with capecitabine and salvage PRRT also showed efficacy in advanced cases. Safety analysis indicated that PRRT is well-tolerated, with minimal severe toxicity reported.

Conclusion: PRRT is a promising therapeutic option for patients with advanced pNETs, offering a balance of efficacy and safety compared to other available treatments. Full dosage PRRT may provide better outcomes than reduced dosages, and salvage PRRT remains effective for progressive disease. However, further high-quality RCTs are needed to confirm these findings and optimize PRRT usage in pNETs.

The number of patients in long-term remission after cancer is steadily increasing. In France, 3.8 million people are living with or cured of cancer. Five years after diagnosis, 63.5% still report sequelae, including pain, fatigue, or psychosocial disorders. This article describes the implementation of PASCA (Care Pathway during Cancer), a day hospital dedicated to survivorship care. Opened at the Comprehensive Cancer Center Léon Bérard in Lyon in November 2023, the program offers a half-day multidisciplinary assessment: physical fitness evaluation, general practice consultation, and nursing intervention with paraclinical tests and educational actions. Assessments initiated the management of frequent but often neglected complications, such as cognitive disorders (53% of patients), musculoskeletal disorders (38%), mood disorders (31%), and sexual health issues (36%), among others. They resulted in at least one medical prescription in more than 99% of cases. These findings highlight the value of a dedicated survivorship pathway to support primary care. A prospective evaluation is needed to measure actual benefits in terms of quality of life, prevention and reduction of sequelae. If confirmed, the PASCA program could represent a concrete response to the objectives of the French 10-Year Cancer Control Strategy and pave the way for harmonized survivorship care at the national level.

Background: The UMBRELLA 2016-SIOP RTSG protocol emphasizes the specific challenges associated with bilateral Wilms tumor and strongly recommends discussion of these cases within a national multidisciplinary Wilms tumor board (MWTB).

Method: A national MWTB dedicated to bilateral disease was established and rapidly expanded to include all complex cases. These monthly, web-based meetings require a minimum board and include participation from radiation oncologists, surgeons, pediatric oncologists, radiotherapists, and pathologists. Patients from all centers within the Société Française des Cancers de l'Enfant (SFCE) are reviewed.

Results: From January 2018 to December 2023, the board held 251 case discussions concerning 171 patients. Reasons for referral included bilateral disease in 50.4%, syndromic patients in 5.8%, complex metastatic cases at diagnosis or relapse in 22.5%, thrombotic complications in 1.5%, and other complex presentations in 19.8% (e.g., tumor rupture, rare histology). The full multidisciplinary board was achieved in 78% of meetings. In two-thirds of cases, expert recommendations resulted in modification or adjustment of the initial proposal from the treating team, guiding individualized strategies rather than applying standard care alone. In particular, surgical type and timing were often specified. A survey indicated high levels of participant satisfaction.

Discussion: This MWTB exemplifies successful national multidisciplinary collaboration and is aligned with current recommendations to enhance the quality of care for patients with complex presentations. Furthermore, the initiative surpasses the UMBRELLA objective, as it includes not only patients with stage V disease.

The evolution of intensive care unit (ICU) admission criteria for cancer patients has profoundly impacted their management and prognosis. Advances in oncologic treatments and intensive care strategies have significantly reduced mortality in these units, leading to an increase in admissions and the need to better define post-ICU trajectories. This narrative review evaluates the impact of unplanned ICU admissions on the prognosis of oncology patients, the resumption of anticancer treatment after ICU discharge, and their medium- to long-term quality of life. Several factors influence these outcomes, including disease stage at admission, the patient's functional and nutritional status, the severity of organ failures, and ICU-related complications. Identifying patients who are likely to resume oncologic treatment after an ICU stay is essential to optimizing their management and improving survival. Close collaboration between oncologists and intensivists is important to guiding admission decisions, anticipating clinical outcomes, and structuring post-ICU follow-up. The goal is to individualize therapeutic strategies to maximize the benefits of intensive care while preserving the quality of life of oncology patients.

The use of haploidentical Hematopoietic Stem Cell Transplants (Haplo-HSCT) in adults has increased due to improved procedures that lower the risk of graft-versus-host disease (GvHD) and Transplant-Related Mortality (TRM). In pediatrics, haploidentical transplants, whether performed with in vivo or in vitro T-cell depletion, are considered an alternative to conventional transplants from genoidentical or phenoidentical donors with bone marrow (BM), peripheral stem cell (PBSC). This review synthesizes current knowledge, highlighting a thorough analysis of pediatric data from Haplo-HSCT for malignancies. In brief, donor selection criteria are the same as those published for adults, and the conditioning used is primarily myeloablative. The incidence of severe GvHD is lower as compared to adults, but other complications, such as hemorrhagic cystitis, veno-occusive disease and cardiac toxicity are present, and long-term follow-up data is lacking. We provide comprehensive recommendations for transplant preparation in treating pediatric AML and ALL, focusing on the "in vivo" T-cell depletion approach with high-dose post-transplant cyclophosphamide (PT-Cy).

In Francophone Africa (343 million inhabitants in 2024, 42% under 15 years of age), childhood cancer is under-documented. The French African Paediatric Oncology Group (GFAOP) launched a centralized hospital registry project (RFAOP) in 2016 to improve knowledge, structure the needs of paediatric oncology units, and address the lack of reliable information. Here, we describe this unique Registry, explaining what has been learned and its impact. Analyses of the Registry (2016-2019) reveal diagnostic disparities and a lack of correlation between the number of cases and the population, highlighting significant needs in human and material resources and underscoring the necessity for targeted investments. The Registry tracks cancer trends, and documents prevalent types of cancer, such as Burkitt's lymphoma in some regions, and very low numbers of brain tumours especially in the sub-Saharan region. The stage and extent of the disease at diagnosis is also discussed. Inter-unit heterogeneities and a hospital registry bias are noted. The application of staging guidelines has improved data quality, but late diagnoses persist with high percentages of advanced stage disease. Follow-up of survival 57% at 12 months is discussed, but encouraging rates are observed for certain cancers. Treatment abandonment is a major problem being studied using socio-economic and cancer type as possible contributing factors. This Registry is crucial for resource planning despite limitations in diagnosis and follow-up. On-going training and support are essential to maintain the quality of this project. It reveals disparities with global data, emphasizing the need for robust population-based registries linked to quality diagnostics and care, and for sustainable funding to ensure a lasting impact.