Bulletin du cancer最新文献

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.

CAR-T-cells represent a major change in the field of relapsed/refractory B-cell acute lymphoblastic leukemia treatment in children, adolescents and young adults. However, despite a high early response rate of more than 90%, almost half of patients relapse after CAR-T-cells treatment. Several clinical and biological factors predicting success and failure of CAR-T-cells have been identified thanks to real life studies. Bridging period between leukapheresis and CAR-T-cells reinfusion is considered as a key stone to allow CAR-T-cells procedure in optimal condition. No prospective study and few retrospective studies are available describing this period. Consequently, there is currently no available guidelines. This article aims to describe the objectives and risks of the bridge, and to define recommendations of treatment in each situation of relapsed or refractory B-ALL, Ph+/ABL-like B-ALL and in case of CNS disease or non-CNS extra medullary disease, precising the specific place of immunotherapy.

In high-income countries such as in Europe, cure rate of children with cancer is high thanks to prospective therapeutic studies, generally randomized. In countries with lower income, these validated and published treatments can be difficult to apply necessitating adaptations to reduce toxicity while trying to maintain cure rate as high as possible. These adaptations to take into consideration local conditions depend on the experience of the treating unit, on the means available such as drugs, supportive care, complementary examinations, especially radiologic. Since the year 2000, GFAOP has selected for the sub-Saharan countries, 2 (Burkitt lymphoma, nephroblastoma), then 3 other pathologies (Hodgkin lymphoma, lymphoblastic leukemia, retinoblastoma) which has cure rates of 90% in France with cheap drugs. The objective of this article is to show how the adapted therapeutic recommendations (accompanied by team training and drug supply) prospectively evaluated, allowed us to know and to increase cure rates and to identify points to improve in the following studies. Among difficulties to overcome in Africa: the absence of health coverage and the late arrival of the children in the specialized units. Presently cure rate of the children who can be treated according to these recommendations are around 50-60%, trying to reach the 60% cure rate fixed by WHO for 2030.

Childhood cancer is rapidly increasing across the African continent, but survival rates remain significantly lower than in high-income countries due to structural and economic barriers. This review analyses the major challenges hindering access to pediatric cancer medicines in Africa and examines the initiatives implemented to address them. Three main obstacles are identified: the low availability of medicines, exacerbated by stockouts and the lack of local production; the high cost of treatments, limiting accessibility, especially in the absence of universal health coverage; and weaknesses in pharmaceutical governance, including inefficient supply chains and insufficient regulation. In response to these challenges, several initiatives are emerging. While emergency actions, such as the shipment of cancer medicines by organizations like the GFAOP, have helped meet urgent needs, they do not replace structural solutions. Sustainable improvement relies on the training of healthcare professionals, particularly pharmacists specialized in pediatric oncology - an area supported by the GFAOP through the MAEva program and the University Diploma in Clinical Oncology Pharmacy -, the integration of anticancer medicines into universal health coverage policies, and the strengthening of local production and pharmaceutical governance, notably through the African Medicines Agency. An integrated approach, combining local production, effective regulation, and specialized training, is essential to sustainably improve access to treatments and reduce inequalities in pediatric oncology care across Africa.

Granulosa cell tumors (GCTs) are rare ovarian neoplasms, accounting for 2-5% of all ovarian cancers. Two histological types have been described: juvenile (JGCT) and adult (AGCT), the latter accounting for around 95% of the GCTs. AGCTs are mostly diagnosed at an early stage and commonly have a good prognosis. However, GCTs tend to be associated with late recurrence in about a third of cases which are a major concern. These recurrences often require repeated surgical interventions. Systemic treatments, for their part, show limited effectiveness in this context, highlighting the need to identify new therapeutic targets. Thus, better biological characterization of these tumors would enable us to propose more targeted treatments. To achieve this, the molecular characteristics of GCTs have been explored. Most AGCTs harbor a mutation in the FOXL2 transcription factor sequence, therefore allowing to investigate therapeutic perspectives targeting its signalling, as well as setting the first steps towards immunotherapy in these tumors. Knowledge of JGCTs is more limited due to their rarity. However, molecular analysis revealed that ∼60% of the JGCTs bore a genetic mutation in the AKT1 oncogene. However, its clinical significance has still to be explored. For both GCTs subtypes, the CDK4/6-Rb1 axis is promising. Consequently, exploring the molecular features and their role in the biology of these tumors could open up new avenues for targeted and personalized therapies, thereby improving patient care.

Acute graft-versus-host disease (GVHDa) is one of the leading causes of morbidity and mortality after allogeneic hematopoietic stem cell transplant (HSCT) patients. While the first-line consensus treatment has been based on systemic corticosteroid therapy for many years, ruxolitinib has recently been approved and has become the standard second-line treatment. Nevertheless, the effectiveness of ruxolitinib remains limited to 40 % of cortico-resistant patients, raising the crucial question of selecting a third-line treatment. Among the therapeutic modalities described, this workshop selected fecal microbiota transplantation (FMT), mesenchymal stromal cells (MSC) injection, and extracorporeal photopheresis (ECP) as the most promising or with a benefit/risk balance that favors their prescription at this stage. The workshop also highlighted the importance of research aimed at identifying markers or score calculations that guide toward a risk-adapted approach as early as possible. To date, aside from calprotectin, no marker or score is routinely used, but all are the subject of intense research. Finally, measures associated with specific treatment remain crucial, and new developments in dietary contributions, infection prophylaxis, and tissue regeneration are also addressed.

Introduction: The transversal specialized formation (TSF) in oncology has been enabling non-oncologist physicians to acquire oncology skills for five years. This study aims to assess the TSF for medical gynecology residents.

Materials and methods: A 23-item questionnaire was sent to physicians from the specialized medical degree (SMD) in medical gynecology who completed the TSF between 2020 and 2023. The data were analyzed using Student's t-tests, Fischer tests, and Chi² tests.

Results: Of the 22 residents identified, 20 (90.9%) responded to the questionnaire. Nine residents (40.9%) were from the Paris region. The reasons for undertaking the TSF included interest in gynecological and breast cancers (81.8%), clinical richness (50.0%), and scientific dynamism (50.0%). Of the 11 respondents who had completed the SMD or had a defined post-residency project, all reported working in a hospital setting. The main activity was gyneco-oncology (n=6, 55.0%), including sexology, monitoring at-risk women, post-cancer care, and medical oncology (n=5, 45.0%). The average satisfaction with the TSF was 7.2/10, with no significant regional difference (P=0.62). Suggested areas for improvement included harmonizing theoretical courses, offering specialized internships in gynecological oncology, and providing mentorship.

Discussion: Five years after its implementation, medical gynecologists are satisfied with the TSF in oncology. The main requests are for strengthening national courses and expanding the range of internships, all focused on the original specialty.

Molecular biologists play an important role in therapeutic decisions in the context of Chronic Myelogenous Leukemia (CML). Before treatment, it is mandatory to identify the BCR::ABL1 fusion and any prognostic cytogenetic abnormalities that may be present. During treatment, regular assessment of measurable residual disease (MRD) is essential to objectively evaluate the optimal response and identify situations of resistance to treatment. Monitoring of MRD is also required when considering treatment discontinuations. In cases of resistance, identifying mutations that confer resistance to tyrosine kinase inhibitors is essential for adapting the treatment. The Group of Molecular Biologists of Hematologic Malignancies (GBMHM) and the France Intergroup of Chronic Myeloid Leukemia (Fi-LMC) convened a panel of experts to critically review methods used for molecular diagnostics and follow-up of patients with CML, define best practices applicable in this context and formulate recommendations.