RESUMO
PURPOSE: Our objective was to compare patient's expectations to their experience and to identify factors predictive of patient's perception of long-term LMWH for the treatment of cancer-associated thrombosis (CAT). METHODS: Results from the validated Perception Anticoagulant Treatment Questionnaires (PACTQ) completed before inclusion (PACTQ1 for expectations) and at the end (PACTQ2 for convenience and satisfaction) of the 6-month TROPIQUE study were studied with principal component analysis. Possible predictive factors of improved perception of LMWH treatment were analyzed with the Kruskall-Wallis test. RESULTS: Among 409 included patients treated with LMWH, 269 PACT-Q1 and 139 PACT-Q2 were evaluable for treatment perception. Patients had high expectations (A1-A7 score of 26.7 ± 3.5, max = 35). Treatment cost (A7 = 1.90 ± 1.31) and concern about a mistake in anticoagulation (A5 = 1.93 ± 1.12) had little importance while LMWH treatment was considered easy to use (A4 = 4.20 ± 0.93). Six-month treatment with LMWH was associated with a high rate of convenience (B1-B11, C1-C2 = 55.1 ± 8.38, max = 65) and a high satisfaction score (D1-D7 = 25.1 ± 4.32, max = 35). Patients' confidence in treatment and perception of possible LMWH side effects were moderate while perception of autonomy and independence significantly improved at the end of the study compared to inclusion. PACT-Q2 satisfaction score was low in patients who experienced bleeding (PACT-Q2 24.1 ± 3.3 vs. 25.1 ± 4.3). LMWH twice daily tended to be found less convenient compared than once daily (53.3 ± 7.2 vs. 55.0 ± 8.3). CONCLUSION: CAT patients had a good perception of the 6-month LMWH treatment when comparing expectations and experience. Using a quantitative scale validated in the general population for VTE and subcutaneous injection and including a large number of patients, bleeding complications and LMWH twice daily were associated with a nonsignificant trend towards a worsen perception.
Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Neoplasias/complicações , Satisfação do Paciente , Percepção/fisiologia , Trombose/tratamento farmacológico , Trombose/etiologia , Adulto , Anticoagulantes/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Hemorragia/psicologia , Humanos , Injeções Subcutâneas/psicologia , Assistência de Longa Duração/psicologia , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Trombose/epidemiologia , Trombose/psicologia , Fatores de Tempo , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologiaRESUMO
UNLABELLED: Cancer is associated with venous thromboembolism in 20% of patients. In such patients, thrombosis is difficult to treat, associated with bleeding, recurrence, and death. Specific treatments for venous thromboembolism in cancer are recommended. Guidelines have been implemented in many countries and international guidelines have been recently developed. We evaluated the adhesion to national French guidelines via a survey of cancer patients treated for venous thromboembolism. METHODS: A national cross-sectional observational study evaluated the adhesion to guidelines in hospitalized patients. Good clinical practice was defined as initial 10-day treatment with injectable molecules followed by long-term treatment with low molecular weight heparin for at least 3 months. Demographic data, cancer type, stage, treatment, risk factors and type of thrombosis, were recorded. RESULTS: Five patients were included in 47 centers. Overall adhesion to guidelines was present in 59% (55-63%) of patients (295/500). During initial treatment, adhesion was high (487/496; 98%) but dropped (296/486; 62%) during the long-term maintenance. In patients with renal insufficiency, only a fourth of them received the adequate treatment. A majority of patients had metastatic disease (64%). Cancer sites were gastro-intestinal (25%), gynecologic (23%), pulmonary (21%), hematological (14%), urologic (10%), or other (8%). Lung and hematological malignancies were significantly associated with the highest and lowest rates of adhesion. CONCLUSION: Adhesion to national guidelines for treatment of venous thromboembolism in cancer is not optimal. Good compliance is observed during initial treatment, but drops after 10 days, underlying the need for further education to achieve a better implementation on a national level.
Assuntos
Anticoagulantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Neoplasias/complicações , Guias de Prática Clínica como Assunto , Tromboembolia Venosa/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Inibidores do Fator Xa/uso terapêutico , Feminino , Seguimentos , França/epidemiologia , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Especificidade de Órgãos , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Insuficiência Renal Crônica/complicações , Fatores de Risco , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Fatores de Tempo , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologiaRESUMO
Trastuzumab is a standard treatment in breast cancer overexpressing Her2 oncogene. However, its administration carries the risk of severe immune adverse events which often lead to the discontinuation of trastuzumab. There is no clear guideline on how patients experiencing trastuzumab-related reaction should be rechallenged with the monoclonal antibody. Here, we present two case reports of patients who have presented severe anaphylactic reactions during trastuzumab infusion. Both of them have been successfully rechallenged in intensive care units with premedication, lower rate of infusion and vitals monitoring. Thereafter, trastuzumab could be continued without any serious adverse reaction. Given the positive impact of trastuzumab on patients' survival, treatment rechallenge should be carefully considered in patients who presented anaphylactic reactions.
Assuntos
Anafilaxia/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Adulto , Anafilaxia/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Neoplasias da Mama/imunologia , Broncodilatadores/uso terapêutico , Clorfeniramina/uso terapêutico , Feminino , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Ipratrópio/uso terapêutico , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Receptor ErbB-2/imunologia , TrastuzumabRESUMO
Neuroendocrine carcinoma is a rare and agressive malignant tumor, mainly developing at the expense of the respiratory and of the digestive tract. Among the digestive tract, appendix, small bowel, and pancreas are the preferential sites of involvement, other locations have been more rarely reported. Neuroendocrine digestive tumors may present with various symptoms in relationship with their localization and a complex pathophysiology. Diagnosis is often made at an advanced stage, explaining partly the bad prognosis of these tumors. The optimal management of digestive neuroendocrine tumors is rendered difficult by their rarity and by a low number of randomized trials. We review the literature regarding epidemiologic and prognostic features of these rare tumors, their diagnostic and therapeutic care. Potential complications are also discussed.
Assuntos
Carcinoma Neuroendócrino , Neoplasias do Sistema Digestório , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/epidemiologia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Técnicas de Diagnóstico do Sistema Digestório , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/epidemiologia , Neoplasias do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/terapia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Terapia de Alvo MolecularRESUMO
PURPOSE: To assess usefulness of ((18)F)-fluorocholine positron emission tomography (PET) for localizing relapse in patients with biochemical relapse from prostate adenocarcinoma and its impact on indications of salvage local therapy. PATIENTS AND METHODS: An ((18)F)-fluorocholine PET coupled with computed tomography was performed in 28 patients with biochemical progression from prostate adenocarcinoma. At the time of ((18)F)-fluorocholine PET, median prostate specific antigen (PSA) was 3.0 ng/mL (from 0.34 to 93 ng/mL) and 17 patients (60.7%) received hormone therapy. Eighteen patients from this cohort were potentially candidates to salvage radiotherapy. RESULTS: A pathologic uptake was shown in 11 patients (39.3%) and 17 patients (60.7%) had no pathologic uptake. Median PSA was 2.4 ng/mL (0.33 to 36 ng/mL) in case of negative ((18)F)-fluorocholine PET, versus 6.75 ng/mL (1.21 to 93 ng/mL) in case of pathologic uptake (P=0.04). Among the 17 patients candidates to salvage radiotherapy, ((18)F)-fluorocholine PET helped deciding for salvage radiotherapy in five patients, since it showed only centropelvic pathologic uptake (27.7%). In one patient, it showed metastatic and radiotherapy was contraindicated. After prostatectomy, ((18)F)-fluorocholine PET was positive in only one patient candidate to salvage radiotherapy (9.1%), showing anastomotic relapse. CONCLUSION: ((18)F)-fluorocholine was positive in about a third of patients with biochemical progression. Its clinical impact is being prospectively investigated.
Assuntos
Adenocarcinoma/secundário , Colina/análogos & derivados , Radioisótopos de Flúor , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/diagnóstico por imagem , Compostos Radiofarmacêuticos , Terapia de Salvação , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/uso terapêutico , Terapia Combinada , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Seleção de Pacientes , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. METHODS: A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. EXPECTED RESULTS: We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Cardiopatias/prevenção & controle , Neoplasias Pulmonares/cirurgia , Ventilação não Invasiva , Pneumonectomia , Respiração com Pressão Positiva , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Adulto , Carcinoma Pulmonar de Células não Pequenas/complicações , Cardiopatias/complicações , Humanos , Neoplasias Pulmonares/complicações , Obesidade/complicações , Seleção de Pacientes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tamanho da AmostraRESUMO
Fever is defined as a body temperature above 37.8°C in the absence of antipyretic drug. It is a frequent and potentially severe event and its interpretation can be difficult in patients with solid tumors. It is usually alleged that more than half of cancer patients will be affected by the occurrence of this event during the course of their disease. Underlying causes are multiple but most frequent and severe causes include infections, the most life-threatening causes being, firstly, febrile neutropenia and secondly, healthcare-associated infections and more particularly infections related to catheter. Opportunistic infections are much less frequent than in hematology oncology but clinicians should be aware of two severe opportunistic infections: systemic candidiasis and Pneumocystis jiroveci pneumonia. Fever related to paraneoplastic or tumor necrosis complicates the diagnosis process. Other common causes of fever include venous thromboembolic disease or more rarely treatment related fever. We aim at examining the optimal diagnostic and therapeutic strategies when facing a cancer patient with fever.
Assuntos
Febre/diagnóstico , Febre/terapia , Neoplasias/terapia , Regulação da Temperatura Corporal/fisiologia , Infecção Hospitalar/complicações , Diagnóstico Diferencial , Febre/complicações , Humanos , Neoplasias/complicações , Neoplasias/diagnóstico , Neutropenia/complicações , Neutropenia/diagnóstico , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Enxerto Vascular/efeitos adversosRESUMO
Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.
Assuntos
Teratoma/patologia , Humanos , Masculino , Neoplasia Residual/patologia , Neoplasia Residual/cirurgia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Síndrome , Teratoma/cirurgia , Neoplasias Testiculares/tratamento farmacológicoRESUMO
Granulocytic sarcoma is a rare extramedullary tumour, which most often occurs in the course of an acute or chronic leukaemia or myeloproliferative disorders. Rarely it is found before peripheral blood or bone marrow evidence of leukemia is present. We report an unusual case of acute paraplegia at first presentation of a spinal epidural granulocytic sarcoma without any haematological disorder. Therapeutic strategies are discussed in the light of the literature.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Citotoxinas/uso terapêutico , Cardiopatias/etiologia , Lesões por Radiação/etiologia , Antineoplásicos/efeitos adversos , Neoplasias da Mama/radioterapia , Terapia Combinada/efeitos adversos , Citotoxinas/efeitos adversos , Feminino , Cardiopatias/induzido quimicamente , HumanosRESUMO
The importance of targeted therapies has been emphasized by clinical trials using antiangiogenic or HER2 inhibitors in breast cancer. First with trastuzumab, it was demonstrated that targeted therapies may improve outcome in patients with HER overexpressing breast cancer in metastatic or adjuvant settings. The emerging role for angiogenesis inhibitors has also been demonstrated with bevacizumab. Unfortunately, there is growing clinical and biological evidence that tumour cells may develop unexpected and complex mechanisms of resistance to those targeted therapies. This review outlines the mechanisms by which tumour cells may resist to new targeted agents. Most recent developments are also highlighted.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Resistencia a Medicamentos Antineoplásicos , Receptor ErbB-2/antagonistas & inibidores , Inibidores da Angiogênese/metabolismo , Anticorpos Monoclonais/metabolismo , Anticorpos Monoclonais Humanizados , Bevacizumab , Neoplasias da Mama/irrigação sanguínea , Neoplasias da Mama/metabolismo , Sinergismo Farmacológico , Feminino , Humanos , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/metabolismo , Receptor ErbB-2/metabolismo , TrastuzumabRESUMO
Although insufficiently documented, the impact of radiation therapy on fertility should not be neglected in female patients. Toxicity on reproductive function is dual and is characterized by both mechanistic deleterious effects on the genital tract and partial or complete loss of ovarian function. Moreover, gonadic toxicity may be increased by the concurrent use of chemotherapy or surgical procedure. In some circumstances, ovarian transposition may be justified for young patients. But no compromise may be accepted in terms of carcinologic results. At least, the effect of low-doses of irradiation has not been demonstrated for extra-pelvic radiotherapy.
Assuntos
Fertilidade/efeitos da radiação , Infertilidade Feminina/prevenção & controle , Ovário/efeitos da radiação , Lesões por Radiação/prevenção & controle , Fatores Etários , Feminino , Humanos , Japão , Cinza Radioativa/efeitos adversos , Dosagem RadioterapêuticaRESUMO
Recently introduced into clinical practice, positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) has proven its utility for diagnosis and staging of malignant diseases on account of its ability for tissue identification. Its utilization is now moving toward the evaluation of anti-tumoral effects of anticancer therapy, because of the correlation between the uptake of a metabolic tracer and malignant cells viability. Metabolic effects of chemotherapy are first observed in cells and this is the explanation for the precocity of scintigraphic visualisation of therapeutic activity. However, monitoring response with FDG-PET requires rigorous method and needs to take into account the limitations of SUV. Moreover, in order to go beyond the limitations of FDG, new tracers are developed and their main indication could be precisely the monitoring of therapy response. The properties of positron emitters allow us to foresee the labelling of the therapeutic molecules themselves in order to try them in vivo before their utilization for a given patient. These prospects are the ground for real treatment personalization in oncology. They open up a wide field of clinical research but the means for image acquisition and radioactive tracers production will be mandatory for anyone who wants to contribute to this work. Due to the current performances of the imaging systems, the critical point will be availability of equipment allowing the designing and synthesis of the radiopharmaceuticals of the future.
Assuntos
Fluordesoxiglucose F18 , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Contagem de Células , Transformação Celular Neoplásica/metabolismo , Fluordesoxiglucose F18/farmacocinética , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Resultado do TratamentoRESUMO
Maxillary sinus carcinomas are rare malignancies of the face, characterized by high local relapsing rate. Modalities of treatment are without consensus and respective roles of radiation therapy and surgery remain controversial. As those malignancies are often diagnosed at locally advanced stage, radiation therapy may frequently be used for patients having unresectable advanced disease. Nevertheless, surgery remains treatment of choice for more localized malignancies, in association with systematic postoperative radiotherapy. For those patients whose prognosis remains pejorative, it is necessary to precise the role of radiotherapy in first intention for inoperable tumors, to define necessity for nodal treatment performing and evaluate the place of neoadjuvant or concomitant chemotherapy in a multimodal strategy.
Assuntos
Carcinoma/radioterapia , Neoplasias do Seio Maxilar/radioterapia , Algoritmos , Quimioterapia Adjuvante , Humanos , Metástase Linfática , Procedimentos Cirúrgicos Otorrinolaringológicos , Prognóstico , Radioterapia AdjuvanteRESUMO
Nausea and vomiting are frequent symptoms that deteriorate the quality of life of lung cancer patients. They are most often iatrogenic and related to chemotherapy based on platinum salts; they can also be evidence of metastasis to the brain or hypercalcemia. Understanding the physiopathological mechanisms at work can make it possible to adopt effective therapeutic measures that are specific to each etiological context.
Assuntos
Náusea/terapia , Neoplasias/fisiopatologia , Cuidados Paliativos/métodos , Vômito/terapia , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Humanos , Náusea/induzido quimicamente , Neoplasias/tratamento farmacológico , Fatores de Risco , Assistência Terminal/métodos , Vômito/induzido quimicamenteRESUMO
The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels.
Assuntos
Seminoma/patologia , Neoplasias Testiculares/patologia , alfa-Fetoproteínas/análise , Adulto , Antineoplásicos , Biomarcadores Tumorais/sangue , Humanos , Excisão de Linfonodo , Masculino , Seminoma/sangue , Seminoma/tratamento farmacológico , Neoplasias Testiculares/sangue , Neoplasias Testiculares/tratamento farmacológicoRESUMO
Disseminated intravascular coagulation is a rare complication of prostatic cancer evolution. Occurring on hormonorefractory phase, it remains most often infraclinic. Cases of acute, severe intravascular disseminated coagulation at first presentation are life-threatening because of hemorragic and thrombotic complications, justifying emergency medical treatment. In the light of a review of literature, we insist on epidemiological features, physiopathology and therapeutics of intravascular disseminated coagulation. In spite of a pejorative prognosis, this could help to achieve a period of remission.
Assuntos
Coagulação Intravascular Disseminada/etiologia , Neoplasias da Próstata/complicações , Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Biópsia , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/epidemiologia , Coagulação Intravascular Disseminada/patologia , Hemorragia/etiologia , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Trombose/etiologiaRESUMO
Despite a very poor prognosis of small cell lung cancer, recent advances in chemotherapy produced long-term survivors requiring a high level of surveillance. Indeed, it is becoming more important to identify earlier unusual sites of tumoral recurrence. We report the first case of uterine metastasis of a small cell lung carcinoma.
Assuntos
Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Metástase Neoplásica/patologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/secundário , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Tumours of the upper aerodigestive tract represent the sixth most frequent kind of cancer in France and throughout the world. If the localised forms may be controlled in the long run in two thirds of cases by surgery or radiotherapy, only one third of locally advanced forms are accessible to a cure after association from radiotherapy and chemotherapy. Besides, with a median of survival less than six months, metastatic tumours present a catastrophic spontaneous prognosis among patients with a medical ground that is often heavily deteriorated by prolonged exposure to alcohol and tobacco. Thus, there is a necessity to implement adapted therapeutic strategies to each patient and based on satisfactory proof levels of effectiveness. Optimisation of existing chemotherapy protocols and development of new therapies, in particular of targeted therapies, remain an important objective in the hope to improve results of treatments in locally advanced and metastatic cancers of the oral cavity.