[Evolution of the costs and management of lung cancer between 2004 and 2014]. / Évolution des coûts et de la prise en charge du cancer pulmonaire entre 2004 et 2014.

BACKGROUND: Given its morbidity and mortality, lung cancer is a major public health issue. In recent years, it has benefited from several therapeutic innovations. The objective of this study was to compare, over two distinct periods of ten years, the impact on survival and the costs of lung cancer management. METHODS: The monocentric study assessed survival and the direct costs of lung cancer management of patients diagnosed in Brest University hospital in 2004 and in 2014. RESULTS: The analysis included 142 patients in 2004 and 156 in 2014. Most patients were smokers (72%), metastatic at diagnosis (60%) both in 2004 and in 2014. Median survival was not significantly improved between the 2 periods (9.7 versus 10.9 months), but there was a significant increase in the average cost of care per patient (€ 17,063 vs. € 29,264, P=<0.0001) between 2004 and 2014. CONCLUSION: The significant increase in treatment costs did not translate into an improvement in the survival of patients with lung cancer between 2004 and 2014.

FDG PET-CT for solitary pulmonary nodule and lung cancer: Literature review.

The investigation of solitary pulmonary nodule (SPN) and non-small cell lung cancer (NSCLC) has rapidly become one of the main indications for 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), currently combined with computed tomography (PET-CT). In this literature review, we first attempt to clarify how PET imaging contributes to investigating SPN, in conjunction with conventional CT. We highlight the prospects of research underway to improve our understanding of SPN. In the second part of this review, we analyze the current role of PET-CT in the overall care process for lung cancer. We review the indications for which consensus has been reached, for example initial staging, as well as new indications such as radiation therapy planning or prognostic assessment.

[Relevance of circulating tumor DNA in lung cancer: A case report]. / Intérêt de l'ADN tumoral circulant dans le cancer pulmonaire : à propos d'un cas.

INTRODUCTION: The identification of an activating mutation of the gene encoding the epidermal growth factor receptor (EGFR) is a predictive factor of effectiveness of tyrosine kinase EGFR inhibitors (TKIs). In advanced stages of the disease, however, this identification is difficult due to the invasiveness of the biopsy and the small size of tumor samples. In that context, liquid biopsies could be useful. CLINICAL CASE: We report the case of a 79-year-old woman suffering from metastatic lung cancer. The molecular analysis of bronchial biopsy for the EGFR gene was not informative due to the low quantity and the poor quality of the extracted DNA. The poor condition of the patient and her refusal to tissue sampling did not allow us to practice another invasive biopsy. The analysis of the tumor DNA circulating (cDNA) allowed to detect exon 19 deletion and to propose her an TKI with in the outcome sustained response. CONCLUSION: Circulating DNA analysis allows the identification of activating mutations of the EGFR gene in pulmonary adenocarcinomas. It is useful for weakened patients and in case of failure or inability of tumor biopsies. Initiation of EGFR TKI is possible on the basis of this result, as stated in the marketing authorization of gefitinib.

[A case of a carcinoid tumour presenting as an "upper lobe syndrome"]. / Un cas de tumeur carcinoïde typique diagnostiqué sur un « syndrome du lobe supérieur ¼

A 53-year-old woman presented with progressive cough related to an endobronchial carcinoid tumour. The location of the tumour in the right upper lobe bronchus could be described as an "upper lobe syndrome" by analogy with the "middle lobe syndrome" or Brock's syndrome. Surgical management consisted of lobectomy and lymph node dissection. This established the diagnosis of typical carcinoid tumour. There was no mediastinal nodal invasion. Three months after surgery all symptoms had disappeared.

Multicenter observational study of erlotinib therapy (OBSTAR) for non small-cell lung cancer: a GFPC study.

CONTEXT: Erlotinib therapy for non small-cell lung cancer (NSCLC) has mainly been evaluated in randomized trials. METHOD: OBSTAR was a multicenter, retrospective, observational study involving all patients treated with erlotinib in 18 French centers between June 2005 and September 2007. The analyses focused on the patients' characteristics, previous treatments, and treatment efficacy during a three-year follow-up period. RESULTS: 534 patients were included in this study. The median survival times were respectively 5.2 [3.7-7.4] and 4.7 [4.1-5.7] months, depending to whether erlotinib was used as second- (n=190), or ≥ third-line treatment (n=305). The disease control rate were 39.1% [30.2-48.7] and 29.9% [29.6-36.9] according to the line of treatment. Factors predictive of an objective response were gender, age, and smoking status. Factors predictive of progression were age, sex, smoking status, the line of treatment, and the number of metastases. Treatment had to be interrupted for toxicity in 8.5% of cases. CONCLUSION: This study of erlotinib therapy in 2005-2007 confirms, in the general NSCLC patient population, the results of pivotal trials.

[Practical approach to an excavated pulmonary lesion]. / Conduite à tenir devant une lésion excavée du poumon.

The aim of this article is to suggest a practical approach when faced with an excavated lesion in a chest X-ray. This is a classic situation both in general practice and in emergency units. A rigorous diagnostic approach is necessary after eliminating the main differential diagnosis. The main diagnoses consist of lung cancer, tuberculosis and abscess. Bronchial endoscopy is essential, but can be misleading. The diagnosis of an excavated pulmonary lesion is not always easy. It must be established rapidly and treated as soon as possible.