Recurrent or primary metastatic cervical cancer: current and future treatments.

Despite screening programs for early detection and the approval of human papillomavirus vaccines, around 6% of women with cervical cancer (CC) are discovered with primary metastatic disease. Moreover, one-third of the patients receiving chemoradiation followed by brachytherapy for locally advanced disease will have a recurrence. At the end, the vast majority of recurrent or metastatic CC not amenable to locoregional treatments are considered incurable disease with very poor prognosis. Historically, cisplatin monotherapy, then a combination of cisplatin and paclitaxel were considered the standard of care. Ten years ago, the addition of bevacizumab to chemotherapy demonstrated favorable data in terms of response rate and overall survival. Even with this improvement, novel therapies are needed for the treatment of recurrent CC in first as well as later lines. In the last decades, a better understanding of the interactions between human papillomavirus infection and the host immune system response has focused interest on the use of immunotherapeutic drugs in CC patients. Indeed, immune checkpoint inhibitors (pembrolizumab, cemiplimab, and others) have recently emerged as novel therapeutic pillars that could provide durable responses with impact on overall survival in patients in the primary (in addition to chemotherapy) or recurrent (monotherapy) settings. Tisotumab vedotin, an antibody-drug conjugate targeting the tissue factor, is another emerging drug. Several trials in monotherapy or in combination with immunotherapy, chemotherapy, or bevacizumab showed very promising results. There is a high need for more potent biomarkers to better accurately determine which patients would receive the greatest benefit from all these aforementioned drugs, but also to identify patients with specific molecular characteristics that could benefit from other targeted therapies. The Cancer Genome Atlas Research Network identified several genes significantly mutated, potentially targetable. These molecular data have highlighted the molecular heterogeneity of CC.

[Locally-advanced cervix cancer : multidisciplinary management]. / Cancer du col utérin localement avancé : approche multidisciplinaire.

Cervical cancer is the fourth most common cancer in women and is linked in over 95 % of cases to papillomavirus infection, the incidence of which has fallen in recent years due to screening and vaccination. Almost half of these cancers are diagnosed at a locally advanced stage with an overall 5-year survival of around 65 %. In recent decades, the management strategy of these locally advanced cancers has changed considerably and has allowed the improvement of survival but above all of local control as well as the reduction of toxicity, due to the implementation of imaging. Standard treatment consists of external beam radiation therapy combined with concomitant chemotherapy followed by intrauterine brachytherapy. The role of neo-adjuvant and adjuvant chemotherapy is still being evaluated. New therapeutic approaches (particularly immunotherapy) in addition to standard treatment are also being studied.

Le cancer du col de l'utérus est le quatrième cancer le plus fréquent chez la femme et est lié, dans sup�rieur a 95 % des cas, à une infection par le papillomavirus, dont l'incidence a chuté ces dernières années grâce au dépistage et à la vaccination. Près de la moitié de ces cancers sont diagnostiqués à un stade localement avancé avec une survie globale à 5 ans de l'ordre de 65 %. Ces dernières décennies, la stratégie de prise en charge de ces cancers localement avancés a considérablement changé. Elle a permis l'amélioration de la survie, mais surtout du contrôle local, ainsi que la réduction de la toxicité, grâce notamment à l'implémentation de l'imagerie. Le traitement standard consiste en une radiothérapie externe associée à une chimiothérapie concomitante, suivie d'une curiethérapie intra-utérine. La place de la chimiothérapie néo-adjuvante et adjuvante est toujours en cours d'évaluation. De nouvelles approches thérapeutiques (immunothérapie), en complément du traitement standard, sont aussi à l'étude.

[Mesogastric desmoid tumor, a rare entity]. / Tumeur desmoïde mésogastrique, une entité rare.

Desmoid tumors, also called «agressive fibromatosis¼, are rare soft tissue tumors, locally invasives with a high recurrence tendency but non metastatic. They arise mainly in people with sporadic somatic CTNNB1 gene mutation or with history of trauma, surgery or during pregnancy. These tumors are often extra-abdominal but may also develop in the abdominal wall or, more rarely, in the mesentery or retroperitoneum. It is hard to distinguish local malignancy recurrence with another type of tumor such as desmoid tumor during the follow-up of intra-abdominal resected malignancy. Even if rare, desmoid tumors must be part of the differencial diagnosis, a fortiori in the context of a surgical history. Clinical behavior, high potential of local invasion and recurrency risk of the tumor must be at the center of the therapeutic decision. A conservative approach is totally justified at the price of a close clinical and radiological follow-up.

Les tumeurs desmoïdes, aussi appelées «fibromatoses agressives¼, sont des tumeurs rares des tissus mous, localement invasives et hautement récidivantes, mais ne présentant toutefois pas de potentiel métastatique. Elles surviennent principalement chez des patients ayant une mutation sporadique somatique du gène CTNNB1 ou ayant des antécédents de traumatisme, de chirurgie ou durant une grossesse. Ces tumeurs sont, le plus souvent, de localisation extra-abdominale, mais peuvent aussi se développer au sein de la cavité abdominale, en général aux dépens des parois et, plus rarement, du mésentère ou du rétropéritoine. Dans le contexte du suivi de patients opérés d'un cancer intra-abdominal, il est difficile de distinguer une récidive du cancer primitif d'un autre type de tumeur. Aussi rares soient les tumeurs desmoïdes, elles doivent faire partie du diagnostic différentiel, a fortiori dans un contexte postopératoire. Les répercussions cliniques de la tumeur, le haut potentiel invasif local ainsi que le risque de récidive après traitement doivent être au centre de la décision thérapeutique. Une prise en charge conservatrice est tout à fait indiquée, au prix d'un suivi clinique et radiologique rapproché.