Investigating oral somatosensory perception and oral symptoms of head and neck cancer patients: insights on eating behaviour.

PURPOSE: Sensory alterations and oral manifestations are prevalent among head and neck cancer (HNC) patients. While taste and smell alterations have been thoroughly investigated, studies on their oral somatosensory perception remain limited. Building upon our previous publication that primarily focused on objective somatosensory measurements, the present work examined self-reported sensory perception, including somatosensation and oral symptoms, in HNC patients and evaluated their link with eating behaviour. METHODS: A cross-sectional study was conducted using self-reported questionnaires on sensory perception, oral symptoms, sensory-related food preference, and eating behaviour among HNC patients (n = 30). Hierarchical clustering analysis was performed to categorise patients based on their sensory perception. Correlations between oral symptoms score, sensory perception, sensory-related food preference, and eating behaviour were explored. RESULTS: Two distinct sensory profiles of patients were identified: no alteration (n = 14) and alteration (n = 16) group. The alteration group showed decreased preference towards several sensory modalities, especially the somatosensory. Concerning eating behaviour, more patients in the alteration group agreed to negatively connotated statements (e.g. having food aversion and eating smaller portions), demonstrating greater eating difficulties. In addition, several oral symptoms related to salivary dysfunction were reported. These oral symptoms were correlated with sensory perception, sensory-related food preference, and eating behaviour. CONCLUSION: This study presented evidence demonstrating that sensory alterations in HNC patients are not limited to taste and smell but cover somatosensory perception and are linked to various aspects of eating. Moreover, patients reported experiencing several oral symptoms. Those with sensory alterations and oral symptoms experienced more eating difficulties.

Oral somatosensory alterations and salivary dysfunction in head and neck cancer patients.

PURPOSE: Patients with head and neck cancer (HNC) are at high risk of malnutrition due to eating difficulties partly mediated by sensory alterations and salivary dysfunction. Clinical studies have mostly focused on taste and smell alterations, while changes in oral somatosensory perception are largely understudied. The study aimed to investigate oral somatosensory (tactile, texture, chemesthetic, and thermal) responses and salivary functions of HNC patients in comparison to healthy controls. METHODS: A cross-sectional study was conducted using psychophysical tests in HNC patients (n = 30) and in age- and gender-matched control subjects (n = 30). The tests included measurements of point-pressure tactile sensitivity, whole-mouth chemesthetic stimulation, food texture discrimination, and temperature discrimination. Salivary functions, including hydration, saliva consistency, pH, volume, and buffering capacity, were also evaluated. RESULTS: HNC patients demonstrated significantly lower chemesthetic sensitivity (for medium and high concentrations, p < 0.05), thermal sensitivity (p = 0.038), and salivary functions (p = 0.001). There were indications of lower tactile sensitivity in the patient group (p = 0.101). Patients were also less sensitive to differences in food roughness (p = 0.003) and firmness (p = 0.025). CONCLUSION: This study provided evidence that sensory alterations in HNC patients extend beyond their taste and smell. The measurements demonstrated lower somatosensory responses, in part associated with their reduced salivary function. Oral somatosensory alterations and salivary dysfunction may consequently impart the eating experience of HNC patients. Thus, further investigations on food adjustments for this patient group seem warranted.

Analysis of the benefit of salvage chemotherapy after progression on nivolumab in patients with squamous cell carcinoma of the head and neck.

BACKGROUND: Checkpoint inhibitor (CI) therapies have shown benefit in the treatment of locally recurrent or metastatic head and neck squamous cell carcinoma (R L/M HNSCC). Previous studies have suggested a superior benefit of salvage chemotherapy (SCT) in R/M HNSCC after progression on CI. We aimed to describe the benefit of SCT after progression on nivolumab. PATIENTS AND METHODS: Patients were eligible if they received at least one injection of SCT in the treatment of R/M HNSCC after progression on nivolumab between 2017 and 2022. The present work was a retrospective and monocenter study. Primary endpoint was the objective response rate (ORR) on first regimen of salvage chemotherapy (SCT1). Secondary endpoints were disease-control rate (DCR), ORR on second course of SCT (ORR2), progression-free survival (PFS) on SCT1 and SCT2 (PFS2) and overall survival (OS). RESULTS: Eighty-three patients received an SCT. The ORR on STC1 was 32%. Median progression-free survival (PFS) was 2.20 months (CI 95% 2.06-3.71). Median OS was 5.55 months (CI 95% 4.82-10.20). The ORR to the first line of treatment in the relapse setting was an independent prognostic factor for SCT1 PFS and OS. CONCLUSION: In R/M HNSCC, SCT following nivolumab is associated with ORRs of 32%. These results are consistent with other publications that suggest a superior benefit of SCT after CI treatment, independent of the tumor outcome on previous immunotherapy.

Oral Somatosensory Alterations in Head and Neck Cancer Patients-An Overview of the Evidence and Causes.

Food-related sensory alterations are prevalent among cancer patients and negatively impact their relationship with food, quality of life, and overall health outcome. In addition to taste and smell, food perception is also influenced by somatosensation comprising tactile, thermal, and chemesthetic sensations; yet studies on oral somatosensory perception of cancer patients are lacking to provide patients with tailored nutritional solutions. The present review aimed to summarise findings on the oral somatosensory perception of head and neck cancer (HNC) patients and the potential aetiologies of somatosensory alterations among this population. Subjective assessments demonstrated alterations in oral somatosensory perception such as sensitivity to certain textures, spices, and temperatures. Physiological changes in oral somatosensation have been observed through objective assessments of sensory function, showing reduced localised tactile function and thermal sensitivity. Changes in whole-mouth tactile sensation assessed using texture discrimination and stereognosis ability seem to be less evident. Available evidence indicated oral somatosensory alterations among HNC patients, which may affect their eating behaviour, but more studies with larger sample sizes and standardised assessment methods are needed. Unlike other types of cancers, sensory alterations in HNC patients are not only caused by the treatments, but also by the cancer itself, although the exact mechanism is not fully understood. Prevalent oral complications, such as xerostomia, dysphagia, mucositis, and chemosensory alterations, further modify their oral condition and food perception. Oral somatosensory perception of cancer patients is an under-investigated topic, which constitutes an important avenue for future research due to its potential significance on eating behaviour and quality of life.

PD-1 Blockade in Solid Tumors with Defects in Polymerase Epsilon.

Missense mutations in the polymerase epsilon (POLE) gene have been reported to generate proofreading defects resulting in an ultramutated genome and to sensitize tumors to checkpoint blockade immunotherapy. However, many POLE-mutated tumors do not respond to such treatment. To better understand the link between POLE mutation variants and response to immunotherapy, we prospectively assessed the efficacy of nivolumab in a multicenter clinical trial in patients bearing advanced mismatch repair-proficient POLE-mutated solid tumors. We found that only tumors harboring selective POLE pathogenic mutations in the DNA binding or catalytic site of the exonuclease domain presented high mutational burden with a specific single-base substitution signature, high T-cell infiltrates, and a high response rate to anti-PD-1 monotherapy. This study illustrates how specific DNA repair defects sensitize to immunotherapy. POLE proofreading deficiency represents a novel agnostic biomarker for response to PD-1 checkpoint blockade therapy. SIGNIFICANCE: POLE proofreading deficiency leads to high tumor mutational burden with high tumor-infiltrating lymphocytes and predicts anti-PD-1 efficacy in mismatch repair-proficient tumors. Conversely, tumors harboring POLE mutations not affecting proofreading derived no benefit from PD-1 blockade. POLE proofreading deficiency is a new tissue-agnostic biomarker for cancer immunotherapy. This article is highlighted in the In This Issue feature, p. 1397.

Impact of the First Wave of the COVID-19 Pandemic on the Lyon University Hospital Cancer Institute (IC-HCL).

This article presents the protective measures put in place at the "Institut de Cancérologie des Hospices de Lyon" (IC-HCL) during the first wave of the COVID-19 pandemic in France (spring 2020) and how they impacted IC-HCL clinical activity. Spring 2020 activities were compared to winter 2019-2020. Results showed a decrease of activity of 9% for treatment dispensations, 17% for multidisciplinary team meetings, 20% for head and neck and thoracic surgeries, and 58% for new patient enrolment in clinical trials. Characteristics of patients treated for solid cancer and hospitalized for COVID-19 during spring 2020 were collected in a retrospective study. Mortality was attributed to COVID-19 for half of the cases, 82% being patients above 70 and 73% being stage IV. This is in concordance with current findings concluding that the risk of developing severe or critical symptoms of COVID-19 is correlated with factors co-occurring in cancer patients and not to the cancer condition per se. While a number of routines and treatment regimens were changed, there was no major decline in numbers of treatments conducted at the IC-HCL during the first wave of the COVID-19 pandemic that hit France between March and May 2020, except for clinical trials and some surgery activities.

Probable paclitaxel-induced pancreatitis: uncommon case report and literature review.

Acute pancreatitis is an inflammatory disorder of the pancreas characterized by upper abdominal pain, nausea, and vomiting, with elevated serum amylase or lipase. Gallstones and alcohol are the two main etiologies; drug-induced pancreatitis is uncommon. Paclitaxel associated with pancreatitis is very rare and since that time, only seven case reports have been published. We report a case of a 54-year-old female who developed an acute pancreatitis after administration of the first cycle of neoadjuvant chemotherapy with paclitaxel (175 mg/m2 over 3 h) and carboplatin (AUC 6) for ovarian adenocarcinoma. After conservative management, pancreatitis was resolved. The patient received an additional five cycles of carboplatin with no complication. Because Paclitaxel is used in many chemotherapy protocols, it is important for clinicians to be aware that paclitaxel can induce acute pancreatitis, as early diagnosis can be vital.

[Clinical burden caused by hospitalization for febrile neutropenia in France in 2010-2011: An analysis of the PMSI database]. / Hospitalisations pour neutropénie fébrile chimio-induite en France en 2010-2011 : impact clinique et caractéristiques des patients à partir des données de la base PMSI.

INTRODUCTION: Febrile neutropenia (FN) is a severe complication of chemotherapy in terms of morbidity and mortality. Using data from the PMSI database, the objective of this work was to estimate the clinical burden caused by hospitalization for FN in France, assessed by number of patients, number of stays and hospital mortality. METHODS: Using the PMSI database (which includes all hospitalizations occurring annually in France), an algorithm was used to select newly-diagnosed patients treated by chemotherapy in 2010/2011 who were hospitalized for FN within the 30 days following each administration of chemotherapy during their first year of treatment. The number, characteristics and comorbidities of patients were described, as well as the number and length of stay and mortality in hospitalized patients. RESULTS: In 2010-11, 10,229 patients were hospitalized for FN, representing a hospitalization rate of 7.4% in newly-diagnosed patients receiving chemotherapy. A total of 13,559 stays were identified, with an average duration of 6.3±8.7 days (median=4 days). A total of 720 deaths occurred during the hospital stays, corresponding to a mortality rate of 7%. Among patients hospitalized for FN, there were 14% of patients with diabetes, 8 % with heart failure, 34% with hypertension and 41% with at least one of these three comorbidities. DISCUSSION: With 10,299 hospitalized patients and 13,559 stays in 2010-11, the clinical burden induced by febrile neutropenia in cancer patients treated with chemotherapy is considerable.

Telomere length is a prognostic biomarker in elderly advanced ovarian cancer patients: a multicenter GINECO study.

PURPOSE: Age induces a progressive decline in functional reserve and impacts cancer treatments. Telomere attrition leads to tissue senescence. We tested the hypothesis that telomere length (TL) could predict patient vulnerability and outcome with cancer treatment. PATIENTS AND METHODS: An ancillary study in the Elderly Women GINECO Trial 3 was performed to evaluate the impact of geriatric covariates on survival in elderly advanced ovarian cancer patients receiving six cycles of carboplatin. TL was estimated from peripheral blood at inclusion using standard procedures. RESULTS: TL (in base pairs) was estimated for 109/111 patients (median 6.1 kb; range [4.5-8.3 kb]). With a cut-off of 5.77 kb, TL discriminated two patient groups, long telomere (LT) and short telomeres (ST), with significantly different treatment completion rates of 0.80 (95% CI [0.71-0.89]) and 0.59 (95% CI [0.41-0.76]), respectively (odds ratio [OR]=2.8, p=0.02). ST patients were at higher risk of serious adverse events (SAE, OR=2.7; p=0.02) and had more unplanned hospital admissions (OR=2.1; p=0.08). After adjustment on FIGO stage, TL shorter than 6 kb was a risk factor of premature death (HR=1.57; p=0.06). CONCLUSION: This exploratory study identifies TL as predictive factor of decreased treatment completion, SAE risk, unplanned hospital admissions and OS after adjustment on FIGO stage.

Optimal management of breast cancer in the elderly patient: current perspectives.

Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.

Acute headache followed by focal neuropsychological impairment in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

Occasionally, patients with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) present atypical features such as confusion, coma, or nonconvulsive status epilepticus. Acute focal neuropsychological syndrome revealing the disease has been poorly documented. We report the atypical presentation of two patients in whom CADASIL was revealed by an episode of headache followed by focal neuropsychological impairment.