Compliance to genomic test recommendations to guide adjuvant chemotherapy decision-making in the case of hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, in real-life settings.

BACKGROUND: Genomic tests are a useful tool for adjuvant chemotherapy decision-making in the case of hormone receptor-positive (HR+), and human epidermal growth factor receptor 2-negative (HER2-) breast cancer with intermediate prognostic factors. Real-life data on the use of tests can help identify the target population for testing. METHODS: French multicentric study (8 centers) including patients, all candidates for adjuvant chemotherapy for HR-positive, HER2-negative early breast cancer. We describe the percentage of tests performed outside recommendations, according to the year of testing. We calculated a ratio defined as the number of tests required to avoid chemotherapy for one patient, and according to patient and cancer characteristics. We then performed a cost-saving analysis using medical cost data over a period of 1 year from diagnosis, calculated from a previous study. Finally, we calculated the threshold of the ratio (number of tests required to avoid chemotherapy for one patient) below which the use of genomic tests was cost-saving. RESULTS: A total of 2331 patients underwent a Prosigna test. The ratio (performed test/avoided chemotherapy) was 2.8 [95% CI: 2.7-2.9] in the whole population. In the group following recommendations for test indication, the ratio was 2.3 [95% CI: 2.2-2.4]. In the case of non-abidance by recommendations, the ratio was 3 [95% CI: 2.8-3.2]. Chemotherapy was avoided in 841 patients (36%) following the results of the Prosigna test. The direct medical costs saved over 1 year of care were 3,878,798€ and 1,718,472€ in the group of patients following test recommendations. We calculated that the ratio (performed test/avoided chemotherapy) needed to be under 6.9 for testing to prove cost-saving. CONCLUSION: The use of genomic testing proved cost-saving in this large multicentric real-life analysis, even in certain cases when the test was performed outside recommendations.

Corrosion inhibition of brass 60Cu-40Zn in 3% NaCl solution by 3-amino-1, 2, 4-triazole-5-thiol.

In this article, we tested a new organic molecule used as a corrosion inhibitor of the 60Cu-40Zn alloy in an aqueous solution similar to sea water 3% NaCl namely 3-amino-1,2,4-triazole-5-thiol (ATT) using stationary and transient electrochemical methods (polarization curves and electrochemical impedance spectroscopy (EIS)). In addition, the metal surface analysis was performed by the scanning electron microscopy (SEM) coupled with the X-ray dispersion energy (EDX) in the absence and in the presence of the inhibitor tested. Analysis of the polarization curves reveals that the ATT acts as a mixed inhibitor, while the inhibition efficiency reaches a value of 97% for a concentration of 1mM of ATT, these results are confirmed by the EIS techniques, indicating that the value of the charge transfer resistance increases with increasing of ATT concentrations, consequently the inhibitory efficiency increases and reaches a maximum value of 99% in the presence of 1mM of ATT. the influence of the immersion time shows that the corrosion inhibition of the brass 60Cu-40Zn improves with the increase of the immersion time and that the molecule adsorbs chemically and follows the Langmuir isotherm. SEM/EDS study confirms the presence of protective film on the Brass surface.

Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial.

BACKGROUND: Breast cancer becomes lethal when visceral metastases develop. At this stage, anti-cancer treatments aim at relieving symptoms and delaying death without resulting in additional toxicity. On the basis of their differential anti-oxidant defence level, tumour cells can be made more sensitive to chemotherapy than non-tumour cells when membrane lipids are enriched with docosahexaenoic acid (DHA), a peroxidisable and oxidative-stress-inducing lipid of marine origin. METHODS: This open-label single-arm phase II study evaluated the safety and efficacy (response rate), as primary end points, of the addition of 1.8 g DHA daily to an anthracycline-based chemotherapy (FEC) regimen in breast cancer patients (n = 25) with rapidly progressing visceral metastases. The secondary end points were time to progression (TTP) and overall survival (OS). RESULTS: The objective response rate was 44%. With a mean follow-up time of 31 months (range 2-96 months), the median TTP was 6 months. Median OS was 22 months and reached 34 months in the sub-population of patients (n = 12) with the highest plasma DHA incorporation. The most common grade 3 or 4 toxicity was neutropaenia (80%). CONCLUSION: DHA during chemotherapy was devoid of adverse side effects and can improve the outcome of chemotherapy when highly incorporated. DHA has a potential to specifically chemosensitise tumours.

[Is staging bone scan useful in patients with small invasive breast carcinoma?]. / Faut-il réaliser une scintigraphie osseuse dans le bilan d'extension des cancers du sein de petite taille?

We conducted a retrospective study including 517 patients with invasive breast cancer classified pT1 less than 20mm. We estimated the relevance of bone scan in the screening of metastases at the time of primary presentation, as well as the costs incurred by such a screening. Postoperative systematic bone scan did not detect the two cases of synchronous bone metastases in this population. No bone metastasis was detected in groups with the highest metastatic risks (low profitability for all pT1 classified cancers). Bone scan's rate of false positive was high (17%). The global cost was estimated at 110,770 euros, that was 215 euros per patient (208 to 232 euros in the risk groups).

[Mycobacterium chelonae myositis]. / Myosite à Mycobacterium chelonae.

INTRODUCTION: Mycobacteria are only exceptionally responsible for infection of the skin and soft tissues. A Mycobacterium chelonae myositis occurred in an immunodepressed patient. OBSERVATION: A 49 year-old man, treated for many years with corticosteroids for vasculitis of the lower limbs associated with rheumatoid polyarthritis, was hospitalized for invasive pulmonary aspergillosis. Ten days later he developed myositis of the right arm with multiple subcutaneous abscesses. Culture of the purulent substance isolated Mycobacterium chelonae. Treatment with ciprofloxacine and clarithromycine led to the regression of the lesions. He was followed-up for 12 months. DISCUSSION: M. chelonae is found in large quantities in the environment. Infection with this mycobacteria is enhanced by immunodepression, notably that secondary to corticosteroid therapy. Resistance to antibiotics are frequent. Clarithromycine is highly effective against this mycobacteria. Bi-therapy is recommended to avoid the emergence of resistance.

[Paraneoplastic dermatopolymyositis with mild glomerular lesion nephropathy associated with non-Hodgkin's lymphoma]. / Dermatopolymyosite paranéoplasique avec néphropathie à lésions glomérulaires minimes associée à un lymphome malin non hodgkinien.

INTRODUCTION: Dermatopolymyositis is an inflammatory disorder of an unknown origin. Twenty to thirty percent cases of this disease are associated with a cancer. Glomerular lesions in dermatopolymyositis are rare. EXEGESIS: We describe the case of a patient who presented a dermatopolymyositis together with a glomerulopathy and then a non Hodgkin's lymphoma. A treatment by corticoid and secondary intravenous immune globulins because of corticoid-resistance of the dermatopolymyositis and oesophagus injury led to a significant improvement of the cutaneous signs and of the muscular weakness. This favourable evolution was also determined by the chemotherapy for lymphoma. Nine months after the diagnosis of dermatopolymyositis remission for dermatopolymyositis and lymphoma is obtained. We also noticed a regression of the glomerular signs. CONCLUSION: A diagnosis of dermatopolymyositis must lead to a meticulous search for an associated cancer. Data from literature indicate that a cancer is usually discovered within the first year of dermatopolymyositis' diagnosis but it can appear until five years after this diagnosis. The most frequent organs concerned by cancer are ovary and the digestive tract. A meta-analysis showed an incidence-standardised rate for lymphoma important in patients suffering from dermatopolymyositis. The treatment of the cancer can improve the evolution of the dermatopolymyositis. However corticoid must be the first treatment for dermatopolymyositis. In case of corticoid-resistant dermatopolymyositis or dermatopolymyositis involving oesophagus treatment by intravenous immune globulins is justified. At last when a glomerular nephropathy is discovered in such a situation, paraneoplasic glomerulopathy, renal lymphomatous infiltration or another associated immune disease must be called to mind.