Immune Checkpoint Inhibitor-Associated Myocarditis: A New Challenge for Cardiologists.

The ever-increasing use of immune checkpoint inhibitors in cancer is leading to a high incidence of autoimmune side effects. This report discusses an autoimmune fulminant myocarditis in an elderly patient with metastatic pulmonary adenocarcinoma in whom the most advanced invasive heart failure therapies were used successfully. She was treated with nivolumab. This case illustrates a severe cardiovascular complication of immunotherapy and highlights to cardiologists the importance of aggressive treatments in patients with metastatic cancers whose prognosis has improved dramatically.

[Recommendations for the use of antiemetic drugs by the general practitioner]. / Utilisation des antiémétiques par le praticien.

Nausea is a common symptom among patients affected by chronic diseases or undergoing various treatments. Because nausea can result from many origins, there is a large differential diagnosis to explore. Its pathophysiology relies on numerous neurotransmitters, on which 5 types of antiemetic antagonists are effective (NK-1 receptor antagonists, antiserotoninergic, antidopaminergic, antihistaminic and anticholinergic agents). Glucocorticoids and benzodiazepines are also used to treat some types of nausea. Choosing the appropriate antiemetic can improve quality of life and treatment compliance.

Les nausées sont un symptôme retrouvé fréquemment en consultation chez les patients atteints de maladies chroniques et/ou traités par certains médicaments. L'absence de spécificité des nausées doit faire ouvrir un large diagnostic différentiel à explorer. Le mécanisme physiopathologique fait intervenir de nombreux neurotransmetteurs, que 5 familles d'antiémétiques antagonisent (antisérotoninergiques, antidopaminergiques, antagonistes du récepteur NK-1, antihistaminiques, anticholinergiques). Les glucocorticoïdes et les benzodiazépines sont également utilisés pour traiter certains types de nausées. Le choix du traitement le plus adéquat amène une amélioration de la qualité de vie et une meilleure compliance thérapeutique.

[Supportive care in oncology: a real change for patients?] / Soins de support en oncologie : un vrai changement pour le patient ?

With the increased incidence of cancers due to an aging population, and a prolonged survival thanks to advances in cancer treatments, new therapeutic challenges have arisen. The management of symptoms, the tolerance of increasingly effective oncologic treatments and, finally, quality of life are central concerns of patients and their loved ones. Supportive care in oncology has helped meet these challenges, offering a holistic approach, encompassing somatic, psychiatric and social aid. Inaugurated in 2005, the oncologic supportive care unit of the Geneva University Hospitals allows many cancer patients access to a team of multidisciplinary care-givers to help meet their needs.

Avec le vieillissement de la population à l'origine d'une augmentation de l'incidence des cancers et face aux progrès thérapeutiques qui permettent aux patients atteints de vivre plus longtemps, surgissent de nouveaux défis de prise en charge. La gestion des symptômes, la tolérance aux traitements oncologiques de plus en plus nombreux et efficaces, et finalement la qualité de vie sont au centre des préoccupations des patients et de leurs proches. Les soins de support en oncologie permettent de répondre à ces attentes en proposant une prise en charge globale, aussi bien somatique que psychique et sociale. Inaugurée en 2005, l'unité hospitalière des soins de support en oncologie des HUG permet à de nombreux patients, atteints de cancer, d'avoir accès à une équipe multidisciplinaire de soignants afin de répondre à ces objectifs.

Recurrent multiple CNS hemangioblastomas with VHL disease treated with pazopanib: a case report and literature review.

Hemangioblastoma is a rare benign neoplasm, accounting for less than 2% of all primitive brain tumors. It may arise sporadically in a solitary form, or associated with Von Hippel-Lindau (VHL) disease with multiple tumors. Surgery is the mainstay treatment, but management is challenging in case of recurrent and/or multiple tumors. VHL protein is defective in both forms of hemangioblastoma, leading to the accumulation of hypoxia-inducible factor, stimulating angiogenesis via VEGF and PDGF mainly. Here, we report a 37-year-old woman's case with recurrent and rapidly progressive VHL-associated hemangioblastomas, causing severe disability. She was treated 24 months with pazopanib, a multityrosine kinase inhibitor (TKI) targeting VEGF and PDGF-ß pathways. Despite moderate radiological changes, progressive improvement in her clinical condition persisting over 3 years was observed. Inhibiting angiogenesis is a therapeutic option that may improve the quality of life and the autonomy of VHL patients disabled with multiple hemangioblastomas.

[Integration of nutritional care into cancer treatment: need for improvement]. / Soin nutritionnel intégré au soin oncologique: un besoin d'optimisation.

Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.