[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.

[A very unusual pleural presentation]. / Une pleurésie très inhabituelle.

Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.

[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.

Randomized open-label non-comparative multicenter phase II trial of sequential erlotinib and docetaxel versus docetaxel alone in patients with non-small-cell lung cancer after failure of first-line chemotherapy: GFPC 10.02 study.

BACKGROUND: Concomitant administration of erlotinib with standard chemotherapy does not appear to improve survival among patients with non-small-cell lung cancer (NSCLC), but preliminary studies suggest that sequential administration might be effective. OBJECTIVE: To assess the efficacy and tolerability of second-line sequential administration of erlotinib and docetaxel in advanced NSCLC. METHODS: In an open-label phase II trial, patients with advanced NSCLC, EGFR wild-type or unknown, PS 0-2, in whom initial cisplatin-based chemotherapy had failed were randomized to sequential erlotinib 150 mg/d (day 2-16)+docetaxel (75 mg/m(2) d1) (arm ED) or docetaxel (75 mg/m(2) d1) alone (arm D) (21-day cycle). The primary endpoint was the progression-free survival rate at 15 weeks (PFS 15). Secondary endpoints included PFS, overall survival (OS), the overall response rate (ORR) and tolerability. Based on a Simon optimal two-stage design, the ED strategy was rejected if the primary endpoint was below 33/66 patients at the end of the two Simon stages. RESULTS: 147 patients were randomized (median age: 60±8 years, PS 0/1/2: 44/83/20 patients; males: 78%). The ED strategy was rejected, with only 18 of 73 patients achieving PFS15 in arm ED at the end of stage 2 and 17 of 74 patients in arm D. In arms ED and D, respectively, median PFS was 2.2 and 2.5 months and median OS was 6.5 and 8.3 months. CONCLUSION: Sequential erlotinib and docetaxel was not more effective than docetaxel alone as second-line treatment for advanced NSCLC with wild-type or unknown EGFR status.

[EGFR activating mutation in lung adenocarcinoma: risk factor of thromboembolic event?]. / Mutation EGFR dans les adénocarcinomes broncho-pulmonaires: facteur de risque de MVTE ?

Cancer is a known risk factor for the development of venous thromboembolism (VTE) and in particular, adenocarcinoma of the lung is known to be associated with a higher risk of thromboembolic event. EGFR activating mutations are more frequently found in this histological subtype than in other lung cancers. We report three cases of VTE in patients with adenocarcinoma of the lung and EGFR activating mutation. Our reported case series is atypical because the VTE event occurred early in the adenocarcinoma history: either leading to the diagnosis of cancer, or appearing very early in the management of the neoplasm.

[Tuberculous involvement of the esophagus]. / Atteinte œsophagienne d'une tuberculose.

Tuberculous involvement of the oesophagus is a rare disease in our country. We report the case of a 76-year-old patient with tuberculous involvement of the oesophagus, who developped an oesophago-lymph nodes fistula. These fistulas are used to be treated by antituberculous chemotherapy. The surgical treatment is rarely needed.

[Discovery of a yellow nail syndrome with major hypothyroidism]. / Découverte d'un syndrome des ongles jaunes lors d'une insuffisance thyroïdienne majeure.

The yellow nail syndrome is rare. It associates the triad: yellow nails, lymphedema and thoracic events. We report two cases of this syndrome with major hypothyroidism. These observations suggest an association between these two diseases.

[Septic pulmonary embolism after removal of a venous access device for septic thrombophlebitis]. / Emboles pulmonaires septiques après ablation d'une chambre implantable pour thrombophlébite septique.

Septic thrombophlebitis on a central venous access device (CVAD) is a rare and serious complication. According to current guidelines, the device should be removed and antibiotics be given. The risk of septic thrombophlebitis is related to the migration of septic emboli to the lung, a potentially fatal event, particularly in frail patients with lung cancer. We report a case observed in a 66-year-old man with multiple metastatic lung cancer who had a CVAD and who developed septic thrombophlebitis leading to coagulase-negative staphylococcal bacteriemia. After removal of the CVAD, the thrombophlebitis was complicated by pulmonary embolism affecting the entire network of the right lung.

[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.

[Effect of tinzaparin on survival in non-small-cell lung cancer after surgery. TILT: tinzaparin in lung tumours]. / Effet de la tinzaparine sur la mortalité du cancer bronchique non à petites cellules opéré.

BACKGROUND: Experimental and clinical findings suggest that low molecular-weight heparins may improve overall survival in patients with cancer. The evidence is still limited and additional studies are needed to confirm these preliminary findings. METHODS: Patients with completely resected stage I, II or IIIA (T3N1) histologically confirmed non-small-cell lung cancer will be included in a prospective, controlled, randomized, multicenter open trial. Patients in the control group will receive usual postoperative care including chemotherapy when indicated. Patients in the experimental group will receive tinzaparin given subcutaneously as a daily 100 IU/kg dose for 90 days along with usual postoperative care. Patients will be followed-up for three to eight years. Main end-point is the overall survival. Five hundred and fifty patients are needed to demonstrate a 10% absolute increase in survival in the experimental group. EXPECTED RESULTS: A 10% absolute increase in the survival rate is expected in the patients receiving tinzaparin.

[Venous thromboembolism and cancer]. / Maladie veineuse thromboembolique et cancer.

Cancer and venous thromboembolism (VTE), VTE and cancer: there is a close bond between these two diseases. On the one hand, a cancer patient runs a high risk of developing VTE. Certain cancer-specific factors, such as its metastatic nature increase this risk. The means involved in the care of cancer (insertion of a venous catheter, chemotherapy, etc.) also increase the probability of a thromboembolism. On the other hand, VTE, especially if it is idiopathic, may be the harbinger of a neoplasm. The present paper involves the dual nature of this relationship, first dealing with several points specific to the occurrence of VTE in a cancer patient, before dealing with the specific care in a curative and prophylactic situation. VTE is then considered as a clinical manifestation prior to a cancer. Several characteristics evoking an underlying neoplasm are known. However, the benefits of the screening for cancer when confronted with an episode of VTE remains to be debated.

[Hand-foot syndrome: A new side effect of erlotinib]. / Syndrome mains-pieds : nouvel effet secondaire de l'erlotinib.

BACKGROUND: Erlotinib (Tarceva) belongs to the family of epidermal growth receptor factor (EGFR) inhibitors. Used in the treatment of some cancers, it is responsible for several cutaneous side effects. We report a case of hand-foot syndrome, which has not previously been described with this drug to our knowledge. PATIENTS AND METHODS: A 65-year-old patient was given erlotinib for lung cancer and after the first month of treatment, he developed severe hand-foot syndrome. DISCUSSION: Hand-foot syndrome consists of abrupt bilateral and painful acral erythema associated with dysesthesia. It is a dose-dependent side effect of certain cytostatic drugs. It may sometimes require withdrawal of the causative drug. Care must be taken to identify the early signs of hand-foot syndrome in patients treated with erlotinib.

[Place of cancer among the risk factors in venous thromboembolism]. / Place du cancer parmi les facteurs de risque de la maladie thromboembolique veineuse.

There is a strong association between cancer and venous thromboembolism (VTE). Cancer patients have a seven-fold higher risk of developing VTE as compared with noncancer patients. In the year following the diagnosis of cancer, 1.6% of patients will develop a VTE event. VTE is one of the main cause of death in cancer patients, accounting for about 15% of deaths. On the other hand, cancer patients represent 15 to 20% of all VTE cases. Beyond classical risk factors for VTE, specific risk factors are associated with VTE in cancer patients: tumor site, stage, histological type, treatment, duration of the disease. VTE occurrence is associated with a poorer outcome in cancer patients: a reduced survival is observed in cancer patients with VTE as compared to non-VTE cancer patients. This impact of VTE on prognosis varies according to cancer characteristics. Conversely, evolution of VTE is different in cancer patients, with a higher short-term risk of mortality and a higher risk of recurrences, including on anticoagulant treatment, also modulated by cancer characteristics.

[Efficacy of gefitinib (Iressa) in the treatment of an inoperable bronchioloalveolar cell carcinoma]. / Efficacité du gefitinib (Iressa) pour le traitement d'un carcinome bronchioloalvéolaire inopérable.

INTRODUCTION: Bronchioloalveolar cell carcinoma (BAC) is a rare bronchial tumour. At present the only curative treatment is surgery and inoperable cases are often resistant to radio and chemotherapy. CASE REPORT: A 76 year old woman was treated surgically for a BAC, stage T2N0M0. Three months later she presented with cough and dyspnoea. Investigation revealed recurrence of the disease with bilateral pulmonarymetastases. She then received two courses of chemotherapy leading, at best, to stabilisation of the disease. At that time the treatment decision was simple observation. Six months later when there was progression of the bilateral lesions treatment was initiated with gefitinib 250 mg daily. This lead to rapid improvement in the clinical symptoms and the chest x-ray and CT scan showed evidence of a partial response that persisted one year after the beginning of treatment. CONCLUSION: This observation describes the effect of gefitinib in the treatment of inoperable BAC for which there is, at present, no effective therapy.