11e réunion internationale sur le myélome, 25–30 juillet 2007, île de Kos, Grèce

11esup> réunion internationale sur le myélome, 25–30 juillet 2007, île de Kos, Grèce

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作者：O. Decaux
关键词：Bayesian Ying– ; Yang (BYY) system ; Harmony learning ; Gaussian mixture ; Automated model selection ; Fixed-point
刊名：La Revue de Medecine Interne
出版年：2008
期刊代码：237_02488663
类别：med
出版时间：May 2008
卷：29
期：5
页码：439-440
文件大小：86 K

摘要

Patients and methods. –span>span> From 1992 to 2000, 92 consecutive patients were treated in our single institution. All of them had stage IV, unresectable squamous cell carcinoma of the pharynx and they received continuous bid radiotherapy (two daily fractions of 1.2 Gy, 5 days a week, with a 6-h minimal interval between fractions). Total radiotherapy dose was 80.4 Gy on the oropharynx and 75.6 Gy on the hypopharynx. Two or three chemotherapy courses of cisplatin (CP) -5-fluorouracil (5FU) were given during radiotherapy at 21-day intervals (third not delivered after the end of the radiotherapy). CP dose was 100 mg/m2sup> (day 1) and 5-FU was given as 5-day continuous infusion (750 mg/m2sup>/day at 1st course; 430 mg/m2sup>/day at 2nd and 3rd courses). Special attention was paid to supportive care, particularly in terms of enteral nutrition and mucositis prevention by low-level laser energy.

Results. –span>span> Acute toxicity was marked and included WHO grade III/IV mucositis (89%, 16%of them being grade IV), WHO grade III dermatitis (72%) and grade III/IV neutropenia (61%). This toxicity was significant but manageable with optimised supportive care, and never led to interruption of treatment for more than 1 week, although there were two toxic deaths. Complete global response rate at 6 months was 74%. Overall global survival at 1 and 2 years was 72%and 50%respectively, with a median follow-up of 17 months. Prognostic factors for overall survival were the Karnofsky index (71%survival at 3 years for patients with a Karnofsky index of 90–100%versus 30%for patients with a Karnofsky index of 80%versus 0%for patients with a Karnofsky index of 60-70%, p span>= 0.0001) and tumor location (55%at 3 years for oropharynx versus 37%for panpharynx versus 28%for hypopharynx, p span>= 0.009).

Conclusion. –span>span> These results confirm the efficacy of concomitant bid radiotherapy and chemotherapy in advanced unresectable tumor of the pharynx. The improvement in results will essentially depend on our capacity to restore in a good nutritional status the patients before beginning this heavy treatment.

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La Revue de Medecine Interne

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src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> sciencedirect.com/science?_ob=ArticleURL&_udi=B6VMG-4NT9J5P-1&_user=10&_coverDate=10%2F31%2F2007&_rdoc=1&_fmt=high&_orig=article&_cdi=6150&_sort=v&_docanchor=&view=c&_ct=368&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b0cb400597f6dcba804aaa2f0f7a17e8">Les nouveaux médicaments du myélome
La Revue de Médecine Interne, Volume 28, Issue 10, October 2007, Pages 682-688
C. Hulin

Abstract

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ss="h3">Résumé

ss="h4">Propos

Après des décennies de progrès minimes, deux nouvelles classes médicamenteuses avec de nouveaux mécanismes d'action : immunomodulateurs (thalidomide et lénalidomide) et inhibiteur du protéasome (bortézomib), ont montré une grande efficacité dans le traitement du myélome multiple.

ss="h4">Actualités et points forts

La thalidomide agit selon des mécanismes variés ; son efficacité est reconnue en situation de rechute particulièrement en association avec la dexaméthasone. Il a été récemment démontré que l'association thalidomide, melphalan et prednisone devait devenir le traitement de référence de première ligne chez les sujets âgés. Les effets toxiques principaux sont la neuropathie périphérique et les thromboses veineuses. Le bortézomib est le premier inhibiteur du protéasome. Son utilisation est approuvée en première rechute. L'association aux glucocorticoïdes est synergique. Cette association est prometteuse en induction avant autogreffe de cellules souches, ainsi que l'association au melphalan et prednisone chez le sujet âgé. Les effets toxiques majeurs sont la fatigue et la neuropathie périphérique. Le lénalidomide est un analogue de la thalidomide. Son efficacité en rechute, en association avec la dexaméthasone, est démontrée. Sa toxicité principale est hématologique. Son utilisation en première ligne est également prometteuse.

ss="h4">Perspectives et projets

Ces nouveaux médicaments ont des toxicités bien identifiées, tolérables et peuvent être utilisés successivement ou en association en vue d'une meilleure efficacité. Ils ont un impact sur les schémas de traitement du myélome multiple et sur le devenir de la maladie elle-même.

ss="h4">Purpose

After decades of minimal progress, two new classes of drugs with novels mechanisms of action: immunomodulatory drugs (thalidomide and lenalidomide) and proteasome inhibitors (bortezomib) have shown great activity for the treatment of multiple myeloma.

ss="h4">Current knowledge and key points

Thalidomide acts by a variety of mechanisms; its efficacy is well known in disease relapse especially associated with dexamethasone. Recent results prove that combination of thalidomide with melphalan and prednisone should be considered as the first line standard of care in elderly patient. The main side effects are peripheral neuropathy and deep-vein thrombosis. Bortezomib is the first proteasome inhibitor. It is approved for the treatment in first disease relapse. The combination with glucocorticoids is synergistic. This combination in induction treatment before autologous stem cell transplantation is promising, as well as the combination with melphalan and prednisone in elderly patient. The main toxicities are fatigue and peripheral neuropathy. Lenalidomide is a structural analogue of thalidomide. Its efficacy in combination with dexamethasone has been proved in relapsing patients. The main toxicity is hematologic. Utilisation as first line treatment is also promising.

ss="h4">Future prospects and projects

These three drugs have toxicities predictable and manageable and can be used successively or in combination for greater effectiveness. They have an impact on the multiple myeloma treatment strategies and on the disease course itself.

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