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Biomedical subjects

F Peyrade

Publications and source records attributed to F Peyrade.

At least 19 recordsLinked to original sources
PubMed2005

Prospective randomized study comparing MEMID with a chop-like regimen in elderly patients with aggressive non-Hodgkin's lymphoma.

OBJECTIVE: This multicenter phase III study compared the MEMID regimen (mitoxantrone, VP16, methylglyoxal, ifosfamide and dexamethasone) with CEOP, a CHOP-like regimen (cyclophosphamide, epirubicin, vincristine and prednisone), in elderly patients (> or =65 years) with aggressive non-Hodgkin's lymphoma (NHL). METHODS: One hundred and forty-nine patients were eligible, 72 in the MEMID arm and 77 in the CEOP arm. The primary endpoint was to compare overall survival (OS) between groups, and secondary endpoints were event-free survival (EFS), response rate and toxicity. RESULTS: Neutropenia (p < 10(-5)), anemia (p < 10(-5)) and thrombocytopenia (p = 0.0006) were significantly more frequent in patients who received MEMID. We observed an objective response rate of 55.5% in the MEMID arm and 64.9% in the CEOP arm (p = 0.24). The median OS and EFS were 15.4 and 8.5 months in the MEMID arm, and 20.3 and 10.5 months in the CEOP arm (p = 0.59 and 0.47), respectively. The median EFS was 15.4 months in the MEMID arm and 20.3 months in the CEOP arm (p = 0.59). CONCLUSION: The increased toxicity without survival benefit confirms the superiority of CHOP and CHOP-like regimens for elderly patient with aggressive NHL.

Aged↗
PubMed2004

Results of a randomised phase II study comparing docetaxel with methotrexate in patients with recurrent head and neck cancer.

We report the results of a randomised phase II trial of docetaxel tested as a single agent in patients with recurrent head and neck cancer using methotrexate as a control arm to validate the results. Eligibility criteria included: histologically-confirmed squamous cell carcinoma, measurable disease, adequate haematological, renal and hepatic functions, no prior chemotherapy for recurrent cancer, signed informed consent. 40 mg/m2 methotrexate was given as a short weekly bolus i.v. injection, and 40 mg/m2 docetaxel was administered as a one hour weekly infusion. A total of 57 patients were randomised based on a ratio of 2/1:37 and 20 patients received docetaxel and methotrexate, respectively. Patient characteristics included 49 males and 8 females; the median age was 59 years (range: 43-82 years). Twenty-eight patients had a local-regional relapse and 29 had distant metastasis, the median disease-free interval was 7.9 months (range: 0-165 months). For patients treated with docetaxel, the following grade 3-4 toxicities occurred: neutropenia (12.5%) with febrile neutropenia in one patient (1%), anaemia (19%) mucositis (9%) and ungueal toxicity (9%). In the methotrexate arm, the grade 3-4 toxicities were: anaemia (15%) and mucositis (5%). The response rate was significantly higher in the docetaxel arm with 27% (95% confidence interval (CI): 21.7-32.3%) of objective responses versus 15% (95% CI: 11.2-18.8%) in the methotrexate arm. Overall survival and time to progression were super-imposable between the docetaxel and methotrexate treatments. Docetaxel given as a weekly infusion has a high activity in patients with head and neck cancer. A phase III trial is needed to test if this translates into a survival benefit for docetaxel use.

Adult↗
PubMed2004

[Alveolar hypoxemic interstitial pneumonia related to rituximab therapy].

INTRODUCTION: Rituximab is indicated for the treatment of low-grade lymphoma. Pulmonary toxicity related to rituximab is exceptional. CASE REPORT: Here we report a patient with non-Hodgkin lymphoma treated with "CHOP" chemotherapy (cyclophosphosphamide, adriamycin, vincristine and prednisolone) and rituximab who developed an interstitial pneumonia with acute respiratory failure. The differential diagnosis of this clinical and radiological diagnosis is discussed. CONCLUSION: Although cases of interstitial pneumonia associated with rituximab are rare, they may be severe and thus any patient experiencing respiratory symptoms on this therapy should be monitored closely.

Acute Disease↗
PubMed2004

A weekly schedule of docetaxel for metastatic hormone-refractory prostate cancer.

RATIONALE: Docetaxel has proven its efficacy in the management of hormone-refractory prostate cancer (HRPC). Schedules of docetaxel administration differ. This prospective phase II study was designed to reevaluate the activity and toxicity of docetaxel administered weekly at an optimal dose to a large cohort of HRPC patients. PATIENTS AND METHODS: Sixty-four patients were treated with docetaxel 40 mg/m(2) i.v., administered weekly for 6 consecutive weeks followed by a 2-week recovery period. Three treatment cycles were planned in the absence of progression or toxicity. The principal end point was the biochemical response based on the prostate-specific antigen (PSA) level (a decline of more than 50% for at least 4 weeks). Secondary end points were objective response to measurable disease, survival and toxicity. RESULTS: Toxicity was assessed in 64 patients. Toxicity was acceptable, with no toxicity-related deaths. Twenty-one percent of the patients developed grade 3-4 hematological toxicity. Sixty-four patients were evaluable for the PSA response. Forty-one patients (64%) achieved a decrease in PSA of >50%, 13 of whom had a PSA <4 ng/ml. Two out of 12 patients with measurable disease exhibited an objective response. With respect to PSA, the median progression-free survival was 29 weeks (95% confidence interval: 18-46 weeks). The global 1-year survival rate was 58%. CONCLUSION: Weekly docetaxel at a dosage of 40 mg/m(2) is a well-tolerated treatment, which has very promising activity on the reduction of PSA in metastatic HRPC. A large phase III study is underway.

Aged↗
PubMed2003

[Diagnosis of a metastatic valvular tumor in a living patient].

INTRODUCTION: The discovery of an endocardial mass always raises the question of its nature. Infectious endocarditis is the most frequent cause, but others diagnoses must be considered. EXEGESIS: We report a case of endocardial metastasis originating from an upper respiratory tract epidermoid carcinoma in a 48-years-old man. The diagnosis was established while the patient was alive, and survival at the time of writing is 8 months. This case report provides an opportunity for discussion of the differential diagnosis when confronted with an endocardial tumor, i.e. bacterial endocarditis, non-bacterial thrombotic endocarditis, primary cardiac tumors, metastatic osteogenic sarcoma and Libman-Sachs endocarditis. CONCLUSION: Non bacterial thrombotic endocarditis and valvular metastasis should be considered upon discovery of a valvular tumor, in the context of neoplastic disease. The prognosis of endocardial metastasis is poor, but early diagnosis and appropriate management should eventually prolong survival.

Antimetabolites, Antineoplastic↗
PubMed1999

[Cancer in patients infected with the human immunodeficiency virus. The unusual aspects].

CANCER AND HIV INFECTION: As the HIV epidemic advances, the spectrum of non-AIDS defining malignancy is expanding. Recent reports suggest an increased incidence of skin cancers, squamous cell carcinomas of the anus, and Hodgkin's disease in HIV-infected patients. Other neoplasms encountered in this setting include oral mucosa, head and neck carcinoma without evidence of increased incidence. PARTICULAR FEATURES: The natural history of lung, testicle and skin cancer (excepting Kaposi sarcoma) as well as ENT cancer appears to be modified in HIV-infected patients. The main problem raised by these tumors is confounding infection which may lead to late diagnosis or an error in tumor staging.

HIV Infections↗
PubMed1999

[Bronchopulmonary cancer, antiphospholipid syndrome and coagulation disorders].

INTRODUCTION: The antiphospholipid syndrome includes recurrent thrombotic manifestations related to antiphospholipid antibodies. Adrenal insufficiency is a rare complication of the antiphospholipid syndrome. EXEGESIS: We report a case of acute adrenal insufficiency secondary to bilateral adrenal hemorrhage in a 45-year-old man. The finding of antiphospholipid antibodies and 6 months later of a polymetastatic bronchopulmonary cancer led us to diagnose a paraneoplasic antiphospholipid syndrome. CONCLUSION: We discuss the role of coagulation disorders in the pathogenesis of tumor growth and rapid metastatic spread. Assessment of the high risk for thrombosis may be of prognostic and therapeutic value in patients with evolutive bronchopulmonary cancer. Early anticoagulation treatment in association with classical treatment of cancer may contribute to prevent malignant process from extending and avoid metastatic spread.

Adrenal Insufficiency↗
PubMed1998

[Influence of HIV-related immunodeficiency on the histopathology of chronic hepatitis C].

OBJECTIVE: There is substantial evidence demonstrating the aggravating effect of human immunodeficiency virus (HIV) infection on the progression of chronic hepatitis C virus (HCV) infection. There is however, little data on the affect of certain factors which could affect liver pathology findings in patients with concomitant HIV infection such as the duration of HIV infection or T-cell subpopulation counts. We examined pathology findings in patients with concomitant HIV and HCV infections to determine the impact of immunodepression. PATIENTS AND METHODS: We reviewed liver pathology data collected in patients with concomitant HIV and HCV infections grouping patients according to severity of the liver pathology: group 1 = cirrhosis or active hepatitis; group 2 = minimally active hepatitis or histologically normal liver. Transparietal liver biopsies were obtained for the work-up of viral hepatitis or because of long-term unexplained fever or suspected lymphoma. Epidemiological and biological data were obtained from medical files. The duration of the liver disease was estimated from the date of exposure to risk of immunodepression as determined by the peripheral CD4+ and CD8+ counts. All pathology specimens were read by two pathologists who established the Knodell score for each patient. RESULTS: Fifty patients were included: 23 were classed in group 1 and 28 in group 2. The Knodell score was significantly different between the two groups, 11 +/- 4 and 4 +/- 3 respectively (p < 0.0001). Disease duration was similar for the two groups: mean 8 years. Mean CD4+ count was significantly higher in group 1: 312/mm3 versus 110/mm3 for group 2 (p = 0.0057); as was the mean CD8+ count (758/mm3 versus 360/mm3, p = 0.0013). For the entire study population, there was a significantly negative correlation (p < 0.05) between the Knodell score and the CD4+ count (r = 0.31) and for the CD8+ count (r = 0.41). CONCLUSION: HCV-related liver pathology in patients co-infected with HIV depends on the level of immunodepression. CD8+ counts are better correlated with pathology findings than with CD4+ counts.

Adult↗
PubMed1998

[Hypercalcemia associated with hyperleukocytosis, a new paraneoplastic syndrome].

BACKGROUND: The association of hypercalcemia and leukocytosis constitutes a novel paraneoplastic syndrome rarely reported in the course of head and neck and lung squamous cell carcinoma. We report 7 new cases. CASE REPORTS: In 5 cases the diagnosis was well-differentiated squamous cell carcinoma, in 1 differentiated non-small-cell carcinoma and in 1 adenocarcinoma of unknown origin. There was no argument favoring hyperparathyroidism in any of the cases. Microbiology tests were negative and large spectrum antibiotics were unsuccessful, eliminating an associated infection as cause of the leukocytosis. DISCUSSION: This association probably involves the secretion of hematopoietic growth factors such as G-CSF or GM-CSF by the tumor, acting simultaneously on osteoclasts and granulomonocytic cells which have common precursers.

Aged↗
PubMed1998

[Lung cancer in patients infected with human immunodeficiency virus. Clinical course and therapeutic implications].

OBJECTIVES: HIV infection is associated with increased frequency of non-Hodgkin's lymphoma and Kaposi sarcoma. Like other malignancies, lung cancer has been described in HIV-infected patients although no evidence of a statistical correlation has been reported. PATIENTS AND METHODS: We performed a retrospective analysis of 15 HIV-infected patients with lung cancer. The patients were relatively younger (mean age 45 years) than is commonly found in lung cancer cohorts. RESULTS: The 15 patients had mild immunodepression (240 CD4+/mm3) and were in advanced clinical stage at diagnosis. Mean overall survival was 6 months and no clinical or biological prognostic factors were found. Death was usually due to infection, suggesting a synergetic effect between HIV and chemotherapy-induced immunodepression. CONCLUSION: We propose early antiretroviral therapy in cases of chemotherapy-treated HIV patients, even when commonly accepted immunological and/or clinical criteria are absent.

Adult↗
PubMed1998

[Epilepsy and cancer].

INTRODUCTION: Seizures are common in patients presenting with intracranial tumors. Nevertheless, the incidence of cancer is not higher in patients with seizures. We attempted to summarize situations that can lead to the diagnosis or treatment of seizures in patients presenting with cancer. CURRENT KNOWLEDGE AND KEY POINTS: Focal neurological signs on clinical examination when seizures occur for the first time in patients with cancer lead to brain imaging. As a result of recent advances in neuro-imaging techniques, the presence of a tumor is now more frequently observed in patients with seizures. PERSPECTIVES AND FUTURE PROJECTS: As it may have irritating effects on the cerebral cortex, chemotherapy is able to either increase or induce seizures in patients presenting with cancer. Potential pharmacological interactions between antiepileptic and cytotoxic drugs thus require close surveillance in patients with cancer.

Anticonvulsants↗
PubMed1998

[Tyrosine kinase: implications in tumor pathology and therapeutic perspectives].

The tyrosine kinase family includes growth factor receptor and cytoplasmic enzymes. It plays a key role in normal cell division and abnormal cell proliferation and differentiation. The most common tyrosine kinases are the epidermal-growth factor (EGFR) and platelet-derived growth factor (PDGF) receptors, and a chromosome Philadelphia product, the Bcr-abl oncogene. Many studies have attempted to correlate clinical evolution of tumors with tyrosine kinase expression. However, clinical application of these new prognostic factors has not yet been demonstrated. More recently, tyrosine-phosphorylation inhibitors (tryphostin) have been developed in phase I studies. Results that were obtained show some objective responses in patients with glioblastoma and polymetastatic cancer. Another approach to block tyrosine kinase expression is the use of monoclonal antibodies. Trials using such antibodies have shown interesting preliminary results.

Antibodies, Monoclonal↗
PubMed1998

[Orthostatic hypotension revealing vitamin B12 deficiency].

Neurological manifestations of cobalamin deficiency are well known and various. We describe an uncommon clinical setting where major orthostatic hypotension was the primary symptom. Recovery was rapidly and completely stabilized with parenteral cobalamin substitution. There was no clinical or electrophysiological signs of neuropathic disorder. This entity is rare but few cases are described in literature. All of them were reversible with vitamin substitution treatment.

Aged↗
PubMed1997

[Hyponatremia during treatment with cisplatin].

BACKGROUND: Cisplatin is one of the most widely used agents in cancer treatment. Cisplatin regimens can lead to a more or less pronounced hyponatremia in 4 to 10% of cases due to salt wasting with hypomagnesemia and normokaliemia. Functional and renal failure and orthostatic hypotension can be observed. CASE REPORT: A 54-year-old woman with brain metastases of a non-small-cell lung cancer was given a chemotherapy regimen containing cisplatin. Hyponatremia with confusion occurred after each cisplatin perfusion. The diagnosis retained was cisplatin-induced salt wasting. The patient was given salt prolonged supplementation and carboplatin was substituted for cisplatin in the chemotherapy regimen. DISCUSSION: Hyponatremia frequently occurs in cancer patients. Cisplatin-induced hyponatremia requires specific management. Treatment is based on sodium intake which sometimes takes several months to replete stores. Carboplatin can be used instead of cisplatin in case of major hyponatremia.

Antineoplastic Agents↗