Biomedical subjects

Jean-Pierre Pignon

Publications and source records attributed to Jean-Pierre Pignon.

22 records · Page 2Linked to original sources

PubMed2004

[Adjuvant chemotherapy in non-small cell lung cancer].

Lung cancer is the leading cause of cancer death in France. Nearly 80% of lung tumors are non-small cell lung cancers (NSCLC). Surgery is the best curative approach, but it only concerns 30% of NSCLC, since the diagnosis is frequently made in patients with locally advanced or metastatic disease. Even when surgery is performed relapse occurs in up to 50% of patients. Several adjuvant trials have been led in the late 90's after an individual data-based meta-analysis suggested a 5% survival benefit at 5 years. Among those, the IALT study, with 1 867 patients included, confirms the benefit of post-operative chemotherapy in resected NSCLC. In this article, the current status of adjuvant chemotherapy is reviewed, and future prospects are discussed.

Antineoplastic Agents↗

PubMed2003

Resected non-small cell lung cancer: need for adjuvant lymph node treatment? From hope to reality.

Even if postoperative thoracic radiotherapy has been widely used as adjuvant treatment, the oncological community has poorly evaluated this treatment after complete surgical resection in lung cancer. The number of patients included in randomised trials has been less than 3000. The analysis of these trials showed rather a deleterious effect in terms of overall survival, suggesting a lethal late treatment-related toxicity in early stage I or II disease. In N2 disease, these effects have not been demonstrated but information is lacking to consider this treatment on an evidence-based medicine policy. We discuss here the available worldwide information on this subject. There is an urgent need for new trials in this topic.

Carcinoma, Non-Small-Cell Lung↗

PubMed2002

A graphical method for exploring heterogeneity in meta-analyses: application to a meta-analysis of 65 trials.

Heterogeneity can be a major component of meta-analyses and by virtue of that fact warrants investigation. Classic analysis methods, such as meta-regression, are used to explore the sources of heterogeneity. However, it may be difficult to apply such a method in complex cases or in the absence of an a priori hypothesis. This paper presents a graphical method to identify trials, groups of trials or groups of patients that are sources of heterogeneity. The contribution of these trials to the overall result can also be evaluated with this method. Each trial is represented by a dot on a 2D graph. The X-axis represents the contribution of the trial to the overall Cochran Q-test for heterogeneity. The Y-axis represents the influence of the trial, defined as the standardized squared difference between the treatment effects estimated with and without the trial. This approach has been applied to data from the Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) comprising 10,850 patients in 65 randomized trials. The graphical method allowed us to identify trials that contributed considerably to the overall heterogeneity and had a strong influence on the overall result. It also provided useful information for the interpretation of heterogeneity in this meta-analysis. The proposed graphical method identifies trials that account for most of the heterogeneity without having to explore all possible sources of heterogeneity by subgroup analyses. This method can also be applied to identify types of patients that explain heterogeneity in the treatment effect.

Clinical Trials as Topic↗

PubMedDate not supplied

Clinical research infrastructures and networks in France: report on the French ECRIN workshop.

A meeting was organised in Paris on 13 September 2004, to provide an in-depth description of the state of the art in institutional clinical research infrastructures and their environment in France. This meeting was scheduled within the ECRIN (European Clinical Research Infrastructures Network) project, funded by the European Union (6th Framework Programme). Ten items were addressed: (i) centres and networks; (ii) funding and sponsoring of clinical research; (iii) ethics; (iv) legislation and regulation; (v) adverse-event reporting and drug dispensing; (vi) methodology, data management and data monitoring; (vii) quality management and audits; (viii) communication with investigators, sponsors and participants; (ix) transparency and registration of clinical studies; and (x) education and careers. This description, together with parallel workshops held in other countries using a similar pattern, helped prepare a comparative analysis enabling better identification of the bottlenecks for multinational research in Europe, and define the most relevant approaches to harmonisation and the services required to support the role of sponsors in transnational studies.

Biomedical Research↗