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Biomedical subjects

M Jouve

Publications and source records attributed to M Jouve.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Malignant epidermoid degeneration of dermoid cysts of the ovary. Apropos of 2 cases].

Malignant transformation of benign ovarian cystic teratomas has been reported in 0.5 to 2% of cases. Many different types of cancer can develop, including squamous cell carcinoma, which is by far the most frequent (75%). The mean age of diagnosis is over 50 years. Minimal surgical techniques have been increasingly popular and laparoscopic removal of benign ovarian cysts has become common practice. Malignant transformation is rare but needs to be recognized in order to avoid dissemination of malignant cells during surgery. Direct invasion of the adjacent pelvic structures and small intestine represents the most common mode of spread. Survival is not improved by post-operative radiotherapy or adjuvant chemotherapy in patients with extracapsular disease. We report two cases, one of which presented with spontaneous ovarian abscess and paraneoplastic hypercalcemia.

Adult↗
PubMed1992

Nucleoside diphosphate kinase/NM23 expression in breast cancer: lack of correlation with lymph-node metastasis.

The product of the nm23-H1 gene, reported to be a metastatic suppressor gene, was recently identified as the nucleoside diphosphate (NDP) kinase A, and was found to be overexpressed in several types of malignant tumors as compared with normal tissues. In order to determine whether NDP-kinase expression serves as a marker for metastatic potential and whether hyperproliferation of neoplastic cells would correlate with expression, we analyzed NDP-kinase levels and activity by immunohistochemical staining and by an enzymatic assay in 13 benign and 98 malignant breast-tissue specimens. Our results confirm that NDP-kinase expression increases in malignant cells of breast carcinomas, but cannot be considered as a biological marker of metastatic dissemination. No correlation was found between NDP-kinase activity and S phase, taken as an index of cell proliferation. Moreover, no correlation was observed between NDP-kinase activity and tumor size, histoprognostic index, estrogen receptors or progesterone receptors. The mechanism of over-expression of NDP in malignant cells and its role in tumor progression remain to be determined.

Breast Neoplasms↗
PubMed1992

Induction chemotherapy in advanced head and neck tumors: results of two randomized trials.

From March 1983 to December 1989, 208 patients with locally advanced squamous cell carcinoma of the head and neck were successively included into two randomized induction chemotherapy trials. The chemotherapy regimen of the first trial, which included 100 patients, consisted of two cycles of a combination of cisplatin, bleomycin, vindesine and mitomycin C; while that of the second trial, which included 108 patients, consisted of three cycles of a combination cisplatin, 5-fluorouracil by continuous infusion and vindesine. Local treatment was the same in the two trials: primary radiotherapy in all patients. The response was then evaluated; in the case of a poor response at 55 Grays surgery was performed; otherwise, radiotherapy was continued to full doses (possibly followed by salvage surgery). The tumor and lymph node responses to chemotherapy (complete and partial response) were higher in the second trial than in the first: 70% versus 50% for primary lesions, 47% versus 25% for lymph nodes. The toxicity of the two chemotherapy regimens was minimal. In the two trials, an initial major response to chemotherapy predicted subsequent efficacy of irradiation in 80% of the patients. The significance of the complete response at the end of the irradiation varies with the previous response to the chemotherapy. With a median follow-up of 60 months with the first chemotherapy regimen and 30 months with the second, overall survival and disease-free interval were very similar in the two groups. The incidence of distant metastasis was significantly reduced (p less than 0.03) with chemotherapy. This trial suggests the need to test new chemotherapy protocols according to new schemes of treatment, with chemotherapy given concurrently with or following the completion of standard treatment by means of multicenter randomized trials.

Antineoplastic Agents↗
PubMed1992

[Role of neoadjuvant chemotherapy in the treatment of advanced head and neck tumors. Results of two randomized therapeutical trials conducted at the Institut Curie on 208 patients].

From March 1983 to December 1989, 208 patients with locally advanced squamous cell carcinoma of the head and neck were successively included into two trials randomizing induction chemotherapy versus no pre-irradiation treatment. The chemotherapy regimen of the first trial, which included 100 patients, consisted of two cycles of a combination of cisplatin, bleomycin, vindesine, mitomycin C; while that of the second trial, which included 108 patients, consisted of three cycles of a combination cisplatin, 5-fluorouracil (continuous infusion) and vindesine. Local treatment was the same in two trials: 'primary' radiotherapy in all patients. The response was then evaluated at 55 Gy; in the case of poor response, surgery was performed, otherwise radiotherapy was continued to full doses (possibly followed by salvage surgery). The tumor and lymph node responses to chemotherapy (complete and partial response) were higher in the second trial and in the first one: 70% versus 50% for primary lesions, 47% versus 25% for lymph nodes. The toxicity of the two chemotherapy regimens was minimal. In the two trials, an initial major response to chemotherapy predicted subsequent efficacy of irradiation in 80% of the patients. Complete response rate at the end of irradiation correlates with the previous response to the chemotherapy. With a median follow-up of 60 months with the first chemotherapy regimen and 30 months with the second, overall survival and disease-free interval did not significantly differ in the two groups of patients, with or without chemotherapy. The incidence of distant metastasis was significantly reduced (P < 0.03) in the chemotherapy arms. This negative trial encourages the design of new chemotherapy protocols according to new schemes of treatment. For advanced stages of head and neck cancers (T3, T4, N2, N3), we recently launched a pilot study combining platinum and irradiation, but according to a concomitant schedule.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Phase I trial of a recombinant human interleukin 2. Results in patients with disseminated solid tumors].

A phase I trial of Roussel-Uclaf recombinant human interleukin 2 (IL 2) was performed on 31 cancer bearing patients of the Institut Gustave-Roussy, Villejuif, and the Institut Curie, Paris. This study allowed to define a schedule for administration of IL 2 in continuous infusion over 5 day cycles. This schedule is manageable in patients without major visceral failure. It is reproducibly feasible in conventional medical oncology units, without specialized intensive care facilities. Toxicities, although numerous, are acceptable for IL 2 doses below 24,000,000 IU/m2/day. There is a close relationship between secondary effect severity and IL 2 doses received. Main toxicities were: fever with chills, fatigue and general discomfort in 23 patients, nauseas and vomiting in 12, diarrhea in 10 and cutaneous rashes with erythema and dermal vascularitis in 13. One peculiar feature of this study was the minimal occurrence of manifestation related to leaky capillary syndrome prominant in other studies. Oliguria, functional renal failure and edema were observed in only 4 patients with functionally unique kidney. Five patients had severe anemia, 2 grade III thrombocytopenia, 1 grade IV hepatic cytolysis, 4 severe confusion episodes and 2 hypothyroidism with anti-thyroid microsome auto-antibodies. All these toxicities were reversible after withdrawal of IL 2 treatment. During this phase I trial, 3 therapeutic objective responses were observed, all 3 occurring in patients with metastatic melanoma treated with IL 2 doses equal to, or above 16,000,00 IU/m2/d. Recombinant IL 2 Roussel-Uclaf thus can be administered through a simple, manageable and efficient regimen.

Adolescent↗
PubMed1991

Neoadjuvant chemotherapy in operable breast cancer.

Primary chemotherapy in localised breast cancer may prevent tumour spread during surgical treatment and reduce proliferation of micrometastases. A randomised clinical trial, in 196 premenopausal and postmenopausal patients with operable (T2-3, N0-1b) breast cancer, was started in November 1983 at the Institut Curie to compare neoadjuvant and adjuvant regimens of chemotherapy with radiotherapy with or without surgery. The patients have been followed up for 35-70 months (median 54). A neoadjuvant group received two monthly cycles of intravenous doxorubicin/cyclophosphamide/5-fluorouracil before locoregional therapy and four cycles subsequently. Six monthly cycles following locoregional therapy were administered to the adjuvant group. Because of inclusion of postmenopausal and/or node-negative patients, compliance was less than optimal in 39 patients who were analysed separately according to actual dose received. Tumour response, evaluated after two cycles of neoadjuvant chemotherapy, was significantly associated with dose (P = 0.003). Survival showed a slight non-significant advantage for the neoadjuvant group. Survival plotted by actual dose was also similar. Neoadjuvant chemotherapy was safe and at least as effective as the adjuvant regimen. Patients have been accrued to a subsequent larger trial of chemotherapy as first-line treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[C-peptide assays of the urine and plasma at baseline and under stimulation with glucagon in healthy subjects and diabetics].

Urinary (CPU) and plasma C peptide values at baseline (CP0) and under stimulation with glucagon were determined in healthy subjects (n = 17) and in insulin-dependent (IDD, n = 45) and non insulin-dependent (NIDD, n = 32) diabetics. A significant difference in the parameters of insulin secretion (x? SD) was found on the one hand between the IDD group (CPU = 5.58 +/- 5.58 nmol/24 h; CP = 0.14 +/- 0.08 nmol/l; maximum C peptide value after stimulation (CPmax) = 0.33 +/- 0.31 nmol/l; C peptide delta (delta CP) = 0.14 +/- 0.14 nmol/l; area under the curve (A) = 5.00 +/- 4.84) and the NIDD group (CPU = 15.47 +/- 8.22 nmol/24 h; CP = 0.64 +/- 0.28 nmol/l; CPmax = 1.14 +/- 0.44 nmol/l; delta CP = 0.50 +/- 0.31 nmol/l; A = 17.5 +/- 5.86) and on the other hand between the IDD group and the control group (CPU = 18.20 +/- 8.40 nmol/24 h; CP = 0.41 +/- 0.11 nmol/l; CPmax = 1.00 +/- 0.31 nmol/l; delta CP = 0.69 +/- 0.20 nmol/l; A = 17.10 +/- 4.45). As regards the NIDD group, only the fasting C peptide and delta C peptide values were significantly different from those found in the control group. The significance of each parameter of insulin secretion was also studied. There was a correlation between the values of C peptidaemia before and after stimulation with glucagon. However, the correlation between plasma C peptide and urinary C peptide values was mediocre, probably because of the numerous variability factors which intervene in the urinary excretion of C peptide.

Adult↗
PubMed1989

Induction chemotherapy in advanced head and neck cancer. Preliminary results of a randomized study.

From March 1983 to June 1986, 100 patients with locally advanced squamous cell carcinoma of the head and neck were randomized to receive either two courses of chemotherapy prior to local therapy (group A), or local therapy alone (group B). Local treatment consisted of primary radiotherapy in all patients. When a poor response was observed after 55 Gy, surgery was performed. The chemotherapy regimen was a combination of cisplatinum, bleomycin, vindesine, and mitomycin C. The response rate to induction chemotherapy (group A) was 50% for the primary tumor (CR: 10% and PR: 40%). At the end of radiotherapy, the overall tumor response rates in the two groups A and B, were 77% and 79% respectively. Complete disappearance of the primary tumor occurred more often than that of the lymph node metastases. The response rate to induction chemotherapy for lymph node metastases was 27.1% (CR: 9% and PR: 18.1%). An initial major response to chemotherapy predicted subsequent efficacy of irradiation on 90% of the cases, while a failure of chemotherapy had no predictive value in this respect. The survival rates in groups A and B were 66.5% vs. 65.1% at 1 year and 35% vs. 46.2% at 2 years. Local disease-free and disease-free intervals were similar in both groups. A Cox's multi-step regression analysis revealed two significant independant prognostic factors: size of primary tumor and nodal status. After adjustment for these factors, the chemotherapy did not seem to improve the effectiveness of the local treatment in terms of loco-regional control and survival.

Adult↗
PubMed1989

[Metastatic breast cancer. Chemotherapy with adriamycin, vindesine, cyclophosphamide and 5 FU. Value of continuous 5 FU perfusion. Results of controlled trials].

Ninety-four patients with metastatic breast cancer were entered in a prospective randomised trial comparing 2 schedules of the same combination chemotherapy. Group I consisted of 46 patients, treated in a monthly three day course with adriamycin (ADM), cyclophosphamide (CPM), vindesine (VDS) and 5 fluoro-uracil (5 FU). Group II included 48 patients who received the same total monthly doses in 4 injections of ADM, CPM, VDS on days 2, 5, 16, 19 of each month together with a continuous infusion of 5 FU over a total of 10 days (days 1-5 and 15 and 19). Patient characteristics in the 2 groups as regards essential prognostic parameters were identical. We observed no difference in myelosuppression between the 2 groups. There were fewer gastrointestinal side effects in group II. Whereas complete alopecia occurred in 100% of patients in group I, only 33% of patients with the fractionated schedule totally lost their hair. The objective response rates at 8 months were 75 and 74% respectively, but the complete response rates (17.5 versus 28%) showed an advantage for group II. This advantage was not statistically significant. Durations of response were 15 months (group I) and 18 months (group II) and the median survival was 27 months in both. We conclude that prolonged low dose and fractionated administration of chemotherapy over 2 five day courses per month improves the therapeutic index and diminishes side effects.

Adult↗
PubMed1988

[Metastatic cancer of the breast treated by polychemotherapy: a new prognostic approach].

The series consisted of 759 patients with metastatic breast cancer entered into randomized clinical trials at the Curie Institute. Twenty factors were found to be significant by univariate analysis. The current report gives a detailed analysis of prognostic factors using a new method of multivariate analysis for survival data, the recursive partition. This method was based on the construction of a regression scheme consisting of eight variables and four prognostic groups. A test sample procedure was used to validate our results and a regression scheme with three variables was constructed (LDH, adjuvant chemotherapy and the Karnofsky scale). The results were compared to the stepwise Cox regression.

Actuarial Analysis↗
PubMed1987

Treatment of metastatic malignant melanoma with recombinant interferon alfa-2b.

Twenty-six patients with histologically proven metastatic malignant melanoma were included in a phase II trial of interferon alfa-2b (Intron A; Schering-Plough). Patients were given 10 X 10(6) IU/m2 of interferon alfa-2b subcutaneously three times a week until major intolerance or progression of disease. General signs of intolerance were seen in all patients; hematological toxicity with leukopenia (below 1,800/mm3) and/or thrombocytopenia (below 600/mm3) was seen in six patients and therapy was interrupted in one patient. Mild liver toxicity was seen in most patients after two weeks of treatment. These manifestations disappeared 1-2 weeks after treatment was discontinued. Twenty-four patients were evaluable for response. There were two complete responses; one skin and one lymph node going into remission for 12 and 12.5 months respectively. A partial response was observed in five cases lasting 1, 1.8, 2, 3 and 5 months respectively. These results indicate a potential role for interferon alfa-2b in treating patients with metastatic malignant melanoma, however, further trials are required to determine the optimum dose and schedule of administration and use of interferon alfa-2b in combination with cytotoxic drugs.

Drug Evaluation↗
PubMed1987

[Metastatic breast cancer. Modality of association of chemotherapy and hormonotherapy. Results of a controlled trial].

Two hundred forty-seven patients with metastatic breast cancer entered into the controlled trial. Its aim was to define the optimal modality of association between hormonotherapy and chemotherapy. Chemotherapy was given a monthly course of an association including: adriamycin: 45 mg/m2 on day 1; cyclophosphamide: 400 mg/m2 on days 1, 2, 3; 5 fluoro-uracil: 500 mg/m2 on days 1, 2, 3; methyl-prednisolone: 80 mg/m2 on days 1, 2, 3. Hormonotherapy was tamoxifen (TAM) at the daily dose of 30 mg. 82 patients in group I were given TAM alone for 4 months and then chemotherapy + TAM; 83 patients in group II were given simultaneously TAM + chemotherapy; 82 patients in group III were given chemotherapy alone for 8 months and then TAM + chemotherapy. The response rates in groups I, II and III were respectively of 59, 74 and 62%. The difference in favour of group II was marginally significant. The survival curves were significantly higher in group II and III than in group I (P = 0.04). This result appears as the consequence of the poor prognostic of the sub-group of 45% patients who did not respond to TAM. These results seem to emphasize that target cells of hormonotherapy are not target cells of chemotherapy and that this difference is persisting for long time under treatment, that others modalities of association between chemotherapy and hormonotherapy must be studied with the aim of reducing the kinetic's implication of chronic administration of TAM.

Adult↗
PubMed1987

[Adriamycin and chemotherapy of breast cancer. Personal experience].

The clinical results achieved for more than 10 years in patients with metastatic breast cancer have clearly demonstrated the efficacy of chemotherapy programs including Adriamycin. This therapeutic effect was confirmed when it is given in protocols of adjuvant chemotherapy. Some complementary studies have demonstrated 4 points in order to define the better modality of application of Adriamycin: the results of induction chemotherapy's protocols are not better if the treatment is given beyond 6 months, the alternative administration of 2 noncross resistant programs of chemotherapy is no more efficient than the continuous administration of a program of chemotherapy including Adriamycin, the increase of the doses of cytotoxic chemotherapy does not change the median of survival of the patients, the fractionated administration of Adriamycin is as effective as the conventional administration of the same total dose.

Adult↗