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Marc Espié

Publications and source records attributed to Marc Espié.

14 recordsLinked to original sources
PubMed2006

Gemcitabine and epirubicin in patients with metastatic breast cancer: a phase I/II study.

Gemcitabine and epirubicin were evaluated in metastatic breast cancer (MBC) patients to determine the maximum tolerated dose (MTD), efficacy, and toxicity of the combination. Patients initially received 800 mg/m(2) of gemcitabine (days 1 and 8) and 50 mg/m(2) of epirubicin (day 1) every 21 days. Each dose level had three to eight patients. Phase II used the dose level preceding the MTD. Forty-eight patients enrolled without reaching MTD; therefore, phase II used the highest dose level (1500 mg/m(2) of gemcitabine, 90 mg/m(2) of epirubicin). After 23 patients (group A) experienced hematologic toxicities and frequent dose reductions, 15 received 1250 mg/m(2) gemcitabine (days 1 and 4) and 90 mg/m(2) epirubicin (day 1) every 21 days (group B). Out of 38 patients, 46% responded (group A 32%, group B 67%). Median response duration was 8.5 months; median time to progression 8.4 months; and median time to treatment failure 4.8 months. Gemcitabine and epirubicin are well tolerated and active in MBC patients, and the group B regimen warrants further investigation.

Adult↗
PubMed2006

[An unusual breast tumor].

Explore the source record for details and available documents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Breast cancer in postmenopausal women with and without hormone replacement therapy: preliminary results of the MISSION study.

OBJECTIVES: To determine breast cancer prevalence in postmenopausal women with or without hormone replacement therapy (HRT). PATIENTS AND METHODS: This was a historical-prospective study with random patient selection. Patients were recruited between January 2004 and February 2005, and allocated to two groups: the 'treated group' comprising postmenopausal women on HRT regimens commonly prescribed in France or who had stopped <5 years previously; or the 'untreated group' of postmenopausal women who had never received HRT or stopped >5 years previously. RESULTS: In total 6755 patients fulfilled all inclusion criteria: 3383 in the treated group and 3372 in the untreated group. The treated group was younger and less overweight than the untreated group (p < 0.0001). The treated group had fewer late menopauses (p = 0.0002) and fewer first-degree family histories of breast cancer (p < 0.0001). Mean HRT duration was 7.9 years; 30.5% of women were treated for >or=10 years. Breast cancer prevalence was 1.01% for the treated group and 6.21% for the untreated group. The European standardized incidence rate of breast cancer in the untreated group was significantly higher than in the French reference population (comparative incidence figure ratio (CIFR) = 2.24; 95% confidence interval (CI) = 1.50-3.36). In contrast, the European standardized incidence rate in the treated group on the studied HRT regimens (excluding some progestins) was not significantly different from that of the reference population (CIFR = 1.04; 95% CI = 0.35-3.15). CONCLUSION: The differences between the two groups may be due to French gynecologists' treatment strategy of avoiding prescribing HRT to high-risk women, and also perhaps to a specific 'studied HRT' effect.

Aged↗
PubMed2005

[GnRH agonists and breast pathology].

The discovery of hormone receptors and tamoxifen has revolutionized the management of breast cancer in women as the existence of oestrogen receptors has improved the response rate to hormone treatment from 30 to 50-70% with a further increase in this efficacy if there are also progesterone-positive receptors. LH-RH analogs induce medical castration. Their efficacy in combination with tamoxifen was demonstrated in terms of survival in pre-menopausal women with metastatic cancer. In the adjuvant situation, a meta-analysis of the 1980s demonstrated a benefit in terms of survival without relapse confirmed by more recent studies showing a reduction in the relative risk of relapse. On radiotherapy or ovariectomy, which are radical treatments, medical castration with LH-RH agonist analogs in combination with tamoxifen is therefore an alternative, reversible therapy for outpatients in particular now that a possible direct anti-tumor effect has been suggested by in vitro studies. Nevertheless, at present in France, Marketing Authorisation has not yet been granted for metastatic cancer.

Antineoplastic Agents, Hormonal↗
PubMed2005

Prognostic significance of a combined clinicopathologic score for response to primary systemic therapy in locally advanced breast cancer.

The response to chemotherapy is one of the best indicators of prognosis in locally advanced breast cancer (LABC). The pathologic response (pR) of 108 LABC patients was analysed and compared with their clinical response (cR). Our aim was to define a new combined clinicopathologic response score (cpR) and to explore its correlation with survival data. The 108 stage IIB to IIIB breast carcinomas were first treated with high-dose anthracycline-based chemotherapy. Standard criteria were used to assess cR. Pathologic analysis of surgical specimens allowed the definition of 5 types of pR. Three groups of combined clinicopathologic response were defined. Twenty-two patients (20%) had complete or almost complete pR. Most patients (88, 81%) had partial cR. This large group of partial cR was very heterogeneous, ranging from pR1 to pR5 and from cpR1 to cpR3. In univariate analysis, pR and cpR both strongly correlated with EFS. cR, pR and cpR all correlated with OS. Subgroups of incomplete pathologic responses were not prognostically different. In multivariate analysis, only cpR correlated strongly with both EFS and OS (p<0.002), identifying good (20%), intermediate (61%) and poor (19%) prognosis patients. In conclusion, in 108 stage IIB to IIIB breast cancer patients initially treated by high-dose chemotherapy, combined grading of clinical and pathologic responses in a single score allowed accurate prediction of outcome.

Adolescent↗
PubMed2004

[Neoadjuvant treatment of early breast cancer: new drugs contribution].

Neodjuvant chemotherapy has been primitively used in locally advanced breast cancer. More recently, indications have been extended to operable lesions. Several randomized trials have compared preoperative chemotherapy with postoperative surgery. None of these studies with anthracyclines have shown benefit in terms of progression free survival and/or overall survival. The rate of breast-conservative surgery seems slightly increased. However, in the NSABP 18 study, there was also a marginally significant increase in local recurrence when patients were converted from mastectomy lumpectomy to as originally planned. The introduction of taxanes in neoadjuvant chemotherapy protocol leads to a better clinical response and a complete histological responses increase when docetaxel is used. In only one study using docetaxel after anthracyclin treatment, a survival benefit is reported but it is a small study; a longer follow up and the updated results of the NSABP B27 trial are needed to confirm the impact of taxotere in the outcome of breast cancer. The integration of trastuzumab with taxane based chemotherapy has already shown high rate of histological complete responses. At least, neoadjuvant chemotherapy has the advantage to study biologic predictive factors of chemotherapy response. This article will review data on standard therapeutic and new agents in neoadjuvant treatment.

Antibodies, Monoclonal↗
PubMed2003

[Mass screening for breast cancer].

A CONTROVERSIAL SUBJECT: Several large randomised studies have demonstrated a reduction in mortality due to breast cancer of around 30% in women aged over 50, with the development of systematic mammography. There are data also suggesting an identical benefit in women aged 40 to 49, when screening is intensified. A recent meta-analysis has contradicted the results of randomised studies on screening, but this study is clearly debatable. THE SITUATION IN FRANCE: No randomised study has been organised. A national program is aimed at screening 7 400 000 women aged 50 to 74. THE KEY TO SUCCESS: The active participation of women, health professionals and public authorities is the fundamental condition for a well-organised mass screening.

Adult↗
PubMed2003

[Breast imaging and biopsy procedures in the diagnosis of breast cancer].

THE INTEREST OF IMAGING: Mammography permits diagnosis of infra-clinical breast lesions with a sensitivity of around 80%. Moreover, with the improvement of the apparatuses and films, the latter permit analysis of the breast areas in most cases. Sonography, indisputable support for the study of dense breasts, is a complement to mammography and clinical examination. Magnetic resonance imaging is the most sensitive technique, but cannot be used in routine controls. The principle images are essentially opacities characterised by enhanced density in the glandular parenchyma (circular or round, asymmetrical opacities of architectural density and disorganisation, stellar and epiculated opacities) and micro-calcifications without specific appearance, revealing when isolated in situ intra-ductal or micro-invasive lesions. THE INTEREST OF BIOPSY PROCEDURES: For non-palpable tumours discovered on imaging, stereo or radio-guided cytological aspirations are proposed so long as the image is not too small. In the presence of infra-clinical images inaccessible to guided cytology, stereotaxy micro-biopsies can be performed. The relative insufficiency of results obtained has led to the proposal of needles of larger calibre used in an apparatus called a mammotome or in the ABBI system, the latter permitting radio-guided surgical excision. PRIORITY GIVEN TO CLINICAL CONTROLS: The technical progress must not lead one to neglect the clinical examination, which, in 5 to 30% of cases, reveals a cancer when the mammography or sonography does not.

Adult↗
PubMed2003

[Ductal carcinomas in situ].

EPIDEMIOLOGY: Presently representing 15 to 30% of new cases of breast cancer, ductal carcinomas in situ do not have specific epidemiological characteristics. The age at which they occur is between 49 and 54 years. DIAGNOSTIC METHODS: The diagnosis is evoked primarily when confronted with an area of micro-calcifications discovered on a mammography. Needle aspiration cytology, useful in cases of palpable abnormalities or infra-clinical masses, is of no interest in isolated micro-calcifications for which surgical biopsy following radiological localisation is the technique of choice. Needle micro-biopsy permits collecting analysable tissue for histological but not cytological examination. Macro-biopsies combine stereotaxic localisation of micro-calcification areas and their excision when isolated. The choice of the method varies depending on the case. FROM AN ANATOMOPATHOLOGICAL POINT OF VIEW: Ductal or intra-galactophoric carcinomas are carcinomas of the glactophores that do not infiltrate the connective tissue. They are defined histologically by architectural and cytological characteristics, which differentiate them from lobular carcinomas in situ. They constitute a group of heterogenic lesions not only morphologically but also histologically and with regard to their progression. THERAPEUTIC MODALITIES: The aim of treatment is to ensure that the patients have a maximum of chances of cure at the cost of the least possible therapeutic consequences. Mastectomy, treatment of choice for many years, is still recommended in certain situations. In other cases, conservative treatment is possible so long as excision of the micro-calcifications is complete on the post-surgical mammography and, in the case of biopsy excision, that healthy margins of at least 10 millimetres exist. Following surgery, there is no sufficient consensus to propose essential recommendations concerning the place of monitoring alone, irradiation or tamoxifen.

Biopsy, Needle↗
PubMed2003

Fertility in young women after chemotherapy with alkylating agents for Hodgkin and non-Hodgkin lymphomas.

INTRODUCTION: Owing to improved lymphoma cure rates, preserving fertility has received attention. MATERIAL AND METHODS: Women under 40 years at diagnosis of lymphoma, treated with >/=3 chemotherapy cycles including alkylating agents and no pelvic or total body irradiation were selected. A total of 84 women fullfiled these criteria with a median age at diagnosis at 27.4 years, the duration of first-line chemotherapy ranged from 3 to 36 months (median: 7 months) and 17 women received consolidation with high-dose therapy (HDT). After complete remission, 16 women relapsed and received second-line regimen followed by HDT for 9 months. RESULTS: With a median follow-up of 100 months, 31 women became pregnant, 34 women had primary ovarian failure (POF) and 19 women retained relative fertility. While women with preserved or relative fertility had the same clinical characteristics those with POF were older at diagnosis (30.6 versus 24.3 years), relapsed more often (34 versus 8%) and received HDT more often (54 versus 16%). After HDT (n=26), only three women (25-27 years) became pregnant. CONCLUSION: Women given alkylating agents have a high risk of POF if they are older than 30 years at diagnosis and older than 25 years at the time of HDT. For these women with a high chance of cure and who wish to be pregnant after treatment, regimens with fewer alkylating agents should be proposed or cryopreservation of embryos when possible.

Adult↗
PubMed2002

Increased incidence of ERBB2 overexpression and TP53 mutation in inflammatory breast cancer.

Inflammatory breast cancer (IBC) is one of the most aggressive forms of breast cancer. We studied the biological characteristics of these tumours by comparing the overexpression of oncogenes ERBB2, MYC, CCND1 and RHOC and TP53 gene mutation rates in IBC with those found in locally advanced and not otherwise specified breast cancers. The prevalence of the TP53 mutation was much higher in IBC than in the two other types of cancer (57% vs 30). Unexpectedly, however, in IBC tumours, histological grade was independent of TP53 status. In addition, ERBB2 overexpression was twice as frequent in inflammatory as in non-inflammatory tumours, whereas the frequencies of MYC, CCND1 and RHOC overexpression did not vary significantly among the three types of breast cancer. These findings suggest that IBC tumours constitute a distinct subset with a specific pathogenesis. Given the importance of TP53 and ERBB2 in the response to treatments, our observations have important therapeutic implications for the clinical management of IBC patients.

Breast Neoplasms↗
PubMed2002

High-dose adjuvant chemotherapy for breast cancer: state of the art.

To date, seven randomised trials of high-dose chemotherapy for high-risk breast cancer have been published, both in Europe and in the US. We will not comment on the discredited Bezwoda trials. The main inclusion criteria for entry into these trials was an involvement of 4 or more axillary lymph nodes. Only two of these trials showed a trend in event-free survival favouring the high-dose arm. However, many differences in the designs of the trials were observed and general conclusions cannot be drawn as yet. The number of randomised patients spanned from 78 to 885, the scheduling and the drug combination of high-dose regimens varied notably and finally the issue of the contamination of the grafts by tumour cells still needs to be correctly addressed. We certainly are only at the end of the beginning.

Antineoplastic Combined Chemotherapy Protocols↗