Author
Pauline Afchain
Bio: Pauline Afchain is an academic researcher from University of Paris. The author has contributed to research in topics: Colorectal cancer & Survival rate. The author has an hindex of 14, co-authored 50 publications receiving 1200 citations.
Topics: Colorectal cancer, Survival rate, FOLFOX, Lynch syndrome, Oxaliplatin
Papers published on a yearly basis
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TL;DR: The planned complete discontinuation of chemotherapy had a negative impact on DDC and PFS compared with the maintenance therapy strategy, suggesting that chemotherapy discontinuation cannot be decided before therapy is initiated in patients with advanced colorectal cancer.
Abstract: Purpose This study compared chemotherapy discontinuation with maintenance therapy with leucovorin and fluorouracil after six cycles of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy in the first-line treatment of metastatic colorectal cancer. Patients and Methods Two hundred two patients with untreated metastatic colorectal cancer were randomly assigned to receive six cycles of modified FOLFOX7 (mFOLFOX7) followed by simplified leucovorin plus bolus and infusional fluorouracil until progression (arm 1 or maintenance arm, n = 98) or six cycles of mFOLFOX7 before a complete stop of chemotherapy (arm 2 or chemotherapy-free interval [CFI] arm, n = 104). Reintroduction of mFOLFOX7 was scheduled after tumor progression in both arms. The primary study end point was duration of disease control (DDC). Results Median DDC was 13.1 months in patients assigned to the maintenance arm and 9.2 months in patients assigned to the CFI arm (P = .046). Median progression-free survival (PFS) and overall surv...
351 citations
TL;DR: Early diagnosis of small bowel adenocarcinoma remains difficult despite significant radiological and endoscopic progress, and adjuvant chemotherapy can be expected to be beneficial, although this has not been established by randomised trials.
238 citations
TL;DR: FOLFOX seems to be the most effective platinum-based chemotherapy regimen for advanced small-bowel adenocarcinoma and Baseline PS and CEA and CA 19-9 levels were the main prognostic factors.
130 citations
TL;DR: This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations.
Abstract: Small bowel adenocarcinoma (SBA) is a rare tumour with a poor prognosis. Molecular biology data on SBA carcinogenesis are lacking. Expression of HER2, β-catenin, p53 and mismatch repair (MMR) protein was assessed by immunohistochemistry. KRAS, V600E BRAF mutations and microsatellite instability were investigated. We obtained samples from 63 SBA patients (tumour stages: I–II: 30%; III: 35%; IV: 32%; locally advanced: 3%). HER2 overexpression (3+) was observed in 2 out of 62 patients, overexpression of p53 in 26 out of 62, abnormal expression of β-catenin in 12 out of 61, KRAS mutation in 21 out of 49, BRAF V600E mutation in 1 out of 40 patients, MMR deficiency (dMMR) in 14 out of 61 and was consistent with Lynch syndrome in 9 out of 14 patients. All of the dMMR tumours were in the duodenum or jejunum and only one was stage IV. Median overall survival (OS) was 36.6 months (95% CI, 26.9–72.2). For all patients, in univariate analysis, stages I–II (P<0.001), WHO PS 0–1 (P=0.01) and dMMR phenotype (P=0.02) were significantly associated with longer OS. In multivariate analysis, disease stage (P=0.01) and WHO PS 0–1 (P=0.001) independently predicted longer OS. For stage IV patients, median OS was 20.5 months (95% CI: 14.6; 36.6 months). In multivariate analysis, WHO PS 0–1 (P=0.0001) and mutated KRAS status (P=0.02) independently predicted longer OS. This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations. The seemingly higher frequency of dMMR than in CRC may be explained by the higher frequency of Lynch syndrome in SBA patients. A dMMR phenotype was significantly associated with a non-metastatic tumour (P=0.02). A trend for a good prognosis and a duodenum or jejunum primary site was associated with dMMR.
98 citations
TL;DR: This work presents a comprehensive overview of MSI phenotype, its biological landscape and current diagnostic methods, and focuses on MSI as a predictive biomarker of response to immune checkpoint inhibition in the context of colorectal cancer and non-coloreCTal tumors.
Abstract: Microsatellite instability (MSI) is a tumor phenotype linked to somatic or germline (Lynch syndrome) inactivating alterations of DNA mismatch repair genes. A broad spectrum of neoplasms exhibits MSI phenotype, mainly colorectal cancer, endometrial cancer, and gastric cancer. MSI tumors are characterized by dense immune infiltration and high load of tumor neo-antigens. Growing evidence is accumulating on the efficacy of immune checkpoint inhibition for patients treated for MSI solid tumors. We present a comprehensive overview of MSI phenotype, its biological landscape and current diagnostic methods. Then we focus on MSI as a predictive biomarker of response to immune checkpoint inhibition in the context of colorectal cancer and non-colorectal tumors.
69 citations
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Journal Article•
2,777 citations
Katholieke Universiteit Leuven1, University of Valencia2, Radboud University Nijmegen3, Sheba Medical Center4, University of Turin5, Hospital Clínico San Carlos6, Université Paris-Saclay7, University of Pisa8, Mayo Clinic9, University of São Paulo10, The Chinese University of Hong Kong11, University of Oxford12, University of Helsinki13, Helsinki University Central Hospital14, Institute of Cancer Research15, Bank of Cyprus16, University of Ioannina17, Odense University Hospital18, University of Amsterdam19, Otto-von-Guericke University Magdeburg20, Geneva College21, Medical University of Vienna22, Martin Luther University of Halle-Wittenberg23, Hebron University24, Imperial College Healthcare25
TL;DR: These ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.
2,382 citations
University of Alabama at Birmingham1, University of South Florida2, Vanderbilt University3, City of Hope National Medical Center4, Fox Chase Cancer Center5, University Of Tennessee System6, Brigham and Women's Hospital7, Seattle Cancer Care Alliance8, Case Western Reserve University9, Roswell Park Cancer Institute10, Northwestern University11, Harvard University12, University of Nebraska Medical Center13, University of Utah14, Memorial Sloan Kettering Cancer Center15
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
1,545 citations
Martin Luther University of Halle-Wittenberg1, Katholieke Universiteit Leuven2, Eppendorf (Germany)3, The Catholic University of America4, Karolinska Institutet5, Uppsala University6, Leiden University Medical Center7, Hebron University8, Radboud University Nijmegen9, Seconda Università degli Studi di Napoli10, University of São Paulo11, University of Oxford12, Medical University of Vienna13, Autonomous University of Barcelona14, Sheba Medical Center15, Ain Shams University16, Clínica Alemana17, Mount Vernon Hospital18, Bank of Cyprus19, Odense University Hospital20, University of Crete21, Marmara University22, University of Valencia23
TL;DR: This ESMO guideline is recommended to be used as the basis for treatment and management decisions, delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations.
1,299 citations
Journal Article•
1,139 citations