Background: In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-boundpaclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumabepaclitaxel in aTNBC. Patients and methods: Eligible patients [no prior systemic therapy or 12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m 2 (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression 1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint. Results: Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P ¼ 0.20; median PFS 6.0 months with atezolizumabepaclitaxel versus 5.7 months with placeboepaclitaxel]. In the PD-L1-positive population, atezolizumabepaclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placeboepaclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumabepaclitaxel versus 28.3 months with placeboe paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug. Conclusion: Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. ClinicalTrials.gov: NCT03125902.
Objective. To determine the current shortfall of medical oncologists (MOs) and the projected supply. Background. Morocco, the medical oncology (MO) is a relatively new specialty. Medical oncology was recognized as a separate specialty in 1994 but the real taking-off was done only since the 2000s after the creation of the chair of medical oncology in the University of Rabat. The GRIOMM (Moroccan group of trialist in medical oncology) was created in 2011 and conducted its first study, EVA-onco, concerning the practice of medical oncology in Morocco in 2011. Design. EVA-onco is a prospective study concerning the practice of medical oncology in Morocco in 2011. Results. The entire public cancer centers completed the survey. There were no missing data. The number of medical oncologist per 100000/habitants in Morocco was 0.09. The average number of new patients seen per medical oncologist was 718 patients (ranging by state from 97 to 1875). The shortfall of MOs was estimated at 26 at least in 2011 according to the national recommendations. Conclusions. Since 2010, a national strategy to increase the capacity of MO workforce existed. The current shortfall of MO is expected to disappear in the future.
We read with great interest the article published by Errihani et al. on the spectrum of epidermal growth factor receptor (EGFR) mutation in Moroccan patients (n = 137) with lung adenocarcinoma (AC), and we would like to congratulate them for their very important study which in our knowledge represent the first study in Morocco and Arab population. In Morocco, lung cancer represents the first cause of cancer in men 1,2 and the ninth cause of cancer in women. 2 AC is the second most common histological subtype after squamous-cell carcinoma according to the Casablanca registry, representing 26% of all lung cancers (24.7% in men and 36.9% in women [most common histology in women]). 2 The authors showed that the overall frequency of the EGFR mutation was 21%, which is higher than that in white population (11%-13.7%). 3-6 Mutations were mainly detected in the exon 19 (69%), followed by exon 21 (21%) and exon 20 (7%), whereas mutations in the LETTERS TO THE EDITOR e115
Background: Gastric cancer represents the fifth most common tumor and the thirdleading cause of cancer-related death worldwide. The results of surgical treatment of locally advanced gastric cancer remain generally poor due to the high rate of relapse after surgery. In the last decade, neoadjuvant chemotherapy has become the standard of care for patients with stage IB resectable advanced gastric cancer. The benefit in progression-free and overall survival was confirmed by several randomised trials and meta-analyses compared to immediate surgery. However, data in the "reallife" setting are rare. We conducted a retrospective study to clarify the question of whether this benefit is achievable under real-life conditions.Methods: Our retrospective study concerned patients with histologically-confirmed advanced gastric cancer clinical stage II-IIIc according to UICC (8th edition) treated at the University Hospital of Marrakech between January 2017 and December 2018. They received 2-4 cycles/3 weeks of neoadjuvant chemotherapy based on FLOT, FOLFOX, XELOX, EOX or 5FU-Cisplatin protocols.Results: 48 patients with a median age of 56 years were diagnosed with advanced gastric cancer. 67% of them are male were. Only 16 patients (33,3%) had received neoadjuvant chemotherapy and 19 were operated immediately (39,5%). Protocols used in perioperative were FLOT in 8 patients (50%) and FOLFOX in 4 patients (25%). The rest have received either EOX (1 patient), XELOX (2 patients) or 5FU-cisplatin (1 patient). 7 patients (43,75%) received 4 cycles of neoadjuvant chemotherapy. Side effects were represented by mycosis grade 2 in 2 patients, neutropenia grade 2 in 4 patients and only one patient had grade 3 toxicity. After neoadjuvant chemotherapy, we observed 3 cases of partial response and 4 of stable disease. 5 patients (31,25%) underwent surgery (R0 in all cases) by total gastrectomy and D2 lymphadenectomy. 68,42% of the group who did not receive neoadjuvant chemotherapy, were treated by concomitant chemoradiotherapy. The median overall survival in the neoadjuvant group was 21 months compared to only 12 in the second group. Conclusion:Despite the small number of patients treated, our analysis showed that selected patients with locally advanced adenocarcinoma can be safely managed with perioperative chemotherapy in daily clinical practice and our results confirm the survival benefit of perioperative treatment.Legal entity responsible for the study: The authors.
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