No abstract

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary cancer syndrome that predisposes affected individuals to the development of multiple benign and malignant tumors. One of the main manifestations of VHL is renal cell carcinoma (RCC). RCC is increasingly being treated with targeted therapies, which offer an alternative treatment option for patients with VHL disease. This study investigated the effectiveness of sunitinib in VHL patients with advanced tumors or tumors unsuitable for surgery.This multicenter, phase II, open-label study from the PREDIR VHL network, treated patients with genetically-confirmed advanced VHL disease with oral sunitinib (50 mg/day for 28 days then a 2-week rest period) until progression. Lesions were performed using magnetic resonance imaging (MRI) and computed tomographic (CT) scan. The primary endpoint was objective response rate; secondary endpoints included tolerability and overall survival.All five patients showed stable disease as best response at 6 months. Two patients showed impressive transitory clinical improvement during early cycles. No patient died during sunitinib treatment. Reasons for discontinuing sunitinib therapy were disease progression (n=1), unacceptable toxicity (n=3) and lack of clinical improvement after 7 cycles (10.5 months) with unacceptable toxicity (n=1).In conclusion, sunitinib was of limited benefit in patients with advanced VHL disease, but had better efficacy against metastatic RCC than other VHL-related lesions. Treatment-related toxicity is an important limiting factor in this frail patient population. New agents with different mechanisms of action are required to treat this disease.

Cet article analyse les rapports entre sentiment d’injustice et violence scolaire. A l’aide d’entretiens réalisés auprès de collégiens et de lycéens, il s’interroge sur la manière dont l’injustice ressentie par les élèves peut favoriser le passage à la violence. Traversant les situations scolaires les plus ordinaires, telles que l’évaluation, les décisions d’orientation, le sentiment d’injustice résulte d’attentes normatives déçues et fait subir aux élèves de nombreuses frustrations ; les plus exposés d’entre eux tentent alors d’y faire face en adoptant des comportements violents. Il s’agit donc d’identifier les mécanismes de formation de l’expérience d’injustice et les conséquences qu’elle entraîne sur la subjectivité des élèves et sur leurs relations à autrui. Seront ainsi abordés les principes de justice qui sont à l’origine du sentiment d’injustice et les facteurs qui favorisent la conversion du sentiment d’injustice en violence.