Lung cancer is the leading cause of cancer related death in France and Europe. Small-cell lung carcinoma (SCLC) represents 15-20% of cases. International standards of care recommend the use of first-line chemotherapy, which has a high response rate. However, tumour recurrence occurs after a variable disease-free period. If the first-line treatment cannot be repeated during the relapse, intravenous topotecan may be used according to its market authorization (MA).

Between treatment which brings no improvement or which can even result in dangerous side effects and the lethal risk of the disease itself, the nurse is often faced with delicate situations. They must examine their conscience and choose between ministering treatment at all costs and not applying a medical prescription.

The efficacy of the combination bevacizumab-chemotherapy in the first-line treatment of metastatic breast cancer (mBC) was demonstrated in several randomized clinical trials. However, limited safety data is available in daily medical practice. ATHENA is an international phase-IIIb study conducted in 2,251 patients with locally advanced or mBC, treated in first-line with bevacizumab combined with taxanes-based chemotherapy. The primary objective is safety assessment. In France, 365 patients were included. Their median age was 56 years (24-93 years) and ECOG performance status was 0 or 1 in 93.9% of patients. Bevacizumab was essentially combined with a taxanes monotherapy: docetaxel (37.3%) or paclitaxel (28.8%) or taxanes-based combination therapy (9.4%). The most frequent grade superior or equal to 3 adverse event (AE) was neutropenia (34.5%). Grade superior or equal to 3 AEs of special interest related to bevacizumab were arterial and venous thromboembolism (5.1%), high blood pressure (4.2%), proteinuria (2.3%) and hemorrhage (2%). Median time to progression was 9.5 months (95% CI: 8.8-10.4). The safety profile and the efficacy of the combination bevacizumab-taxanes in a population more representative of daily oncology practice in France are comparable to those reported in clinical trials in mBC.

The treatment of metastatic melanoma is presently in complete revolution. Two molecules have recently been authorized for this indication. These treatments have a very different mechanism of action compared to previous chemotherapies. Vemurafenib is a targeted therapy, which blocks BRAF selectively. This molecule induces objective responses in more than 50 % of the patients with V600E mutated melanoma and a benefit in terms of overall survival. However, many patients relapse after about 6 to 8 months of treatment. Many mechanisms are evoked to explain these secondary resistances to therapy. Ipilimumab is an immunotherapy that blocks CTLA4, a physiological brake of lymphocyte activation. With ipilimumab, the objective responses are less frequent than with vemurafenib but are more prolonged over time. Two phases III have demonstrated that ipilimumab treatment is effective on the overall survival of patients with metastatic melanoma. New combination therapies and additional targeted and immunotherapy agents are exciting perspectives that make us more optimistic for the future of metastatic melanoma treatment.

High-dose methotrexate treatment requires pharmacological monitoring in order to tailor administration of folinic acid to reduce side effects. The aim of the study was to validate the adaptation of the EMIT reagent on the l'Unicel DxC 600® Beckman Coulter. The establishment of two assays was necessary to obtain a quantification limit as low as possible (0.05 μmol/L). The linearity of the adapted methods extends from 0.05 to 0.25 μmol/L on the one hand, and from 0.25 to 1 μmol/L on the other hand. For each method, fidelity and accuracy were studied and the limits of detection and quantification were quantified. The correlation with the FPIA method was performed on the Abbott TDX(®). The results of all tests are satisfactory with coefficients of variation (CV) of repeatability and reproducibility of less than 6%. However the daily assays are heavy as 66% of blood samples require at least two dosages and 30% a manual dilution.

There is evidence that anthracyclins may affect the heart and ventricular function. This cardiac toxicity is frequent and serious. It is the first study in Morocco to investigate the frequency of anthracyclins cardiotoxicity. It has for objective to analyze the cardiotoxicity connected to anthracyclins, these risk factors as well as the echocardiographic parameters, which deteriorate prematurely. We led a forward-looking study between October 2008 and December 2009. With 90 patients followed in the service of oncology-radiotherapy and put under chemotherapy with anthracyclins. We conducted a study of various ultrasound parameters of cardiac function, before with anthracyclins, the third cure of chemotherapy, then in the 6th cure of treatment. Only 70 patients have been assessable. Average age was of 47 years (20-68 years); 91% were female. The cardiac function was preserved in 40% of the cases. Among our patients, 56% developed a decrease moderated in light of the cardiac function and 4% of cases developed a severe cardiotoxicity. The echocardiographic parameter most significant in our series was LVEF, followed by TEI index. We found a cardiotoxicity was strictly correlated with the cumulative dose, anthracyclins type and associated comorbidity. The anthracyclins cardiotoxicity is quite common in our series, which requires more thorough preventive measures including monitoring by echocardiography.

Anemia in oncology is no longer seen only as a side effect of chemotherapies. This comorbidity may be multifactorial, clinically and, for example, may be rather chronic when the patient has chronic renal failure associated, resulting in renal anemia. Similarly, the presence of iron deficiency, which can be solely responsible or contributing factor of anemia, is also a factor to be taken into account in both the diagnosis and exploration of anemia and in its treatment, requiring the use of injectable iron complexes for treatment, if necessary in combination with an erythropoiesis agent stimulating.

Evaluate the early anthracyclines cardiotoxicity.

Methotrexate is an antifolate drug used intravenously at high-dose in acute lymphocytic leukemia (ALL). Therapeutic drug monitoring is required to identify patients at risk of developing toxicity and to control folinic acid rescue. We report a case of Münchausen syndrome by proxy revealed by high and persistent falsely toxic methotrexate plasmatic levels. A 12 year-old child was treated with chemotherapy including methotrexate every 70 days for an ALL. The last methotrexate plasmatic level was 0.15 μmol/L at the 72th hour of the infusion. Then, he was treated by oral rout low-dose methotrexate. Ten days after methotrexate infusion, the patient consulted for asthenia, vomiting and presented a mucositis. Methotrexate plasmatic level was 2323 μmol/L. Renal function was normal. All drugs' intake was stopped. Folinic acid rescue was instituted. Even though there was no clinical sign of toxicity, therapeutic drug monitoring showed persistent high methotrexate plasmatic levels. Investigations eliminated measurement errors and pharmacokinetic problems. A deliberate methotrexate addition in each child blood sample brought by the mother was highly suspected. We confirmed this hypothesis by measuring methotrexate plasmatic levels in three samples: one brought by the mother, the second brought by the child's doctor and the last collected in our laboratory. Methotrexate plasmatic levels were respectively over 10,000 μmol/L (first sample) and lower than 0.02 μmol/L (the two others). The diagnosis of Munchausen's syndrome by proxy revealed by falsely toxic methotrexate plasmatic levels was made and the mother was addressed to the psychiatric department.

Fotemustine is an alkylating cytostatic drug belonging to the nitrosourea family and is used in particular in the treatment of disseminated malignant melanoma. Herein, we report a case of interstitial lung disease associated with fotemustine.

Treating a patient with cutaneous malignant melanoma relies on the recognition of a clever stratification of the distinct stages of the disease. The histoprognostic criteria were recently revisited. In addition, translational research fueled the development of new treatments with at last increased efficacy in the metastatic stage. Such therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the beneficial effects.

Fatigue is one of the most distressing side effects of cancer for patients, yet clinicians often do not focus on it during busy clinic appointments. The purpose of this project was to evaluate the psychometric properties of a new instrument designed to quickly identify patients experiencing difficulties with fatigue. The evaluation was conducted with a mixed group of 220 patients receiving chemotherapy. The two-item Fatigue Pictogram had good reliability for test-retest over a 24-hour period (Spearman Coefficient 0.69 for Question 1 and 0.72 for Question 2) and for equivalence of method (in person versus phone) (Spearman Coefficient 0.69 for Question 1 and 0.59 for Question 2). Validity was assessed by comparing results of the new tool against the Multidimensional Fatigue Inventory and the FACT-an. Overall, patients who indicated high fatigue levels did so on all respective scales. The new Fatigue Pictogram was easy to administer and score in a busy clinical setting. It provides a standardized reliable and valid instrument to screen patients experiencing difficulty with fatigue and set the stage for a conversation about this bothersome side effect.

The management of oncology patients has been deeply modified over recent years by the development of new targeted anticancer therapies. Though these new therapies generally have a good safety profile, the skin is probably the organ most affected by their toxicity, in terms of frequency and symptom diversity. This review describes the most frequent cutaneous side effects induced by the new targeted therapies used in oncodermatology, whether they are well-established drugs such as EGF receptor inhibitors (cetuximab, erlotinib) or imatinib, or new treatments for metastatic melanoma such as selective BRAF (vemurafenib) or MEK inhibitors (selumetinib) and CTLA-4 monoclonal antibodies (ipilimumab).

The fast modifications in French medical legislation, the increasing number of litigations and the professional consequences for the practitioner warrant the necessity to recall the "how to manage" a claim for medical error.

During the past few years, medical treatments of cancer have improved thanks to the discovery of targeted therapies. These therapies are today widely used in cancer treatment. The mechanism of action of targeted therapies and the adverse effects they induce are different from the classic chemotherapies, and require a specific management. Most of these drugs are taken at home and orally, and as a consequence, general practitioners should be able to manage these side effects. The most current toxicities in general medicine are fatigue, high blood pressure, dermatologic, gastrointestinal and metabolic side effects. These effects, often moderate are frequent and diverse, and can impact the patient's quality of life and reduce treatment compliance. Management of these toxicities should then be well known by general practitioners in order to optimize care and improve patient wellness.

Trastuzumab is humanized monoclonal antibody targeting her 2 neu receptor, overexpressed in 20% of breast cancers and part of the complex of Epidermal Growth Factor Receptor.