Temozolomide has significantly improved the outcome of patients with glioblastoma. However, the optimal duration of continuation treatment after chemoradiation remains uncertain. This retrospective analysis aims at assessing the feasibility, the tolerance, and the potential benefit of prolonging adjuvant temozolomide more than six months, which is the reference protocol.

The survival improvement of patients treated with chemotherapy or radiotherapy for malignancies are increasing therapy-related acute myeloid leukemia (t-AML). It was thought to be the direct consequence of genetic events induced by such treatments. We here review the mechanisms of specific chemotherapy-related DNA damage inducing the chromosomal or genomic abnormalities characteristic of t-AML. We also focus on how such aberrations could initiate or participate to leukemogenesis. However, only a part of patients exposed to cytotoxic therapy is developing t-AML, suggesting that some genetic predisposition may be involved such as polymorphisms in genes related to DNA repair.

Bevacizumab is a monoclonal antibody, which neutralizes the effect of vascular endothelium growth factor (VEGF) allowing regression of tumour vessels and a decrease in the permeability of the blood-brain barrier. Already used in oncology as adjuvant treatment for certain metastatic cancers and in second line for high-grade gliomas, it has been recently used as a treatment of cerebral radionecrosis resisting conventional drug treatment and hyperbaric oxygen. This article presents three patients with cerebral radionecrosis and treated by monthly infusions of bevacizumab (10 mg/kg per month). The patients had developed cerebral radionecrosis after radiation therapy for a malignant brain tumour. The radionecrosis was proved by magnetic resonance imaging and spectroscopy. The first patient received only one perfusion of bevacizumab, as the development of a lymphopenia prevented the patient from continuing with the treatment. The second patient received four infusions, but the absence of improvement of the clinical symptoms and progression of the radiolesion led to discontinuation of the treatment. The third patient developed several severe side effects, a transient ischemic accident and a perforated corneal ulcer, resulting again in premature discontinuation of treatment. The development of severe side effects, combined with the absence of notable clinical and radiologic improvements resulting from the use of bevacizumab as a treatment resulted in the premature interruption of such treatment, in all three patients.

DNA repair is implemented through a large variety of mechanisms, each of them being adapted to a specific type of lesion: direct repair, mismatch repair for the errors occurring during the replication process, base-excision repair, nucleotide-excision repair, double-strand breaks DNA repair by homologous or non-homologous recombination. Each of these mechanisms involves numerous proteins associated as supramolecular functional complexes. Some anticancer drugs are able to generate DNA lesions which may overflow the repair mechanisms. The impossibility to repair DNA damage usually leads to cell death, but alterations of repair mechanisms may favour genetic instability and hence contribute to oncogenesis.

Biological therapies targeted at bronchial cancer have a mode of action different from that of the various types of chemotherapies and are therefore associated with different types of toxicity. EGFR inhibitors cause mainly cutaneous toxicity, which can be controlled by cyclin and local care. Antiangiogenic agents increase the risk of arterial thrombosis and the risk of minor (nosebleeds) or severe (hemoptysis) bleeding. Hypertension is also a frequent side effect, generally controlled by standard antihypertensive treatment, preferably calcium channel blockers or angiotensin-converting enzyme inhibitors. Combined management by an oncologist, specialists in the relevant organs (lungs, heart, and skin) and a general practitioner is essential for optimal management of these frequent but rarely severe drug events.

Patients aged 70 and over represent the third of the population of patients with lung cancer. There has been for a long time a certain nihilism regarding the treatment of elderly patients with advanced lung cancer as well from medical doctors but also from families and patients themselves with the false belief of an indolent course of the disease in elderly patients. As a result, clinical trials devoted to elderly patients were quite scarce until the end of the last decade. Nevertheless, an important trial was published in 1999 with the comparison of vinorelbine as a single agent versus best supportive care only in patients aged 70 and over with an advanced non-small cell lung cancer. The survival benefit with vinorelbine was important. Then two trials were published comparing monotherapy with either vinorelbine or gemcitabine to the doublet vinorelbine and gemcitabine without convincing results. As a consequence, the ASCO 2004 recommendations were to treat elderly patients with a monotherapy (gemcitabine or vinorelbine). Recently an IFCT trial was presented at the plenary session of the ASCO 2010. A carboplatin (every 4weeks)+weekly paclitaxel doublet was compared to a vinorelbine or gemcitabine (choice of the center). The survival benefit was of such magnitude that the paradigm of treatment of elderly patients PS 0-2 with advanced NSCLC should be modified in favor of the tested doublet. There should be a reappraisal of the geriatric indexes recommended by the oncogeriatricians regarding their exact prognostic or predictive role.

Hydroxyurea (HU) is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Dermatological side effects are frequent and usually benign. Leg ulceration following HU therapy is less common.

The aim of our work was to assess the potential clinical impact of therapeutic education in patients treated with anticancer drugs. One hundred-one ambulatory adult patients (mean age: 60 years, range: 24-88) treated by anticancer chemotherapy were included. The occurrence of adverse events was reported by 83% of the patients. Twenty-one percent (14/67) of the patients were not compliant with their supportive care treatment, 60% (60/101) took over-the-counter medications (one contraindication identified) and 14% (14/101) claimed they had received no counsel on risk behaviour (UV exposure, lack of contraception, driving) from health care professionals. Overall, 11% (44/397) of adverse events were associated with a lack of information. Twelve percent (4/33) of the calls to the doctor, 6% (1/17) of the visits to the physician and 21% (3/14) of the hospitalizations could be associated with a lack of therapeutic education. These data enlighten the importance of therapeutic education of cancer patients treated by chemotherapy.

The aim of this study was to evaluate the efficacy of treatment of AIDS-related and non AIDS-related Kaposi's sarcoma (KS) using vinblastine (Velbé®). A retrospective study was conducted between January 1990 and December 2009 in the Department of Dermatology at the Lomé teaching hospital. The therapeutic protocol is the administration of 10 injections of vinblastine every 15 days. Evaluation was done at 10 weeks, 5 months, 11 months and 17 months. Twenty-three patients including 11 cases of non AIDS-related KS and 12 cases of AIDS-related KS were included in our study. The average age of patients was 39.3 ± 11.2 years. The sex-ratio (M/F) was 6:7. At ten weeks, partial remission was 26% and failure rate was 74%. Side effects as a result of the first five injections were dominated by anemia. At 5 months, complete remission was 17% including 3 cases of non AIDS-related KS, partial remission was 26% including 4 cases of non AIDS-related KS. Side effects of the last five injections were dominated by anemia and nervous toxicity. At 11 months, one patient was lost to follow-up and complete remission persisted in 13% of the patients. At 17 months, complete remission persisted in 9% of the patients against 4% of relapses. No long-term side effects were identified. Our study shows a poor efficacy of vinblastine in the treatment of AIDS-related and non AIDS-related KS and confirms the hematologic and nervous toxicity of this drug. The efficacy is better in the non AIDS-related KS than in the AIDS-related KS.

In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies.

Standard treatment of advanced non-small cell lung cancer is based on several lines of therapy separated by treatment-free intervals in which each new line is started when tumour progression is detected. The maintenance strategy consists of pursuing an appropriate, well-tolerated treatment after the end of first-line chemotherapy in order to maintain the initial therapeutic benefit and to avoid rapid clinical deterioration that would rule out further treatment. Two kinds of maintenance therapy have been investigated: continuation maintenance which consists in continuing a targeted agent or a chemotherapy agent that was part of initial induction therapy and switch maintenance defined by initiating a new agent immediately after the end of induction chemotherapy. Clinical trials show that maintenance strategy provides a significant benefit in terms of disease control and improves overall survival for switch maintenance with pemetrexed or erlotinib. Survival benefit appears to be due mainly to the progression-free survival gain and to the increase in the proportion of patients who can receive several lines of treatment. Maintenance therapy is an important option for patients receiving first-line treatment, particularly for those with rapid disease progression. The choice of continuation or switch maintenance will depend on drug used in combination to platinum for induction treatment, response to first-line, histology and patient's preference.

Sorafenib is a multikinase inhibitor approved for the treatment of renal cell carcinoma and hepatocellular carcinoma. Associated short-term cutaneous adverse events are well known. Regarding long-term adverse events, keratoacanthoma has been reported more recently and, more rarely, invasive squamous cell carcinoma.

The use of anti-angiogenic therapies has revolutionized the treatment of cancer. However, some of these drugs are associated with cardiovascular damage. An early detection and personalized management is necessary to screen and treat an increase in blood pressure, proteinuria or symptomatic left ventricular dysfunction. Angiotensin-converting enzyme inhibitors and angiotensin II antagonists are the first line treatment of this cardiotoxicity. The interruption of treatment is recommended if cardiac manifestations are uncontrolled, unless the expected benefit is greater than the risks.

To compare chemoradiation with systemic chemotherapy to chemotherapy alone in locally advanced pancreatic cancer.

Administration of intravesical chemotherapy by mitomycin C decreases the risk of recurrence in non-muscle-invasive bladder tumours. We report the case of a man, who presented a full bladder necrosis after an immediate adjuvant mitomycin C instillation. The failure of resection of the necrotic area led us to perform a total cystectomy with an intestinal reconstruction. A review of the literature showed four other cases of necrosis of the bladder or of lower urinary tract. In all cases the rules of early instillation were observed.

Pneumocystis pneumonia is a life-threatening infection in patients undergoing chemotherapy for solid malignancies.

Combining bevacizumab with platinum-based chemotherapy significantly improves survival for patients with advanced non-squamous non-small cell lung cancer. The objective of this study was to assess the proportion of patients who could receive this combined therapy.