Publications by authors named "Elise Rowinski"

8 Publications

  • Page 1 of 1

Cardiovascular disease events within 5 years after a diagnosis of breast cancer.

BMC Cancer 2020 Apr 21;20(1):337. Epub 2020 Apr 21.

Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.

Background: Concern for cardiovascular disease (particularly atrial fibrillation-AF) among women with breast cancer is becoming a major issue. We aimed at determining the incidence of cardiovascular disease events (AF, arterial and cardiac events, venous-thromboembolism-VTE) in patients diagnosed with breast cancer, and assessing potential risk factors.

Methods: We reviewed medical records of all patients diagnosed with breast cancer from 2010 to 2011 in our cancer center. Baseline characteristics of patients and tumors were collected. The main outcome was the occurrence of cardiovascular disease events (AF, VTE, arterial and cardiac events) during the 5-years follow-up.

Results: Among the 682 breast cancer patients, 22 (3.2%) patients had a history of atrial fibrillation. Thirty-four patients (5%) presented at least one cardiovascular disease event, leading to a cumulative incidence of 5.8% events at 5-years ([3.8-7.7] CI 95%), with most of them occurring in the first 2 years. AF cumulative incidence was 1.1% ([0.1-2.1] CI 95%). Factors associated with the occurrence of cardiovascular disease events (including AF) were an overexpression of HER-2 (HR 2.6 [1.21-5.56] p < 0.011), UICC-stage III tumors or more (HR 5.47 [2.78-10.76] p < 0.001) and pre-existing cardiovascular risk factors (HR 2.91 [1.36-6.23] p < 0.004).

Conclusion: The incidence of cardiovascular disease events was 5.8% ([3.8-7.7] CI 95%), with HER-2 over-expression, UICC-stage III tumors or more and pre-existing cardiovascular diseases being associated with them. These findings call for the development of preventive strategies in patients diagnosed with breast cancer.
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http://dx.doi.org/10.1186/s12885-020-06838-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216603PMC
April 2020

[From bench to bedside for new treatment paradigms in chordomas: An update].

Bull Cancer 2020 Jan 24;107(1):129-135. Epub 2019 Dec 24.

Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108, bis avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France. Electronic address:

Chordomas are rare malignant tumours, which typically occur in the axial skeleton and skull base. They arise from embryonic remnants of the notochord. They constitute less than 5 % of primary bone tumours. They are characterised by their locally aggressive potential with high frequency of recurrences and a median overall survival of 6 years. The initial therapeutic strategy must be discussed in an expert centre and may involve surgery, preoperative radiotherapy, exclusive radiotherapy or therapeutic abstention. Despite this, more than 50 % of patients will be facing recurrences with few therapeutic options available at this advanced stage. This review aims to outline current treatment options available in chordomas, as well as discussing potentiality of new therapeutic approaches through their molecular characterization and the comprehension of their immunological environment.
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http://dx.doi.org/10.1016/j.bulcan.2019.10.008DOI Listing
January 2020

Current management of stage I testicular germ cell tumors in a French cancer institute. A practice analysis over the 10 past years.

Bull Cancer 2019 Dec 30;106(12):1086-1093. Epub 2019 Sep 30.

Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France.

Background: Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations.

Methods: Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006-2011] and [2012-2016] according to the European Association of Urology Guidelines in 2011.

Results: Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006-2010 versus 53% between 2011-2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006-2010). Surveillance was used for 64% of NSGCT.

Conclusions: In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.
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http://dx.doi.org/10.1016/j.bulcan.2019.08.012DOI Listing
December 2019

Maintenance Therapy in Metastatic Solid Tumors: Innovative Strategy or Simple Second-line Treatment?

Am J Clin Oncol 2019 08;42(8):615-623

Departments of Medical Oncology.

Managing metastatic diseases involves defining the best strategy that is supposed to take into account both efficacy and quality of life. To this end, clinicians use stop and go or maintenance strategies. As a matter of fact, 2 maintenance strategies can be distinguished: continuation maintenance using a drug already present in induction treatment and switch maintenance with a newly introduced drug. Several drugs have been approved as maintenance therapy with several current indications in solid tumors. Questions remain concerning such strategies, notably duration, cost, tolerability, and shortcut between switch maintenance and early second line. If the concept of maintenance strategy remains trendy with numerous trials ongoing, several issues are still pending. The aims of this review were to accurately define and describe the various facets of maintenance therapy through its several indications in real life and then to discuss the future challenges of maintenance therapy in oncology.
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http://dx.doi.org/10.1097/COC.0000000000000574DOI Listing
August 2019

High-throughput sequencing in clinical oncology: from past to present.

Swiss Med Wkly 2019 Mar 4;149:w20057. Epub 2019 Apr 4.

Radiotherapy Department , Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.

The war on cancer remains a major challenge as one of the hurdles for additional progress is the complexity of the mechanisms underlying the disease. Cutting-edge technologies and computing tools have led to whole genome sequencing as well as an integrated and inclusive omic approach of cancers with accurate molecular tumors' signatures through impressive progress in the field of Next Generation Sequencing (NGS). Genomic data may foster strategies for new drug development in addition to a better understanding of cancer genesis, opening a new era in oncology clinical practice. This review discusses the development of genomics approaches in cancer research and its perspectives for precision medicine, as well as clinical implications and remaining challenges.
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http://dx.doi.org/10.4414/smw.2019.20057DOI Listing
March 2019

Advocacy for a New Oncology Research Paradigm: The Model of Bevacizumab in Triple-Negative Breast Cancer in a French Cohort Study.

Oncology 2019 2;97(1):1-6. Epub 2019 Apr 2.

Department of Pharmacology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France.

Background: Triple-negative breast cancer remains a disease with poor prognosis and few treatment options, due to the lack of therapeutic targets. Bevacizumab, the first anti-VEGF agent approved in the treatment of cancer, has demonstrated efficacy in breast cancer in combination with paclitaxel for the first-line treatment of HER2-negative metastatic breast cancer. Despite the fact that the benefit was particularly significant for triple-negative breast cancer with its approval in 2008 by the FDA, this decision was later reversed as there was no improvement in overall survival in addition to significant costs.

Objectives: The scope of the present study is to focus on the role of bevacizumab in triple-negative breast cancer through the analysis of overall survival, progression-free survival, and cost benefit among 45 patients in a French monocentric study and to discuss new paradigms of endpoints.

Methods: All patients diagnosed with metastatic triple-negative breast cancer, for whom first-line treatment was bevacizumab in combination with paclitaxel between January 2011 and April 2018 were included in this single-center retrospective study, and a chart review of all recruited subjects was performed from medical records.

Results: In this real-life study among 45 patients with metastatic triple-negative breast cancer, bevacizumab provided a significant benefit for a category of patients, with longer median progression-free survival and the ability of maintenance therapy associated to limited side effects.

Conclusions: Beyond being the phoenix of breast oncology and a magnet of controversy, the case of bevacizumab in metastatic breast cancer highlights one of the greatest challenges in oncology, namely to balance modest clinical benefits with exponential costs. A balance needs to be found between health care affordability, high price of progress, and the best medical decision for the patients, in order to avoid the "unbreathable tipping point" we are actually dealing with.
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http://dx.doi.org/10.1159/000499583DOI Listing
July 2019

Cancer du rein et radiothérapie : radiorésistance et au-delà.

Bull Cancer 2018 Dec;105 Suppl 3:S280-S285

Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France; Laboratoire de radiobiologie cellulaire et moléculaire, CNRS UMR 5822, Institut de physique nucléaire de Lyon, IPNL, 69622 Villeurbanne, France. Electronic address:

Kidney Cancer And Radiotherapy: RADIORESISTANCE AND BEYOND: Metastatic renal cancer has a poor prognosis because of the limited impact of usual treatment modalities, and notably radiotherapy. Renal cell carcinoma is traditionally considered to be radioresistant, and conventional radiotherapy fraction sizes of 1.8 to 2 Gy are thought to have little role in its management. Technological advances in radiation oncology have led to stereotactic approaches that overcome radio resistance mechanisms of renal cancer cells and could be successful. The technical ability of applying high dose per fraction, leads to a distinct biological response which is different from the one observed with conventional irradiation through high responses rates. The increased radiobiological effect is attributed to endothelial apoptosis triggered by high fractional dose. The combination of such radiotherapy regimens with targeted drugs paves the way for new therapeutic opportunities.
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http://dx.doi.org/10.1016/S0007-4551(18)30383-7DOI Listing
December 2018

Cancer du rein métastatique : recommandations et perspectives en 1 ligne.

Bull Cancer 2018 Dec;105 Suppl 3:S235-S241

Département de radiothérapie, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France. Electronic address:

Metastatic Renal Cell Carcinoma: WHICH TREATMENTS IN FIRST-LINE SETTING?: The treatment of metastatic kidney cancer has radically changed during the past decade, notably with the development of tyrosin kinase inhibitors (TKI) and the rise of immunotherapy. Kidney cancer, especially clear cell renal cell carcinoma (CCRC) which regroups 80% of cases, is associated with increased angiogenesis and VEGF (vascular endothelial growth factor) dependent signaling pathways. Targeted therapies have therefore modified therapeutical strategies through direct inhibition of VEGF on its receptor or inhibition of the PI3K/AKT/mTOR pathway. Consequently, new anti-angiogenic molecules are now available as first line treatment and are to be prioritized depending on tumoral histology and prognostic groups. These new molecules have allowed increased patient survival. Immunotherapy is again currently transforming our first line therapeutical approach of metastatic kidney cancer with numerous ongoing therapeutical trials including combination of targeted therapies with immune checkpoint inhibitors or association of various immunotherapies. Beyond these major first line changes, difficulties still remain in the therapeutical sequence which is crucial in the care of these patients. This report aims to underline first line therapeutical recommendations in metastatic kidney cancer and expose results of recent assays.
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http://dx.doi.org/10.1016/S0007-4551(18)30378-3DOI Listing
December 2018