{"id":5522,"date":"2015-10-07T14:15:58","date_gmt":"2015-10-07T18:15:58","guid":{"rendered":"https:\/\/themedicalxchange.com\/2015\/10\/07\/congres-europeen-sur-le-cancer-de-2015-cec\/"},"modified":"2021-07-20T10:11:06","modified_gmt":"2021-07-20T14:11:06","slug":"congres-europeen-sur-le-cancer-de-2015-cec","status":"publish","type":"post","link":"https:\/\/themedicalxchange.com\/fr\/2015\/10\/07\/congres-europeen-sur-le-cancer-de-2015-cec\/","title":{"rendered":"Un iTK ciblant la mutation T790M dans les cas de cancer du poumon permet d\u2019obtenir des taux \u00e9lev\u00e9s de ma\u00eetrise de la maladie"},"content":{"rendered":"

Pleins feux sur le R-EGF et les mutations\u00a0T790M<\/h2>\n

Les donn\u00e9es issues de l\u2019analyse de deux essais de Phase\u00a0II r\u00e9unis ont r\u00e9v\u00e9l\u00e9 que \u00ab\u00a0selon l\u2019analyse d\u2019un laboratoire central ind\u00e9pendant, le taux de r\u00e9ponse objective s\u2019\u00e9levait \u00e0 61\u00a0% et le taux de ma\u00eetrise de la maladie, \u00e0 91\u00a0%\u00a0\u00bb, a affirm\u00e9 le Dr<\/sup>\u00a0Glenwood Goss, Directeur du Programme sur le cancer du poumon, du Centre de canc\u00e9rologie de l\u2019H\u00f4pital d\u2019Ottawa, en Ontario. Ces r\u00e9sultats concordent avec les donn\u00e9es initialement publi\u00e9es sur l\u2019efficacit\u00e9 et l\u2019innocuit\u00e9 de cet agent l\u2019an dernier (J\u00e4nne, P.\u00a0A. et al.<\/em> N Engl J Med<\/em>, vol.\u00a0372, 2015, p.\u00a01689-1699). Si ces donn\u00e9es ont attir\u00e9 l\u2019attention, c\u2019est parce qu\u2019il ne reste plus de beaucoup d\u2019options th\u00e9rapeutiques pr\u00e9sentement pour les patients atteints d\u2019un CPNPC porteurs de mutations activatrices du R-EGF, qui deviennent r\u00e9sistants aux inhibiteurs de la tyrosine kinase (iTK) utilis\u00e9s en premi\u00e8re intention, tels que l\u2019erlotinib, le g\u00e9fitinib ou l\u2019afatinib. Le plus rassurant de tout cela? L\u2019activit\u00e9 syst\u00e9matique de l\u2019AZD9291, un iTK pour voie orale oppos\u00e9 aux mutations du R-EGF et \u00e0 la mutation\u00a0T790M g\u00e9n\u00e9ratrice de r\u00e9sistance dans toutes les strates de patients, que ces derniers aient \u00e9t\u00e9 stratifi\u00e9s en fonction de la s\u00e9quence de traitement (deuxi\u00e8me intention vs premi\u00e8re intention), du groupe ethnique (asiatique vs non asiatique) ou du type de mutation (Fig. 1)<\/a>. D\u2019apr\u00e8s les donn\u00e9es r\u00e9unies chez 411\u00a0patients, un laboratoire central ayant confirm\u00e9 que 98,5\u00a0% d\u2019entre eux \u00e9taient porteurs de mutations\u00a0T790M du R\u2011EGF, 31\u00a0% de ces patients ont re\u00e7u de l\u2019AZD9291 comme traitement de deuxi\u00e8me intention et 69\u00a0% comme traitement de troisi\u00e8me intention. La population \u00e0 l\u2019\u00e9tude \u00e9tait form\u00e9e \u00e0 40\u00a0% de sujets non asiatiques et le sous-type de mutation\u00a0T790M le plus r\u00e9pandu \u00e9tait l\u2019Ex19del (68\u00a0%) suivi du L858R (29\u00a0%). L\u2019AZD9291 a \u00e9t\u00e9 bien tol\u00e9r\u00e9. Bien que la diarrh\u00e9e et une \u00e9ruption cutan\u00e9e aient \u00e9t\u00e9 rapport\u00e9es par 38\u00a0% des sujets chacune, les cas de grade\u00a03 ou plus ont touch\u00e9 moins de 1\u00a0% des sujets. Seulement 4\u00a0% des sujets ont abandonn\u00e9 le traitement pour cause d\u2019effets ind\u00e9sirables. Comme cet agent prolonge la ma\u00eetrise de la maladie, une forte proportion de sujets ont poursuivi le traitement et b\u00e9n\u00e9ficiaient toujours d\u2019une ma\u00eetrise durable de leur maladie lors de la plus r\u00e9cente analyse des donn\u00e9es cumul\u00e9es.<\/p>\n

\n
Il s\u2019agit de transformer le CPNPC avanc\u00e9 en maladie chronique pouvant \u00eatre ma\u00eetris\u00e9e \u00e0 l\u2019aide de traitements successifs ciblant les mutations sous-jacentes.<\/div>\n<\/blockquote>\n

Ces essais de Phase\u00a0II se sont d\u00e9roul\u00e9s dans plusieurs centres de recherche situ\u00e9s en Europe, en Am\u00e9rique du Nord et en Asie. La confirmation de la pr\u00e9sence de la mutation\u00a0T790M \u00e9tait obligatoire. Les patients pr\u00e9sentant des m\u00e9tastases c\u00e9r\u00e9brales stables \u00e9taient admissibles. Des donn\u00e9es distinctes ayant servi \u00e0 \u00e9valuer le v\u00e9cu des patients trait\u00e9s par l\u2019AZD9291 ont fait ressortir un taux de satisfaction \u00e9lev\u00e9, soit une note de 9,1 sur 10. Questionn\u00e9s pr\u00e9cis\u00e9ment sur la p\u00e9nibilit\u00e9 des effets ind\u00e9sirables, les patients ont accord\u00e9 \u00e0 l\u2019AZD9291 une note de 2,1 sur 10, signe de sa bonne tol\u00e9rabilit\u00e9.<\/p>\n

Conclusion<\/h2>\n

\u00c0 la lumi\u00e8re de sa tol\u00e9rabilit\u00e9 et de son efficacit\u00e9, l\u2019AZD9291 pourrait constituer un nouveau pas en avant dans les efforts visant \u00e0 transformer le CPNPC avanc\u00e9 en maladie chronique pouvant \u00eatre ma\u00eetris\u00e9e \u00e0 l\u2019aide de traitements successifs ciblant les mutations sous-jacentes recens\u00e9es par profilage mol\u00e9culaire. Le tiers des cas de CPNPC est activ\u00e9 par les mutations du R-EGF. Pour l\u2019heure, il n\u2019existe aucun m\u00e9dicament homologu\u00e9 pour les patients porteurs de telles mutations qui deviennent r\u00e9sistants aux inhibiteurs de la TK actuellement offerts sur le march\u00e9 en raison d\u2019une mutation T790M.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vienne <\/b> \u2013 Selon des donn\u00e9es pr\u00e9sent\u00e9es lors du Congr\u00e8s europ\u00e9en sur le cancer de 2015, un nouvel agent cibl\u00e9 utilis\u00e9 en deuxi\u00e8me intention ne cesse de produire des taux \u00e9lev\u00e9s de ma\u00eetrise de la maladie chez les patients atteints d\u2019une forme avanc\u00e9e de cancer du poumon non \u00e0 petites cellules (CPNPC) qui deviennent porteurs de la mutation T790M du r\u00e9cepteur du facteur de croissance \u00e9pidermique (R-EGF). Bien que les donn\u00e9es soient issues d\u2019essais de Phase II, l\u2019activit\u00e9 intense et le bilan d\u2019innocuit\u00e9 favorable de cet agent pourraient bien propulser ce dernier vers l\u2019homologation par les organismes de r\u00e9glementation.<\/p>\n","protected":false},"author":1,"featured_media":5523,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"tags":[410,397,523,286],"class_list":["post-5522","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-2015-fr","tag-cec","tag-extract-fr","tag-oncologie","area_tag-oncologie"],"acf":[],"yoast_head":"\nUn iTK ciblant la mutation T790M dans les cas de cancer du poumon permet d\u2019obtenir des taux \u00e9lev\u00e9s de ma\u00eetrise de la maladie - The Medical Xchange<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/themedicalxchange.com\/en\/2015\/10\/07\/2015-european-cancer-congress-ecc\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Un iTK ciblant la mutation T790M dans les cas de cancer du poumon permet d\u2019obtenir des taux \u00e9lev\u00e9s de ma\u00eetrise de la maladie - The Medical Xchange\" \/>\n<meta property=\"og:description\" content=\"Vienne \u2013 Selon des donn\u00e9es pr\u00e9sent\u00e9es lors du Congr\u00e8s europ\u00e9en sur le cancer de 2015, un nouvel agent cibl\u00e9 utilis\u00e9 en deuxi\u00e8me intention ne cesse de produire des taux \u00e9lev\u00e9s de ma\u00eetrise de la maladie chez les patients atteints d\u2019une forme avanc\u00e9e de cancer du poumon non \u00e0 petites cellules (CPNPC) qui deviennent porteurs de la mutation T790M du r\u00e9cepteur du facteur de croissance \u00e9pidermique (R-EGF). 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