Institut Claudius Regaud

Abstract Background To date, no prospective randomized trials have been published to validate a curative-intent strategy combining standard-of-care systemic therapy (SOC ST) with local ablative treatment (LAT) in patients with oligometastatic breast cancer (OMBC). Available evidence derives solely from retrospective series. These series can sometimes be criticized for their short follow-up periods, the biological and anatomical heterogeneity of the patients’ tumors, the use of suboptimal or insufficiently detailed imaging modalities, and the non-consecutive nature of their recruitment. Our objective was to identify prognostic factors for progression-free survival (PFS) and overall survival (OS) in patients with HR+/HER2- OMBC. We specifically evaluated the impact of modern versus standard imaging techniques and the contribution of LAT. To minimize selection bias, we enrolled all eligible patients consecutively, and to ensure biological homogeneity we therefore restricted inclusion to the HR+/HER2- phenotype. Methods We retrospectively reviewed all patients consecutively diagnosed and treated from 2012 to 2020 at our institution for HR+/HER2-negative OMBC. OMBC was defined as breast cancer with 1 to 5 distant metastases. Cases were categorized as de novo or metachronous. Surrogate intrinsic subtype - Luminal A-like (Lum-A) and Luminal B-like (Lum-B) were defined according to St Gallen consensus criteria. Imaging were classified as modern imaging methods (MIMs: PET-CT or whole-body MRI) versus standard imaging methods (SIMs: bone scintigraphy or thoraco-abdomino-pelvic (TAP) CT). Number and location of metastases, treatments - SOC ST vs SOC ST plus LAT (surgery or SBRT) were collected. Survival analyses were performed using the Kaplan-Meier method, the Logrank test, and the Cox model including time-dependent variable. The use of time-dependent models allowed adjustment for the timing of LAT and helped mitigate immortal time bias. Results Median age was 57.0 years [29.0; 90.0]; 23% patients had Lum-A and 77% had Lum-B tumors. OMBC was de novo in 34%, and metachronous in 65%. One organ was involved in 94% and 1 to 3 metastases in 88% cases. Metastatic sites included bone in 98 (68%), lymph node in 20 (14%), liver in 18 (12%), lung in 10 (7%), and brain in 7(5%) cases. MIMs were applied for staging in 54% of patients. No patients with four or five metastases received LAT (surgery or SBRT). Unfortunately, by lake of data, systemic treatment could not be analyzed. The median follow-up was 82.8 months. 73% relapsed and 51% died. Median OS was 81.1 months (95%CI [60.0-94.1]). Median PFS was 26.5 months (95% CI [21.0-33.8]). In univariable analysis, worse OS was associated with 4-5 metastases, liver metastases, Lum-B and SIMs (HR=2.56, 95% CI [1.58-4.13], p<0.0001). LAT was associated with improved PFS (HR=0.34, 95% CI [0.20-0.58], p<0.0001) and OS (HR=0.32, 95% CI [0.16-0.63], p=0.0009). In multivariable analysis: worse OS was associated with Lum-B, liver metastases and SIMs (HR=1.64, 95% CI [1.12-3.16], p=0.017). LAT improved PFS (HR=0.52, 95% CI [0.29-0.91], p=0.0233), showed a non-significant trend toward better OS (HR=0.52, 95% CI [0.25-1.08], p=0.078). In the subgroup staged with MIMs, in univariable analysis, LAT was significantly associated with improved PFS (HR=0.40, 95% CI [0.21-0.77], p=0.0064) and OS (HR = 0.29, 95% CI [0.12-0.73], p= 0.008). Conclusion This retrospective study reports prognostic data from a biologically homogeneous and unselected cohort of HR+/HER2- OMBC patients, with extended follow-up. In this study, LAT significantly improved PFS and showed a strong trend toward improved OS. In patients staged with MIMs, LAT was significantly associated with both PFS and OS, underscoring the importance of advanced imaging in selecting candidates for curative-intent strategies. Citation Format: J. Lacaze, F. Dalenc, E. De Maio, B. Cabarrou, T. Cassou Mounat, C. Massabeau, V. Nicolai, G. Selmes, E. Jouve, M. Ung, C. Korenbaum. Impact of modern imaging on survival in a retrospective and consecutive cohort of 145 HR+/HER2 negative oligometastatic breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-10-15.

To evaluate oncological outcomes and their predictors following salvage oropharyngectomy. This single-center retrospective study included patients who underwent a salvage oropharyngectomy in an irradiated neck for recurrent or metachronous oropharyngeal squamous cell carcinoma (OPSCC) between 2014 and 2023. Ninety-four patients were included. Five-year overall survival (OS), disease-specific survival (DSS), and local recurrence-free survival (LRFS) were 31.7%, 58.5%, and 55.2%, respectively. In multivariable analysis, pN+ status (HR 2.32; p = 0.031), pT status ≥ 3 (HR 2.03; p = 0.020), and age (HR 1.05; p = 0.014) were associated with OS. DSS was associated with pT status ≥ 3 (HR 5.24; p < 0.001), metachronous (vs. recurrent) OPSCC (HR 0.32; p = 0.006), and cN+ status (HR 2.31; p = 0.053). LRFS was associated with metachronous OPSCC (HR 0.30; p = 0.002) and pT status ≥ 3 (HR 3.60; p = 0.001). This last-resort procedure is associated with poor survival outcomes. In this series, patients with p16-positive OPSCC did not fare better than their p16-negative counterparts.

Abstract In approximately one third of patients, resected head and neck squamous cell carcinoma will recur. We postulated that the induction of tumor neoantigen-specific T cell responses could prevent relapse. To this end, we developed TG4050, an individualized neoantigen therapeutic vaccine encoding up to 30 patient-specific predicted tumor neoantigens delivered by a Modified Vaccinia Ankara virus viral vector. We tested TG4050 as single agent in a randomized phase I trial. We found that of 16 evaluable patients randomized to immediate vaccination with TG4050, none relapsed after a median follow-up of 30 months, while 3 relapsed in the 16 control arm patients randomized to observation and treatment with TG4050 after recurrence. Polyepitopic responses to vaccine neoantigens were detected in the blood of patients from both arms after treatment initiation. These responses were maintained throughout treatment and persisted for over one year after the last dose. Vaccine neoantigen-specific CD8 + T cells had an effector phenotype and displayed high expression of cytotoxic and tissue-resident markers. TCR repertoire analysis showed that vaccine neoantigen-specific CD8 + T cell responses were polyclonal and comprised both de novo responses and amplification of pre-existing tumor-infiltrating T cell clones. Together, this translational data is consistent with the model in which single-agent delivery of TG4050 induces long-lasting tumor neoantigen-specific cytotoxic T cell responses that prevent tumor recurrence.

PurposeOral supportive care is essential in comprehensive cancer management, particularly for patients with head and neck cancer and those with hematologic cancers, who experience significant oral complications. While supportive care has been extensively explored in medical oncology, dentists’ knowledge and practices regarding oral supportive care for cancer patients remain understudied. This study aimed to assess French dentists’ knowledge, practices, and training needs regarding supportive care for cancer patients.MethodsA cross-sectional survey was distributed electronically to dental surgeons across France through Departmental Councils of the Order of Dental Surgeons. The questionnaire investigated practitioners’ knowledge of cancer patient management, care modalities, encountered difficulties, knowledge of supportive care, and training needs.ResultsAmong 165 respondents, 96% reported treating cancer patients, with head and neck cancers being significantly over-represented compared to general population incidence. Among respondents, 89% expressed concern about supportive care in oncology, while 73% rated their knowledge in this area below 5/10, and 27% were unaware of risks associated with cancer therapies. Head and neck cancers (54%) and hematological malignancies (15%) presented the greatest management challenges. The most common difficulties included performing invasive procedures (46.7%), writing prescriptions (45.8%), and completing medical questionnaires (40.2%). Only 29% of dentists reported having knowledge of supportive care in oncology, with 89% expressing a need for further training.ConclusionFrench dentists demonstrate concern about their role in cancer patient care, yet face significant knowledge gaps and training deficiencies. Enhanced educational programs, improved interprofessional communication, and clear clinical guidelines specifically designed for dental professionals are needed to optimize supportive care delivery for cancer patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10392-9.

BackgroundWe evaluate the Omni Legend 32 cm (OMNI6R), a digital-BGO PET/CT using the deep learning (DL) based algorithm, Precision Deep Learning (PDL), emulating time-of-flight (TOF) enhancement and compare its performance to the TOF-equipped Discovery-MI 25 cm (DMI5R) in terms of detection sensitivity, quantification, and overall image quality.MethodsThirty patients were administered with an average single dose of 2 MBq/kg [18F]-FDG and were scanned consecutively on DMI5R first and on OMNI6R afterwards. Total scan duration on DMI5R and OMNI6R were 10 and 6 min, respectively. OMNI6R data were reconstructed using Bayesian Penalized Likelihood (BPL) algorithm with a beta of 650 and PDL-High setting. A total of 150 inserted synthetic lesions (ISL), ranging in size from 6 to 10 mm and exhibiting contrast levels between 3 and 15 relative to their initial background activity, were distributed across the cohort. Three readers blindly assessed detection sensitivity and quantification of these lesions. We tested a non-inferiority hypothesis based on the ISL true positive rate (TPR) and compared calculated recovery coefficients (RC) using SUVmean and SUVmax metrics of the detected ISL. Additionally, image quality, sharpness, conspicuity, noise characteristics, and diagnostic confidence were assessed as clinical quality indicators with a 5-point Likert scale on clinical images without ISL, using same beta as DMI5R and different PDL settings (None, High, Medium, Low).ResultsTPR were 84.67% (95% CI 80.04–89.29%) and 84.44% (95% CI 77.76–91.13%) respectively for DMI5R and OMNI6R-PDL-High, and demonstrated non-inferiority. OMNI6R-PDL-High yielded higher RC without overestimation for all ISL sizes. Remarkably, these findings were observed despite a 9% activity decay in ISL and a 40% reduction in whole-body acquisition time. All PDL settings led to increased average median scores across clinical quality metrics, surpassing the DMI5R in most cases.ConclusionsOMNI6R using PDL-High demonstrated non-inferior diagnostic performance compared to DMI5R, as evidenced by ISL detection sensitivity and quantitation. Importantly, the use of OMNI-PDL-High did not increase the risk of false-negative findings, despite reductions in activity and acquisition time. OMNI6R using PDL enhances overall image quality while improving clinical workflow and patient comfort. These results support DL-based enhancement algorithms as effective solutions for non-TOF PET imaging.Trial registration number and date of registration: NCT05154877, December 13th 2021.