Le mésothéliome pleural malin (MPM) est une tumeur rare et agressive qui se développe au niveau de la plèvre.L'Adrénomedulline (AM) est un peptide de 52 acides aminés. Il intervient dans plusieurs processus physiologiques et physiopathologiques. Il est surexprimé dans plusieurs tumeurs où il joue un rôle important dans la croissance tumorale.Dans un premier temps nous avons montré que l'AM et ses récepteurs sont exprimés dans des biopsies de patients atteints de MPM suggérant son implication dans la croissance tumorale du MPM. In vitro l'incubation de lignées de MPM: H2452 et MSTO_211H avec des anticorps αAM ou αAMR inhibent la prolifération, l'invasion et la migration cellulaires. In vivo, le traitement avec un anticorps αAM ou l'antagoniste AM22-52, inhibe la croissance tumorale des xénogreffes de MSTO_211H par rapport au groupe contrôle. L'analyse histologique montre une augmentation significative de l'apoptose et une diminution importante de la vascularisation chez les tumeurs traitées par rapport aux tumeurs contrôles. Ces résultats démontrent le rôle important joué par l'AM dans la croissance tumorale du MPM et fait du système de l'AM une cible thérapeutique potentielle.Dans un deuxième temps, Nous avons émis l'hypothèse de la transactivation de l'EGFR par l'AM. Notre hypothèse s'est concrétisée dans la mesure où L'inhibition de l'EGFR par un inhibiteur spécifique l'AG1478 abolie l'activation de ERK par l'AM,La phosphorylation de l'EGFR par l'AM,La neutralisation de l'EGFR avec son propre anticorps inhibe la phosphorylation par l'AM suggérant une activation ligand dépendante. Ces résultats nous permettent de mieux comprendre le mécanisme d'action de l'AM. / Malignant pleural mesothelioma (MPM) grows aggressively in the thoracic cavity without curative possibilities, underlining the need for new therapeutic targets. Adrenomedullin (AM), a multifunctional peptide, is highly expressed in several tumors and plays an important role in angiogenesis and tumor. In the first part of our work, QRT-PCR showed an increase of AM mRNA levels in MPM when compared to normal pleura tissue. Immunohistochemically, AM and its receptors were localized in the carcinomatous epithelial compartment of MPM. The MPM cell lines H2452 and MSTO_211H expressed AM with a significant increase under hypoxia. The proliferation, migration and invasion of MPM cells are decreased by anti-AM and anti-AM receptors antibodies (αAM and αAMR) supporting that MPM cells can be regulated by AM. In vivo, αAM and AM22-52 antagonist therapies of MSTO_211H xenografts blocked angiogenesis and stimulated apoptosis, resulting in tumor regression. Histologic examination of treated tumors showed evidences of disruption of tumor vasculature. These findings highlight the implication of the AM pathway in the MPM growth and in neovascularization by supplying/amplifying signals essential for pathologic neoangiogenesis and lymphangiogenesis.In the second part of this work, we reported that the EGFR becomes rapidly tyrosine-phosphorylated upon stimulation of lung cancer cells lines with AM, suggesting that there is an intracellular mechanism for transactivation. Specific inhibition of EGFR function by the AG1478 or EGFR blocking antibody suppressed MAPK activation. These results suggest strongly a ligand-dependent mechanism of EGFR transactivation by AM.

No description available.

Le cancer broncho-pulmonaire du non-fumeur est considéré comme une entité à part du fait de ses particularités épidémiologiques. Il est en outre un excellent modèle pour l'étude des facteurs de risque de cancer bronchique autres que le tabagisme actif. Il n'existe que très peu de données non-asiatiques concernant cette entité d'intérêt. Le bio-observatoire national des cancers bronchiques de non-fumeurs (BioCAST I IFCT-1002) est une étude épidémiologique multicentrique prospective. Son objectif principal est de décrire une population de patient strictement non-fumeur (moins de 100 cigarettes au cours de la vie) atteint de cancer bronchique, notamment sur le plan de leur profil moléculaire somatique et de leur exposition aux facteurs de risque. Les objectifs secondaires étaient d'étudier si l'exposition aux différents facteurs de risque pouvait influencer le profil moléculaire ; et d'utiliser cette cohorte particulière (grande fréquence et diversité de mutations somatiques attendue) afin de développer un test multiplex pour le diagnostic non-invasif du profil moléculaire somatique tumoral à partir d'ADN circulant. Au total, 384 patients non-fumeurs atteints de cancer broncho-pulmonaire ont été inclus dans cette cohorte. Deux-tiers d'entre eux étaient exposés au tabagisme passif, et il s'agissait essentiellement d'une exposition domestique touchant les femmes. Inversement, 35% des hommes étaient exposés de manière certaine à au moins un cancérogène professionnel, contre 8% des femmes. Au total, 72% des patients présentait une anomalie moléculaire, essentiellement au niveau de l'EGFR (51% de l'ensemble de la cohorte). Le genre, ou l'exposition à différents facteurs de risque (tabagisme passif, exposition professionnelle, exposition hormonale chez les femmes) n'affectait pas de manière significative et cliniquement pertinente le profil mutationnel, avec les limites liée à de faibles effectifs dans certains groupes et aux expositions multiples. Seule l'exposition professionnelle à l'amiante et / ou à la silice semble avoir pour effet de diminuer la fréquence des mutations de l'EGFR / Lung cancer in never smokers (LCINS) is considered as a separate entity given its epidemiological specificities. It is also a very interesting template to assess alternative risk factors for lung cancers than tobacco smoking. However, there is very little non-Asian data about this particular topic. The BioCAST / IFCT1002 study is a prospective, nationwide, and multi-centric epidemiological study. Its main objective was to describe a French population of lung cancers in lifelong never smokers (less than 100 cigarette during all lifetime); with a special focus on molecular somatic profile and risk-factors exposure. Secondary objectives were to assess the interaction between risk-factor exposure and molecular profile; and to use this particular cohort to develop a multiplex test for non-invasive diagnosis of tumor mutations in circulating free DNA. Overall, 384 patients were recruited in the cohort. Two-third were exposed to passive smoking (mainly women and in domestic setting). By contrast, 35% of men were definitely exposed to occupational carcinogens versus 8% of women. Finally, 72% were found with a somatic mutation, mainly in the EGFR gene (51% of the whole population). Gender or exposure to risk factors such as passive smoking, occupational exposure, or hormonal status in women, were not significantly associated with a specific and/or clinically meaningful molecular profile in tumor. These findings should be interpreted with caution given that some subgroups were small and/or with many simultaneous exposures. However, exposure to asbestos and/or silica was significantly associated to a decreased risk for EGFR mutation. On the pilot study (n=106), circulating free DNA was associated with tumor burden. The multiplex diagnosis (12 amplicons on 5 genes) by next-generation sequencing was feasible and gave encouraging results in stage 4 patients (67% sensitivity, 73% concordance rate). LCINS is an interesting entity for the study of non-tobacco-related cancer risk factors; or to optimize liquid biopsy strategy

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-22T13:03:09Z No. of bitstreams: 1 schirleysantanamedeiros.pdf: 2068227 bytes, checksum: 845e9f62691a822685f4425cfe32abc4 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:51:47Z (GMT) No. of bitstreams: 1 schirleysantanamedeiros.pdf: 2068227 bytes, checksum: 845e9f62691a822685f4425cfe32abc4 (MD5) / Made available in DSpace on 2016-01-25T18:51:47Z (GMT). No. of bitstreams: 1 schirleysantanamedeiros.pdf: 2068227 bytes, checksum: 845e9f62691a822685f4425cfe32abc4 (MD5) Previous issue date: 2014-02-17 / A análise das taxas de mortalidade por câncer de pulmão, traqueia e brônquios segundo os efeitos do período e da coorte é relevante devido às mudanças de comportamento com relação ao tabagismo, cuja prevalência vem sofrendo alterações ao longo dos anos, segundo sexo e faixa etária. O objetivo do estudo foi analisar a tendência da mortalidade por câncer de pulmão, traqueia e brônquios no Estado de Minas Gerais, de 1980 a 2010 e comparar as taxas específicas de mortalidade e o comportamento das séries temporais, segundo subgrupo etário e sexo, conforme as coortes de nascimentos. Trata-se de um estudo ecológico de série temporal com a utilização de dados secundários de óbitos por câncer de pulmão, traqueia e brônquios composta por indivíduos acima de 30 anos de idade. Foram utilizados dados do Sistema de Informação sobre Mortalidade e do Instituto Brasileiro de Geografia e Estatística. Foi realizada a correção dos sub-registros através da redistribuição dos óbitos por causas mal definidas. Os dados foram avaliados levando-se em consideração o período e a coorte de nascidos vivos, através dos subgrupos etários agrupados de cinco em cinco anos. As taxas de mortalidade pelas causas selecionadas foram ajustadas pela faixa etária, conforme a técnica de padronização pelo método direto, utilizando como população padrão a de Minas Gerais, do ano de 2010. O efeito do período apontou uma tendência significantemente crescente de mortalidade no sexo feminino e uma estabilidade no sexo masculino. A análise de coorte e faixa etária foi realizada por meio do indicador taxa específica de mortalidade e da razão das taxas, mostrada por meio de gráficos de tendências e tabelas. O efeito da coorte mostrou convergência de taxas entre os dois sexos, com um aumento maior das taxas no sexo feminino. As taxas de mortalidade em ambos os sexos aumentaram com a idade, porém esse efeito foi maior no sexo feminino que no masculino. A avaliação das taxas específicas de mortalidade, segundo faixa etária, mostrou redução das taxas de mortalidade no sexo masculino entre 30 a 54 anos. Entre as mulheres, houve um aumento das taxas específicas em todas as faixas etárias acima dos 35 anos de idade. Os resultados sugerem que o impacto das mudanças de comportamento tenha sido “negativo” para o sexo feminino. Além disso, o fato de neste estudo terem sido realizadas análises por coorte possibilitou evidenciar com mais clareza as diferentes fases da epidemia do tabaco pelos quais passam homens e mulheres de Minas Gerais. A variação nas taxas de mortalidade entre os sexos pode estar contribuindo para a diminuição do diferencial entre os sexos no Estado. Ressalta-se a necessidade de ampliação das ações de controle do tabagismo, levando em consideração as diferenças de comportamento entre os sexos, a fim de permitir a diminuição da prevalência do câncer de pulmão, traqueia e brônquios. As diferenças de tendências entre os sexos despertam a necessidade de melhor compreender outras questões relacionadas ao gênero, que possam influenciar as taxas de mortalidade. / Analysis of mortality rates for cancer of the lung, trachea, and bronchi according to period and cohort effects is relevant due to changes in behavior related to smoking, whose prevalence has been changing over the years, by sex and age group. The aim of the study was to analyze trends in mortality from lung, tracheal, and bronchial cancer in the State of Minas Gerais, from 1980 to 2010, and compare the specific mortality rates and time series behavior, by age and gender subgroup, according to birth cohorts. This is an ecological study of time series using secondary data on deaths from cancer of the lung, trachea, and bronchi, comprised of individuals over 30 years of age. Data from the Mortality Information System and the Brazilian Institute of Geography and Statistics were used. Correction for underreporting was performed by redistributing deaths from poorly-defined causes. Data were evaluated by taking into account the period and the cohort, across age subgroups in five-year segments. Mortality rates for the selected causes were adjusted by age group, according to the direct method standardization technique, using the population of Minas Gerais, from the year 2010, as the standard. The period effect indicated a significantly increasing mortality trend in females and stability in males. The cohort and age group analysis was performed by means of the specific mortality rate indicator and the ratio of the rates, depicted via trend charts and tables. The cohort effect showed a convergence of rates between the two sexes, with a greater increase in the rates for females. Mortality rates for both sexes increased with age, but this effect was greater for females than for males. The evaluation of specific mortality rates, by age group, showed a reduction in mortality rates in males between 30 and 54 years. Among women, there was an increase in the specific rates for all age groups above 35 years. The results suggest that the impact of the changes in behavior has been "negative" for females. Moreover, the fact that cohort analyses were performed in this study made it possible to show more clearly the different stages of the tobacco epidemic that men and women of Minas Gerais undergo. The variation in mortality rates between the sexes may be contributing to the reduction of gender-related differences in this state. We emphasize the need for further actions to control smoking, taking into account the differences in behavior between the sexes, in order to reduce the prevalence of lung, tracheal, and bronchial cancer. The differences in trends between the sexes raise the need to better understand other gender-related issues that may influence mortality rates.

As neoplasias induzidas pela forma oncogênica da KRAS são doenças muito comuns, para as quais não existem terapias efetivas. Uma inibição direta da KRAS falhou em ensaios clínicos e esforços intensos tem sido feitos para identificar alvos de KRAS importantes para a oncogênese. Uma via promissora regulada por KRAS, que tem sido pouco explora a é a via dos microRNAs (miRNAs). Nossa meta foi identificar miRNAs regulados pela KRAS em células pulmonares e pancreáticas, que possam contribuir para o fenótipo oncogênico. Para alcançar esta meta nós usamos duas abordagens: (1) Nós investigamos o miRNA 486-5p como um alvo de KRAS em câncer de pâncreas e de pulmão. A expressão deste miRNA havia sido correlacionada positivamente com a presença de mutações em KRAS em pacientes portadores de câncer de cólon; (2) Nós usamos uma plataforma de microarranjo para identificar miRNAs diferencialmente expressos entre células humanas primárias imortalizadas pulmonares ou pancreáticas e suas linhagens isogênicas transformadas por KRAS. Na primeira abordagem, conseguimos mostrar que a expressão do miRNA 486-5p está correlacionada ao status de KRAS em células primárias pulmonares, mas não em células primárias pancreáticas. Além disso, geramos células pulmonares tanto com ganho e perda de função de KRAS e demonstramos que KRAS regula a expressão do miRNA 486-5p. Também de terminamos uma correlação negativa entre a expressão de KRAS e a expressão do alvo do miRNA 486-5p FoxO1, um supressor tumoral. Para avaliar como o miRNA 486-5p afeta as propriedades oncogênicas induzidas por KRAS, nós transfectamos oligonucleotídeos inibitórios para o miRNA 486-5p em células pulmonares positivas para mutações em KRAS. A inibição da expressão do miRNA 486-5p levou a uma redução da clonogenicidade e viabilidade celulares. Esta redução não está associada a um aumento de morte celular, mas a uma redução da proliferação celular. Interessantemente, a transfecção de oligonucleotídeos mímicos do miRNA 486-5p em células pulmonares negativas para mutações em KRAS ou em células com perda de função de KRAS por RNAi levou a um aumento da proliferação e clonogenicidade. Estes dados indicam que o miRNA 486-5p, não só é um alvo de KRAS em câncer de pulmão, mas também age como um oncomiR contribuindo para a proliferação celular induzida por KRAS. Na nossa segunda abordagem, nós identificamos 17 miRNAs com expressão aumentada e 3 com expressão diminuída em células primárias pancreáticas expressando KRAS oncogênica. Destes, 9 miRNAs foram foram também identificados por metanálise de dados de microarranjo publicados comparando amostras tumorais pancreáticas com amostras não tumorais. Apesar do experimento de microarranjo com as linhagens primárias pulmonares não ter produzido resultados estatisticamente significativos após a correção por FDR, uma tendência à expressão diferencial foi observada para vários miRNAs e nós validamos por qPCR a expressão diferencial dos miRNAs 720 e 139-3p. Em conclusão, nós conseguimos identificar miRNAs regulados pela KRAS tanto em células pulmonares, quanto pancreáticas. Um melhor entendimento das suas funções biológicas, bem como dos alvos por eles regulados nestes contextos, pode revelar novas vias para a exploração terapêutica. / KRAS-induced lung cancer is a very common disease, for which there are currently no effective therapies. Direct targeting of KRAS has failed in clinical trials and intense efforts are underway to identify KRAS targets that play a crucial role in oncogenesis. One promising KRAS-regulated pathway that has so far been overlooked is the micro RNA (miRNA) pathway. Our goal was to identify miRNAs regulated by oncogenic KRAS in lung and pancreatic cells that could contribute to the oncogenic phenotype. In order to achieve this goal we used two different approaches: (1) We investigated miRNA 486-5p as a KRAS target in lung and pancreatic cancer. The expression of this miRNA had been correlated to the presence of KRAS mutations in colon cancer patients; (2) we used a microarray platform to identify differentially expressed miRNAs between immortalized human primary pulmonary or pancreatic epithelial cell lines and their isogenic K-Ras-transformed counterparts. In our first approach, we were able to show that mi486-5p expression correlates with KRAS status in lung primary cells, but not in pancreatic primary cells. Furthermore, we generated lung cancer cells with either gain-of-function or loss-of-function of KRAS and demonstrated that KRAS regulates miRNA 486-5p in these cells. We also found, in all lung cell models analyzed, a negative correlation between expression of KRAS and expression of miR-486-5p target FoxO1, a tumor suppressor. In order to evaluate how miR-486-5p affects KRAS-induced oncogenic properties, we transfected miR-486-5p inhibitor oligonucleotides into KRAS-positive lung cancer cell lines. Inhibition of miR-486-5p expression leads to reduced clonogenic growth and viability. This reduction is not associated with increased cell death, but with decreased cell proliferation. Interestingly, transfection of miR-486-5p double-stranded RNA mimic oligonucleotides in to KRAS negative lung cancer cell lines or into cells with loss-of-function of KRAS by RNAi leads to enhanced proliferation and clonogenicity. These results indicate, not only that miR-486-5p is a KRAS target in lung cancer, but also that miR-486-5p acts as an oncomiR contributing to KRAS-induced cell proliferation. In our second approach, we identified 17 upregulated microRNAs and 3 downregulated microRNAs in the primary pancreatic cell line expressing KRAS. Of these, 9 miRNAs were also identified by a metanalysis of published microarray datasets comparing pancreatic cancer patient samples to non-cancerous pancreatic tissues. Even though our array experiment in the primary pulmonary cells did not produce statistically significant results after FDR correction, differential expression trends were seen for many miRNAs and we validated miRNAs 720 and 139-3p as differentially expressed. In conclusion we were able to identify miRNAs regulated by KRAS both in lung and pancreatic cancer cells. Further understanding of their biological function, as well as the targets they regulate in these settings, could uncover novel pathways for therapy design.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23121号 / 人健博第83号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 椎名 毅, 教授 藤井 康友, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Depuis peu, l’immunothérapie a émergé comme une nouvelle stratégie chez les patients atteint de Cancer Bronchique Non à Petites Cellules (CBNPC), confirmant ainsi le rôle du système immunitaire dans cette maladie. Malgré ces nouveaux traitements (thérapies ciblées, immunothérapie), les taux de réponses restent faibles avec un impact modeste sur la survie globale. Des biomarqueurs sont donc nécessaire pour définir les populations cibles de ces traitements. Une des pistes explorées est le statut immunitaire des patients, en effet celui-ci a un impact pronostic et pourrait influencer la réponse aux traitements standards tels que la chimiothérapie, les thérapies ciblées et même l’immunothérapie. Parmi les cellules du système immunitaire, les cellules Natural Killer (NK) auraient un rôle effecteur dans le CBNPC. Il est maintenant clairement établit que les cellules NK favorisent la mise en place d’une immunité adaptative fonctionnelle et efficace. Ainsi une altération des fonctions NK pourrait être un mécanisme associé à l’échappement à l’immunité adaptative de la tumeur. Dans notre première étude, nous avons mis en évidence que les exosomes de cellules dendritiques stimulaient les cellules NK via NKp30, cette activité étant associée à un gain de survie sans progression chez des malades inopérables porteurs d’un CBNPC avancé. Notre second projet a révélé, pour la première fois, un rôle pronostic des transcrits de NCR3 (gène de NKp30) chez des patients naïfs de tout traitement. L’activation des cellules NK via NKp30 pourrait être une stratégie efficace d’immunomodulation chez les patients atteints de CBNPC avancé. Ces travaux confirment le rôle important des cellules NK dans le CBNPC avancé. / Recently, immunotherapy has emerged as a new strategy in Non-Small Cell Lung Cancer (NSCLC) patients, confirming the key role of the immune system in this disease. Despite these new treatments (targeted therapies, immunotherapy), response rates remain low with a modest impact on overall survival. Biomarkers are needed to define the target population of these treatments. One of the options explored is the immune status; indeed the immune status of cancer patients has a prognosis impact and may influence the response to standard treatments such as chemotherapy, targeted therapies and even immunotherapy. Among the immune cells, Natural Killer cells (NK) have an effector role in NSCLC. It is now established that NK cells can promote a functional and efficient adaptive immunity. Therefore, an impaired NK functions could be a mechanism associated with the escape from adaptive immunity of the tumor. In our first study, we demonstrated that exosomes from dendritic cells stimulated NK cells through NKp30, this activity is being associated with improved survival in advanced NSCLC. Our second project has revealed, for the first time, a independent prognostic role of NCR3 transcript (NKp30 gene) for naïve advanced NSCLC. Activation of NK cells via NKp30 could be an effective strategy for immunomodulation in advanced NSCLC patients. These studies confirm a major role of NK cells in advanced NSCLC.

Les résultats insuffisants de la radiochimiothérapie conventionnelle dans les cancers bronchiques non à petites cellules (CBNPC) ont motivé l’évaluation d’une nouvelle stratégie de modulation pharmacologique de la radiosensibilité tumorale basée sur les modifications épigénétiques. Pour cela nous avons évalué la combinaison de la radiothérapie et d’un nouvel pan-inhibiteur des histones déacétylases (HDACi), l’abexinostat en préclinique in vitro et in vivo sur deux modèles de CBNPC puis en phase clinique précoce chez l’homme dans le cadre d’un essai de phase I. Nous avons d’abord montré que l’abexinostat augmente la radiosensibilité des cellules de CBNPC de manière dépendante de la séquence thérapeutique en normoxie et en hypoxie en augmentant l’apoptose caspase dépendante ainsi que les cassures doubles brins radio-induites et en réduisant la signalisation et la réparation de ces dommages de l’ADN. L’abexinostat potentialise également le retard de croissance tumorale induit par la radiothérapie in vivo dans des xénogreffes sous-cutanées de CBNPC avec un profil de toxicité acceptable. Nous avons également montré pour la première fois que la triple combinaison de radiothérapie, abexinostat et cisplatine potentialise le retard de croissance tumorale in vivo.Les premiers résultats in vitro et in vivo confortant le rationnel pour la combinaison abexinostat-radiothérapie nous avons réalisé étude de phase I exploratoire d’escalade de dose combinant l’abexinostat à la radiothérapie palliative hypofractionnée standard délivrant 30y en 10 fractions pour des tumeurs solides métastatiques. Parmi les 58 patients traités, d’âge médian 61 ans (20-82), on note 71% de stade M1 et 88% de patients ayant déjà reçu des traitements préalables par chimiothérapie et/ou radiothérapie et/ou chirurgie. La dose recommandée pour un essai de phase 2 que nous avons établie est de 90mg/m². Sur les 51 patients évaluables, on observe un taux de réponse globale de 7,8% (1 réponse complète (RC) et 3 réponses partielles (RP)) et un taux de réponse locorégionale de 11,8% (1 RC et 5 RP) avec un suivi médian de 16 semaines. Les patients présentant des lésions (cibles ou non) cérébrales ont présenté des taux de réponse encourageant avec notamment un patient en RC. Nous avons retrouvé peu d’effets secondaires de grade ≥3, les plus fréquents étant la thrombopénie (17,2%), la lymphopénie (12,1%) et l’hypokaliémie (6,9%). Au total, 6 patients (10%) ont interrompu leur traitement du fait des effets secondaires. Nous n’avons pas observé de prolongation de l’intervalle QTc de grade ≥3 et il n’y a pas eu d’interruption de traitement en rapport avec cet effet secondaire. Dans l’ensemble nos données in vitro et in vivo montrent une potentialisation de l’effet antitumoral par la combinaison d’abexinostat et radiothérapie. Chez les patients présentant des tumeurs solides avancées l’abexinostat oral en combinaison à la radiothérapie est bien toléré. Cette combinaison pourrait avoir un potentiel particulièrement intéressant dans le traitement des métastases cérébrales.De plus nos travaux précliniques suggèrent pour la première fois un effet prometteur d’une triple combinaison avec HDACi, cisplatine et radiothérapie qui justifie de plus amples investigations et pourrait guider de nouvelles stratégies thérapeutiques dans les CBNPC.Nos travaux s’inscrivent dans une stratégie de recherche translationnelle et montrent l’importance de la recherche préclinique pour les études d’association aux rayonnements ionisants. Seuls un développement préclinique rationnel et un développement clinique méthodique permettront l’émergence de combinaisons modulant la radiosensibilité tumorale de manière suffisamment efficace pour modifier nos standards de traitement et améliorer le pronostic de nos patients. / Insufficient results of conventional chemoradiotherapy in non-small cell lung carcinomas (NSCLC) have encouraged assessment of new pharmacological strategies for modulation of radiosensitization based on epigenetic changes. We have investigated the combination of radiotherapy and a novel pan-histone deacetylase inhibitor (HDACi), abexinostat in vitro and in vivo in two NSCLC models and in an early phase clinical trial. Our findings demonstrate that abexinostat enhances radiosensitivity of NSCLC cells in a time dependent way in vitro in normoxia and hypoxia increasing radio-induced caspase dependent apoptosis and persistent DNA double strand breaks associated with decreased DNA damage signaling and repair. Interestingly, abexinostat potentiates tumor growth delay in vivo in combined modality treatments associating not only abexinostat and irradiation but also in the triplet combination of abexinostat, irradiation and cisplatin.We conducted an exploratory phase 1, dose-escalation study of abexinostat in combination with standard hypofractionated radiotherapy (30Gy in 10 fractions) in patients with advanced solid tumors treated in a palliative setting. Among 58 treated patients, the median age was 61.5 years (range, 20-82); 47% of the patients had M1 stage disease, and 95% had received previous chemotherapy alone or chemotherapy in combination with surgery and/or radiotherapy. The recommended phase 2 dose was determined to be 90 mg/m2. Of the 51 patients evaluable for response, best overall response was 8% (1 complete response [CR], 3 partial responses [PRs]), and best loco-regional response was 12% (1 CR and 5 PRs) at a median follow-up of 16 weeks. Of note, patients with target or non-target brain lesions showed encouraging responses, with 1 patient achieving a best loco-regional response of CR. Treatment-emergent grade ≥3 adverse events (AEs) were few, with most common being thrombocytopenia (17%), lymphopenia (12%), and hypokalemia (7%). Six patients (10%) discontinued treatment due to AEs. No grade ≥3 prolongation of the QTc interval was observed, with no treatment discontinuations due to this AE.Altogether, our data demonstrate in vitro and in vivo a potentiation of anti-tumor effect by abexinostat in combination with irradiation in NSCLC. Oral abexinostat combined with radiotherapy was well tolerated in patients with advanced solid tumors. The combination may have potential for treatment of patients with brain lesions.Moreover, our work suggest for the first time to our knowledge promising triple combination opportunities with HDACi, irradiation and cisplatin which deserves further investigations and could be of major interest in the treatment of NSCLC.Our studies which are part of a translational research strategy highlight the importance of preclinical investigations in the area of radiotherapy and drug combination research. Only rationale preclinical development and methodologically well conducted clinical development will allow new standards of treatment to emerge and improve patient’s prognostic.

The aim of this work has been the development and optimization of methods for early diagnosis of lung cancer, their utility and integration into daily practice. Firstly, we developed a device for measurement of endobronchial temperature (thermobronchoscopy) and found significant difference in endoluminal temperature above tumors and infiltrated lymph nodes compared to healthy regions. We further designed an appliance for near infrared spectroscopy of the bronchial mucosa and identified spectroscopic features useful for localization of solitary pulmonary nodule. The use of the appliance improved yield of endobronchial biopsy compared to endobronchial ultrasound. In the next part of the study, we describe further techniques for early diagnosis of lung cancer including endobronchial ultrasound, optical coherence tomography, confocal fluorescence microendoscopy, reflectance spectroscopy, autofluorescence bronchoscopy, fluorescence bronchoscopy, and narrow band imaging with concise introduction of our experience gained in several pilot projects. Next, we showed the utility of measurement of acetic acid in exhaled air as a promising biomarker for non-invasive identification of patients with symptomatic acid gastroesophageal reflux. Lastly, we demonstrated significant difference in radiation dose in HRCT...

The aim of this work has been the development and optimization of methods for early diagnosis of lung cancer, their utility and integration into daily practice. Firstly, we developed a device for measurement of endobronchial temperature (thermobronchoscopy) and found significant difference in endoluminal temperature above tumors and infiltrated lymph nodes compared to healthy regions. We further designed an appliance for near infrared spectroscopy of the bronchial mucosa and identified spectroscopic features useful for localization of solitary pulmonary nodule. The use of the appliance improved yield of endobronchial biopsy compared to endobronchial ultrasound. In the next part of the study, we describe further techniques for early diagnosis of lung cancer including endobronchial ultrasound, optical coherence tomography, confocal fluorescence microendoscopy, reflectance spectroscopy, autofluorescence bronchoscopy, fluorescence bronchoscopy, and narrow band imaging with concise introduction of our experience gained in several pilot projects. Next, we showed the utility of measurement of acetic acid in exhaled air as a promising biomarker for non-invasive identification of patients with symptomatic acid gastroesophageal reflux. Lastly, we demonstrated significant difference in radiation dose in HRCT...