M. Coudurier

Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France

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Publications (25)8.13 Total impact

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    ABSTRACT: Mediastinal angiosarcoma is a rare intrathoracic tumour and the therapeutic approach remains poorly codified. We report the case of a 65-year-old female patient presenting with chest pain. Further exploration revealed an anterior mediastinal mass with pericardial invasion. Transthoracic biopsy gave the diagnosis of angiosarcoma. Multimodal treatment with neoadjuvant chemotherapy (doxorubicin 20mg/m(2), Ifosfamide 2500mg/m(2), Uromitexan(®) 2500mg/m(2)) and surgery followed by adjuvant radiotherapy has led to remission of the tumour that has persisted for 12 months. Systematic recording of such conditions in dedicated registries could contribute to enhance the description of the clinical and pathological characteristics, thus helping define the principles of specific management.
    Revue des Maladies Respiratoires 11/2012; 29(9):1120-3. · 0.50 Impact Factor
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    ABSTRACT: Standard treatment of small-cell lung cancer (SCLC) is a combination of etoposide and platinum for patients with extensive disease, associated with radiotherapy for patients with limited disease (LD). Therapeutic strategies for relapse, although well characterized, are disappointing. Between 1997 and 2009, 300 patients were treated for SCLC at Grenoble University Hospital. We analyzed patients' characteristics and outcomes at different treatment steps, to determine prognostic factors and propose subsequent treatment strategies according to "sensitive", "resistant" or "refractory" status established after first-line treatment (L1). The median patient age was 63.2 years, 46.3% had LD, and 23% were female. The objective response rate (ORR) to first-line chemotherapy was 73% [CI(95%): 67.6-77.9] and median survival was 13 months. After L1, comparison between "refractory" and "sensitive" groups showed more extensive disease (76.6% vs. 34.3%, p=0.003), poorer Performance Status (PS 0-1: 48.4% vs. 67.8%, p=0.008), more endocrine paraneoplastic syndrome (18.7% vs. 8.4%, p=0.03) and more composite histology (17.2% vs. 4.9%, p=0.004) in "refractory" patients. After second line (L2), ORR was 55.8% [CI(95%): 45.2-66.0] in "sensitive", 18.2% [CI(95%): 8.2-32.7] in "resistant", and 14.7% [CI(95%): 4.9-31.0] in "refractory" groups; with partial response only for the last two groups. After L3 and L4, ORR was 24.0% [CI(95%): 14.9-35.2] in "sensitive", 9.1% [CI(95%): 11.2-29.2] in "resistant" with partial response only. No response was observed for "refractory". After L1, the median survival was respectively 23, 10 and 6.4 months for "sensitive", "resistant" and "refractory" groups (p<0.001). Multivariate analysis showed that LD and classical SCLC histology were positive predictors of belonging to the "sensitive" group. Positive factors for survival were sensitivity to L1, PS 0-1, LD, Charlson score <4, no endocrine paraneoplastic syndrome and no occupational exposure. Limited disease is the major predictive factor for sensitivity to treatments and survival. Factors linked to the patients' clinical presentation also impact on survival. With currently recommended drugs, the "sensitivity" of the patient determined by the response to L1 indicates that it is pointless to treat "sensitive" with L4, "resistant" with L3 and "refractory" with L2, except for a few selected patients after multidisciplinary group discussion.
    Lung cancer (Amsterdam, Netherlands) 07/2012; 78(1):112-120. · 3.14 Impact Factor
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    ABSTRACT: The insulin-like growth factor I receptor (IGF-IR) pathway plays a major role in cancer growth, tumor cell survival and resistance to therapy. Preclinical evidence that targeting the IGF-IR is effective in cancer treatment has been accumulating for almost 2 decades. Early clinical trials revealed an acceptable safety profile together with pharmacodynamic evidence that the receptor can be targeted successfully. It is premature to draw conclusions regarding the therapeutic potential of this class of compounds but well-documented single-agent activity was noted during phase I evaluations, and recent evidence from a phase-II study suggests that co-administration of an anti-IGF-1R antibody with chemotherapy for non-small-cell lung cancer (NSCLC) improves objective response rate and progression-free survival. These early results are a strong indication for continued research on the targeting of IGF-R, particularly in the treatment of NSCLC. Today, IGF-1R targeting appears a promising approach, more than two dozen compounds have been developed and clinical trials are underway.
    Revue des Maladies Respiratoires 10/2010; 27(8):959-63. · 0.50 Impact Factor
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    ABSTRACT: The first lung complications of anti-TNF-alpha therapy in rheumatoid arthritis (RA) that were reported were infections. Recently, interstitial lung disease (ILD) has been described as a consequence of this treatment. We report two cases of women treated with anti-TNF-alpha therapy for RA who both developed exacerbations of their preexisting ILD thought to be due to the treatment. In one case, this complication occurred 2 months after anti-TNF-alpha therapy, whereas the delay of occurrence was 26 months in the second case. Based on these two cases and on the first 40 observations in the literature, we hypothesize that ILD may be exacerbated according to two distinct patterns during anti-TNF-alpha treatment for RA, occurring early (most frequently) or late after treatment was started, with a mean of 4 and 26 months, respectively. Other features that may differ between these two presentations include the risk factors, the anti-TNF-alpha molecule used, the histopathological pattern, and the prognosis.
    Revue des Maladies Respiratoires 03/2010; 27(3):232-7. · 0.50 Impact Factor
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    ABSTRACT: The first lung complications of anti-TNF-α therapy in rheumatoid arthritis (RA) that were reported were infections. Recently, interstitial lung disease (ILD) has been described as a consequence of this treatment. We report two cases of women treated with anti-TNF-α therapy for RA who both developed exacerbations of their preexisting ILD thought to be due to the treatment. In one case, this complication occurred 2 months after anti-TNF-α therapy, whereas the delay of occurrence was 26 months in the second case. Based on these two cases and on the first 40 observations in the literature, we hypothesize that ILD may be exacerbated according to two distinct patterns during anti-TNF-α treatment for RA, occurring early (most frequently) or late after treatment was started, with a mean of 4 and 26 months, respectively. Other features that may differ between these two presentations include the risk factors, the anti-TNF-α molecule used, the histopathological pattern, and the prognosis.
    Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2010; 27(3):232-237.
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    ABSTRACT: Introduction The insulin-like growth factor I receptor (IGF-IR) pathway plays a major role in cancer growth, tumor cell survival and resistance to therapy. Background Preclinical evidence that targeting the IGF-IR is effective in cancer treatment has been accumulating for almost 2 decades. Early clinical trials revealed an acceptable safety profile together with pharmacodynamic evidence that the receptor can be targeted successfully. It is premature to draw conclusions regarding the therapeutic potential of this class of compounds but well-documented single-agent activity was noted during phase I evaluations, and recent evidence from a phase-II study suggests that co-administration of an anti-IGF-1R antibody with chemotherapy for non-small-cell lung cancer (NSCLC) improves objective response rate and progression-free survival. Viewpoints These early results are a strong indication for continued research on the targeting of IGF-R, particularly in the treatment of NSCLC. Conclusions Today, IGF-1R targeting appears a promising approach, more than two dozen compounds have been developed and clinical trials are underway.
    Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2010; 27(8):959-963.
  • D Moro-Sibilot, M Coudurier
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    ABSTRACT: The pathway of Insulin-like Growth Factor (IGF-1) and its receptor (IGF-1R) is preponderant in solid tumours, and particularly in non small cell lung cancer (NSCLC). Several anticancer therapeutics, targeting this pathway, have been developed, whether it is monoclonal antibodies or small molecules (tyrosine kinase inhibitors, TKI). The results of phase II and III in stage IV NSCLC are promising, with response rate around 78% in non squamous cell carcinomas, that seem to be the histological type benefiting the most of anti-IGF-R therapies. Adverse effects are acceptable, essentially neutropenia or hyperglycaemia, with an interesting effect of metformin in this indication. Some other studies have underlined a synergic effect of EGFR (Epidermal Growth Factor Receptor) TKI and anti-IGF-1R antibodies. These promising results must be confirmed in phase III trials, currently opened or planned.
    Revue de Pneumologie Clinique 12/2009; 65S2:S80-S83. · 0.20 Impact Factor
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    ABSTRACT: Anaemia is a common complication of systemic anti-cancer treatment. In this context erythropoiesis-stimulating agents (ESA) have a demonstrable efficacy in improving anaemia and reducing the requirement for red cell transfusion. Consequently ESA therapy has gained increasing prominence in the management of chemotherapy related anaemia. However, recent trial data have suggested a higher rate of thromboembolic events, a possible enhancement of tumour progression and reduced survival in some patients with cancer who receive ESA therapy. In the light of these new developments we consider the current role of ESA in the management of chemotherapy related anaemia. The administration of cytotoxic chemotherapy may be complicated by the emergence of neutropenia and, above all, febrile neutropenia, leading frequently to hospital admission and intravenous treatment with broad spectrum antibiotics. Granulocyte growth factors (G-CSF) stimulate the proliferation and differentiation of neutrophils and reduce the duration of severe neutropenia and febrile neutropenia associated with cytotoxic chemotherapy. This article reviews the evidence supporting the use of granulocyte growth factors in thoracic oncology.
    Revue des Maladies Respiratoires Actualités. 10/2009; 1(4).
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    ABSTRACT: The law specifies how a doctor may write a medical certifcate and how a patient or his beneficiaries can obtain his medical records. It's important for a doctor to know this rules. A 56 years old patient was referred to our hospital for pulmonary adenocarcinoma cT2N2M1, the clinical stage was IV. The patient underwent radiotherapy and chemotherapy. During the treatment, the relations with the family were difficult. The patient refuse to accept the doctors tell his son any information and get married with his companion in secret. After patient's death, the son and the wife asked for many medical certificates. The doctors turned down so the son asked for the patient medical records. This observation asks the question of the medical certificates: how and when write them, which are obligatories? Moreover, how should a patient or his beneficiaries obtain medical records?
    Bulletin du cancer 09/2009; 96(7):805-9. · 0.61 Impact Factor
  • Denis Moro-Sibilot, Marie Coudurier
    La Revue du praticien 09/2009; 59(7):952-3.
  • Denis Moro-Sibilot, Marie Coudurier
    La Revue du praticien 09/2009; 59(7):955-6.
  • Denis Moro-Sibilot, Marie Coudurier
    La Revue du praticien 09/2009; 59(7):950-1.
  • European Respiratory Review 09/2009; 18(113):190-2.
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    ABSTRACT: Medical confidentiality is sometimes difficult to impose on patient's families, especially in the field of oncology. Here, we describe the case of a 54-years-old woman with a T1N0M0 lung adenocarcinoma. After the diagnosis was made, she advised the medical team not to inform her family about her disease. Although the patient was aware of the high-risk of relapse, she was lost of follow-up after first-line treatment. Five years later, she presented with multi-metastatic recurrence and had to be admitted in an intensive-care unit for severe respiratory failure due to tumor progression. She kept refusing to inform her family, which in the end was contacted by the patient's sister, a few hours before her death. This observation highlights the absolute inviolability of medical confidentiality and led the French Association of Young Pneumologist to initiate a multi-disciplinary symposium on ethical problems raised by the management of patients with lung cancer.
    Bulletin du cancer 09/2009; 96(7):791-5. · 0.61 Impact Factor
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    ABSTRACT: The patient information and obtaining their consent before any therapeutic constitute a basis for medicine exercise. However, there are situations where the physician may be in default. In that case, concepts of benefit/risk balance, of clear and appropriate information, and of legal liability for medico-surgical staff takes all their magnitude. That was the case in our observation, with a 69 years old patient with history of smoking, presenting a suspicious lung opacity which will require, following an agreement by multidisciplinary meeting, an exploration by thoracotomy despite an acceptable but altered respiratory function, as a result of a post-smoking broncho-emphysema. The non-malignant character of the suspected lesion raise questions about the risks involved, the benefit/risk balance, and the legal risk scopes of the medicosurgical staff as defined in the Cancer programme framework.
    Bulletin du cancer 08/2009; 96(7):785-9. · 0.61 Impact Factor
  • D. Moro-Sibilot, M. Coudurier
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    ABSTRACT: The pathway of Insulin-like Growth Factor (IGF-1) and its receptor (IGF-1R) is preponderant in solid tumours, and particularly in non small cell lung cancer (NSCLC). Several anticancer therapeutics, targeting this pathway, have been developed, whether it is monoclonal antibodies or small molecules (tyrosine kinase inhibitors, TKI). The results of phase II and III in stage IV NSCLC are promising, with response rate around 78% in non squamous cell carcinomas, that seem to be the histological type benefiting the most of anti-IGF-R therapies. Adverse effects are acceptable, essentially neutropenia or hyperglycaemia, with an interesting effect of metformin in this indication. Some other studies have underlined a synergic effect of EGFR (Epidermal Growth Factor Receptor) TKI and anti-IGF-1R antibodies. These promising results must be confirmed in phase III trials, currently opened or planned.
    Revue De Pneumologie Clinique - REV PNEUMOL CLIN. 01/2009; 65.
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    ABSTRACT: Although an association between thymic tumour and autoimmune disease (including autoimmune cytopenia) has been established, the association between thymic tumour and autoimmune neutropenia has rarely been reported, with only 13 cases described in the literature. We report on a 30 year old man diagnosed with autoimmune neutropenia who had been treated for invasive thymic tumour one year previously. He successfully responded to cyclosporin and steroids therapy. A few months later, the patient presented with autoimmune haemolytic anaemia after prematurely halting his own immunosuppressive treatment. This observation brings additional insights about the clinical features, biology and treatment of autoimmune neutropenia associated with thymic tumours and underlines the potential severity of such an association. Furthermore, the association of a thymic tumour with both autoimmune neutropaenia and autoimmune haemolytic anaemia has not been reported previously.
    Revue des Maladies Respiratoires 06/2008; 25(5):605-9. · 0.50 Impact Factor
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    ABSTRACT: M. Coudurier, R. Houot, L.Geriniere, S. Blandin, G. Salles, T. Lamy, P.-J. Souquet Introduction Although an association between thymic tumour and autoimmune disease (including autoimmune cytopenia) has been established, the association between thymic tumour and autoimmune neutropenia has rarely been reported, with only 13 cases described in the literature. Observation We report on a 30 year old man diagnosed with autoimmune neutropenia who had been treated for invasive thymic tumour one year previously. He successfully responded to cyclosporin and steroids therapy. A few months later, the patient presented with autoimmune haemolytic anaemia after prematurely halting his own immunosuppressive treatment. Conclusion This observation brings additional insights about the clinical features, biology and treatment of autoimmune neutropenia associated with thymic tumours and underlines the potential severity of such an association. Furthermore, the association of a thymic tumour with both autoimmune neutropaenia and autoimmune haemolytic anaemia has not been reported previously.
    Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2008; 25(5):605-609.
  • La Revue du praticien 12/2007; 57(17):1863.
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    ABSTRACT: Nocardial pneumonias are due to a genus of aerobic, filamentous, partly acid-alcohol fast, mainly Gram positive, actinomycetes. We report here two cases of nocardial pneumonia. The first was a 62 year old man with a history of fludaribine treatment and bone marrow transplant for lymphocytic leukaemia. During the investigation of pyrexia evidence of N. farcinica infection was found in the bronchial secretions. The second case was a man of 61 receiving long term corticosteroids and cytotoxic chemotherapy. Investigation of a pneumonia with pleural effusion found evidence, on culture of blood and pleural fluid, of disseminated infection with N. nova (cerebral, pleural, pulmonary and splenic). Nocardiosis is a rare cause of pneumonia mainly occurring in immuno-compromised adults (corticosteroid therapy, HIV infection, transplantation, cancer or leukaemia). It should be suspected in the presence of pleuro-pulmonary symptoms associated with neurological and cutaneous signs, general deterioration and weight loss. The microbiology laboratory should be advised of this eventuality as soon as possible in order to optimise the search for the organism.
    Revue des Maladies Respiratoires 04/2007; 24(3 Pt 1):353-7. · 0.50 Impact Factor