B Dreno

Centre Hospitalier Universitaire de Nantes, Naoned, Pays de la Loire, France

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Publications (486)1667.5 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Early diagnosis of melanoma can save lives. However, mass screening is not recommended, and few studies have addressed targeted screening. Objective: To evaluate a targeted melanoma screening intervention by measuring the cumulative melanoma incidence and patient compliance with the screening. Methods: This was a prospective one-year follow-up of a cohort of 3923 French patients at elevated risk of melanoma who were recruited from April to October 2011 by 78 GPs using the Self-assessment of melanoma risk score. Following standard practice, based on the GPs’ opinions, a subset of these patients was referred to dermatologists. The dermatologists scheduled excisions when required. Melanomas were confirmed using pathology reports. Patient compliance with the clinical pathway was assessed retrospectively. The cohort was followed prospectively using three data sources (GPs, dermatologists and patients). Analyses of factors associated with compliance were performed using multiple logistic regression. Results: GPs examined the skin of 3923 high-risk patients, 1506 of whom were referred to dermatologists. Nine cases of melanoma were diagnosed, corresponding to a cumulative incidence of 229.4/100 000. Of the referred patients, 57.9% attended the dermatologist consultation. Patient attendance was better when the GPs provided a dermatologist's name (OR = 2.15, 95% CI: 1.51–3.09). A delay before consulting a dermatologist was inversely associated with the estimated lesion malignancy. Conclusion: Performing this targeted screening in a high-risk population resulted in a high melanoma detection rate, despite moderate compliance. Observations suggest that naming a dermatologist is a simple, inexpensive means of increasing patient compliance with the screening.
    European Journal of General Practice. 08/2014;
  • Lucie Peuvrel, Brigitte Dréno
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    ABSTRACT: Targeted therapies have developed rapidly over the last few years in the field of oncology thanks to a better understanding of carcinogenesis. They target pathways involved in signal transduction (EGFR, HER2, HER3, HER4, FLT3, RAS, RAF, MEK, KIT, RET, mTOR, SRC, EPH, SCF), tumor angiogenesis (VEGFR, TIE2), and tumor microenvironment (PDGFR, FGFR). They rarely cause the systemic adverse reactions generally associated with chemotherapy, but frequently cause disabling and specific skin toxicity. The impact on patient quality of life can be important both in terms of symptoms caused and of potentially aesthetic consequences. Inappropriate management can increase the risk of dose reduction or discontinuation of the cancer treatment. In this review, we will discuss skin toxicity associated with the main drug classes-EGFR, BRAF, MEK, mTOR, c-KIT, CTLA4, and SMO inhibitors, and anti-angiogenic agents. Targeted therapy-induced skin toxicities will be detailed in terms of symptoms, frequency, evolution, complications, and topical and oral treatments in order to improve their diagnosis and management.
    American Journal of Clinical Dermatology 08/2014; · 2.52 Impact Factor
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    ABSTRACT: Vemurafenib is indicated for the treatment of patients with BRAF (V600) -mutant metastatic melanoma. We studied for the first time the characteristics of brain metastases developed during treatment with vemurafenib in real-life conditions. We included all patients treated over 3 years with vemurafenib in our department for metastatic melanoma without initial brain involvement. Our primary endpoint was to assess the incidence of brain metastases in these patients. Our secondary endpoints were to identify the risk factors for metastases occurrence and their characteristics and course. In our retrospective cohort of 86 patients, 20 % had developed brain metastases on average 5.3 months after vemurafenib initiation. The median follow-up was 9 months (1-26 months). Radiological examinations revealed multiple brain metastases in 41 % of patients. The only risk factor for metastasis occurrence identified was a high number of metastatic sites when initiating vemurafenib (p = 0.045). Metastasis development was associated with a trend toward a decrease in overall survival from 12.8 to 8.5 months (p = 0.07) and a significant decrease in progression-free survival from 7 to 5 months (p = 0.04). Among the patients who developed brain metastases, 82 % died, of whom 64 % within 3 months, versus 58 % of patients without brain metastases over the same period. The extra-cerebral disease was well controlled in 59 % of patients during brain progression. In vemurafenib-treated melanoma patients, brain metastases are frequent and associated with a particularly poor prognosis. Because of their high frequency in patients with controlled extra-cerebral disease, brain explorations should be systematically performed during treatment.
    Journal of Neuro-Oncology 08/2014; · 3.12 Impact Factor
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    ABSTRACT: Brentuximab vedotin (BV), a monomethyl auristatin E-conjugated anti-CD30 monoclonal antibody, has shown its efficacy in patients with Hodgkin and anaplastic large-cell lymphomas (ALCL). We report our experience with BV in 2 patients with transformed mycosis fungoides (MF) and transformed Sezary Syndrome (SS).This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2014; · 3.76 Impact Factor
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    ABSTRACT: Vismodegib was approved for the treatment of advanced basal cell carcinoma (aBCC) based on the pivotal ERIVANCE BCC study. The primary endpoint (objective response rate [ORR]) was assessed 9 months after the last patient was enrolled. To confirm the clinical benefit of vismodegib, an additional analysis was performed 12 months after the primary analysis.MATERIALS AND METHODS: ERIVANCE BCC was a multicenter, nonrandomized, two-cohort study of 104 patients with histologically confirmed aBCC. Patients received 150 mg oral vismodegib daily until disease progression, intolerable toxicity, or withdrawal. An independent review panel comprising three expert clinicians reviewed patient photographs individually and as a consensus panel to evaluate baseline disease severity and clinical benefit after vismodegib treatment in 71 patients with locally advanced BCC (laBCC).RESULTS: Sixty-three patients were efficacy evaluable; baseline and postprogression photographs for 61 were available for review. Baseline disease severity was judged as 5 or 4 (very severe or moderately severe) in 71.4%. Clinical benefit was observed in 76.2% (significant: 65.1%; some: 11.1%). Interpanelist agreement (maximum difference ≤1 point among panelists' scores in 65.1% and 87.3% of patients for clinical benefit and baseline disease severity, respectively) and correlation between individual and panel reviews were strong. Clinical benefit scores showed good concordance with the protocol-specified ORR obtained by an independent review facility and with investigator-assessed response.CONCLUSION: Clinical benefit assessed by independent review based on expert clinical judgment provides strong evidence that treatment with vismodegib results in clinically meaningful and durable responses in patients with laBCC.
    The Oncologist 07/2014; · 4.10 Impact Factor
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    ABSTRACT: A 77-year-old patient treated with ipilimumab (anti-CTLA-4 antibody) for metastatic melanoma developed autoimmune pancytopenia (anemia, thrombocytopenia, and neutropenia) 8 days after the fourth infusion. This pancytopenia was resistant to high-dose oral corticosteroids (1 mg/kg) and to hematopoietic growth factors. It resolved after intravenous immunoglobulins injection. To date, only 1 case of autoimmune pancytopenia has been reported after this treatment. According to the case that we report, it seems essential to control the leukocyte count before any injection of ipilimumab.
    Journal of immunotherapy (Hagerstown, Md.: 1997) 07/2014; 37(6):348-350. · 3.20 Impact Factor
  • International journal of dermatology 07/2014; · 1.18 Impact Factor
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    ABSTRACT: The relationship between BRAF mutations and the patient clinical profile is still under question. The objective of the present study was to correlate the BRAF mutation status in primary and metastatic melanomas with the clinicopathological profile, disease-free (DFS) and overall survival (OS). A total of 367 melanoma samples from 278 patients were screened for their BRAF status using a combination of allele-specific amplification and DNA sequencing. Two or three tissue samples from the same patient were available for 74 patients. The clinicopathological characteristics were tested for their association with the BRAF mutation using the Fisher's or Pearson's χ2 test. Log-rank tests and Cox models were used for survival analyses. BRAF mutation was found in 152 samples (41.4%). Ten of the 74 patients with several tissue samples (13.5%) had discordant BRAF mutation results. BRAF-mutated patients were significantly younger at the time of primary melanoma and first diagnosis of metastasis than BRAF wild-type patients but with no difference in DFS and OS. According to our results, a primary melanoma with BRAF mutation is not associated with a more aggressive illness.
    Oncology reports. 06/2014;
  • Annales de Dermatologie et de Vénéréologie 06/2014; 141(6-7 Suppl 2):S85. · 0.60 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 06/2014; 141(6-7 Suppl 2):S83. · 0.60 Impact Factor
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    ABSTRACT: Background Basal cell carcinoma (BCC) is the most common cancer in humans. Vismodegib, a Hedgehog pathway inhibitor, has proved its effectiveness in treating non-resectable advanced BCC.AimHowever, its action on squamous cell carcinoma (SCC) is unknown. We present three SCC cases developed into BCC in vismodegib-treated patients.Material and methodsWe have described three cases of patients developing SCC during treatment by vismodegib for BCC.ResultsPatient 1 was treated with vismodegib for five facial BCC. Due to the progression of one of the lesions at month 3 (M3), a biopsy was performed and showed SCC. Patient 2 was treated with vismodegib for a large facial BCC. A biopsy was performed at M2 on a BCC area not responding to treatment and showed SCC. Patient 3 was treated with vismodegib for a BCC on the nose. Due to vismodegib ineffectiveness, a biopsy was performed and showed SCC.DiscussionTwo similar cases have been described in the literature. This could be due to the appearance of the squamous contingent of a metatypical BCC or to the squamous differentiation of stem cells through inhibition of the hedgehog pathway.Conclusion In practice, any dissociated response of a BCC to vismodegib should be biopsied.
    Journal of the European Academy of Dermatology and Venereology 06/2014; · 2.69 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 06/2014; 141(6-7 Suppl 2):S85. · 0.60 Impact Factor
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    ABSTRACT: Since the approval of vorinostat for the treatment of refractory cutaneous epidermotropic T-cell lymphoma (CTCL) in 2006, very little data about this treatment have been published. The aim of this retrospective study was to assess the efficacy and safety of vorinostat in patients with CTCL treated between 2007 and 2013 in our department. Fifteen patients (median age 64 years) were included: 9 with Sézary syndrome and 6 with mycosis fungoides. They were all in progression and the median number of systemic treatments previously administered was 3 (range 1-7). With vorinostat treatment, the best response was partial remission in 5 (33%) patients and stabilization in 4 (27%) patients. Six patients experienced disease progression. The mean time to response and response duration were 70 (range 31-140) and 300 (range 157-663) days, respectively. The most frequent adverse events were asthenia, weight loss, nausea and anaemia. Vorinostat could be a therapeutic alternative for CTCL after treatment failure.
    Acta Dermato-Venereologica 05/2014;
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    ABSTRACT: Background/Objectives: Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients. Methods: Review of literature augmented by expert opinion when literature was sparse. Results: Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3-4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation. Conclusions: The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.
    European journal of dermatology : EJD. 04/2014;
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    ABSTRACT: Background: Psoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of pro-inflammatory mediators that exaggerate inflammation. Objectives: to provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis. Methods: A review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis. Results: Either alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy. Conclusion: We provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.
    European journal of dermatology : EJD. 04/2014;
  • European journal of dermatology : EJD. 04/2014;
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    ABSTRACT: To assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a GP referral and to determine individual predictors of non-compliance. This survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011. Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment). Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression. Compliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR=13.22;[7.66-23.56]); no previous participation in cancer screenings, including smear tests (OR=5.03;[2.23-11.83]) and prostate screening (OR=2.04;[1.06-3.97]); lack of knowledge that melanoma was a type of cancer (OR=1.94;[1.29-2.92]); and reporting no time to make an appointment (OR=2.08;[1.82-2.38]), forgetting to make an appointment (OR=1.26;[1.08-1.46]), long delays in accessing an appointment (OR=1.25;[1.12-1.41]), not being afraid of detecting something abnormal (OR=1.54;[1.35-1.78]), no need to consult a dermatologist to feel secure (OR=1.28;[1.09-1.51]). Physicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better GP counseling might enhance compliance in high-risk populations.
    Preventive Medicine 04/2014; · 3.50 Impact Factor
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    ABSTRACT: Background: The efficacy and safety of clindamycin phosphate 1.2%/tretinoin 0.025% (Clin-RA) were evaluated in three 12-week randomised studies. Objectives: To perform a pooled analysis of data from these studies to evaluate its efficacy and safety in a larger population, in adolescents and in different acne severities. Materials & Methods: 4550 patients were randomised to Clin-RA, clindamycin, tretinoin and vehicle. Evaluations included percentage change in lesions, treatment success rate, proportions of patients with ≥50% or ≥80% continuous reduction in lesions, adverse events and cutaneous tolerability. Results: In the overall population, the percentage reductions in inflammatory, non-inflammatory and total lesions and the treatment success rates were significantly greater with Clin-RA compared with clindamycin, tretinoin and vehicle alone (all p<0.01). The percentage reduction in all types of lesion was also significantly greater with Clin-RA in the adolescent subgroup (2915 patients, p<0.002) and in patients with mild/moderate acne (3662 patients, p<0.02) versus comparators. In patients with severe acne (n = 880), the percentage reduction in all lesion types was significantly greater with Clin-RA versus vehicle (p<0.0001). A greater proportion of Clin-RA treated patients had a ≥50% or ≥80% continuous reduction in all types of lesions at week 12 compared with clindamycin, tretinoin and vehicle. Adverse event frequencies in the active and vehicle groups were similar. Baseline-adjusted mean tolerability scores over time were <1 (mild) and similar in all groups. Conclusion: Clin-RA is safe, has superior efficacy to its component monotherapies and should be considered as one of the first-line therapies for mild-to-moderate facial acne.
    European journal of dermatology : EJD. 04/2014;
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    ABSTRACT: Few validated questionnaires are available in French to assess sexual function. The aim of this study was thus to validate a French version of the Female Sexual Function Index (FSFI) in a sample of French women. In this prospective monocentric and cross-sectional study, an already existing French version of the FSFI, was back-translated and compared to the original version. It was then randomly distributed to 800 women attending Gynecology consultation at Nantes University Hospital in April 2012. Various statistical analyzes were used to test the psychometric properties of the French FSFI. 512 questionnaires were completed. Mean FSFI summary score was 25.2. Intraclass correlation coefficients were superior to 0.75 and Cronbach's coefficients superior to 0.8 similarly to the original version. Variance analysis revealed significant differences in summary score between premenopausal and postmenopausal women and according to the marital status. Convergent validity was excellent (100 %) and discriminant validity was satisfactory (89.5 %). The factorial structure corresponded to the original version with six retrieved dimensions. Our study demonstrated similar or adequate psychometric properties of the French version of the FSFI compared to the original English version.
    Quality of Life Research 03/2014; · 2.41 Impact Factor
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    ABSTRACT: Our increased knowledge of normal skin physiology has ushered in a subtle revolution in cosmetic science. Originally designed as preparations to enhance personal appearance by direct application on to the skin, cosmetics have now taken on a new role in dermatology, through the support of the management of many skin disorders. This evolving role of cosmetics in skin care is primarily due to scientific and technological advancements that have changed our understanding of normal skin physiology and how cosmetics modify its appearance both physically and biologically. The vast array of techniques currently available to investigate skin responsivity to multiple stimuli has brought about a new era in cosmetic and dermocosmetic development based on a robust understanding of skin physiology and its varied responses to commonly encountered environmental insults. Most cosmetic research is undertaken on reconstructed skin models crucial in dermatological research, given the strict ban imposed by the European Union on animal testing. In addition, the design and conduct of trials evaluating cosmetics now follow rules comparable to those used in the development and evaluation of pharmaceutical products. Cosmetic research should now aim to ensure all trials adhere to strictly reproducible and scientifically sound methodologies. The objective of this review is to provide an overview of the multidisciplinary scientific approach used in formulating dermocosmetics, and to examine the major advances in dermocosmetic development and assessment, the safety and regulatory guidelines governing their production and the exciting future outlook for these dermocosmetic processes following good practice rules.
    Journal of the European Academy of Dermatology and Venereology 03/2014; · 2.69 Impact Factor

Publication Stats

7k Citations
1,667.50 Total Impact Points

Institutions

  • 1986–2014
    • Centre Hospitalier Universitaire de Nantes
      • Service de dermatologie
      Naoned, Pays de la Loire, France
  • 2013
    • Assistance Publique – Hôpitaux de Paris
      • Département de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
  • 1995–2013
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2012
    • L'Oréal
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire Rouen
      • Service de Dermatologie
      Rouen, Upper Normandy, France
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
    • Charité Universitätsmedizin Berlin
      • Department of Dermatology, Venerology and Allergology
      Berlin, Land Berlin, Germany
  • 2003–2012
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      Lutetia Parisorum, Île-de-France, France
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 1997–2010
    • Hotel Dieu Hospital
      Kingston, Ontario, Canada
  • 2009
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 1995–2009
    • University of Nantes
      Naoned, Pays de la Loire, France
  • 2008
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service de Dermatologie
      Créteil, Ile-de-France, France
    • Cancer Research Center of Lyon
      Lyons, Rhône-Alpes, France
  • 2007
    • Athens State University
      Athens, Alabama, United States
  • 2005
    • Société Française de Cardiologie
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • Institut de Génétique et de Biologie Moléculaire et Cellulaire
      Strasburg, Alsace, France
  • 1987
    • Institut National de la Transfusion Sanguine, Paris
      Lutetia Parisorum, Île-de-France, France