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The Fourth Biennial Cancer Meeting in Monaco

Department of Hematology, Taunton and Somerset Hospital, Taunton, Somerset UK

Correspondence: Stephen A. Johnson, M.D., Department of Hematology, Taunton and Somerset Hospital, Musgrove Park, Taunton, Taunton, Somerset TA1 5DA, UK. Telephone: 44-1823-342269; Fax: 44-1823-271023.

Held in the comfortable surroundings of Monte Carlo in January under clear skies and an impressive winter sun, the Fourth Biennale Monegasque de Cancerologie held in Monaco, January 26-29, 2000, is an important meeting for francophone oncologists. As such, although it is obliged to address some of the same problems which preoccupy oncologists at meetings held in English, it can also bring a different slant to the issues of the day and is capable of taking a stand on particular problems of management which reflects the strong structure of collaborative trials groups which exists in France.

An early session reviewing the activity of the therapeutic antibody Herceptin started with a review by J.P. Bellocq (Strasbourg) on the biology of c-erbB2 (HER-2) in the breast and the available diagnostic methods for establishing its over-expression; in agreement with other pathologists he felt that immunohistochemistry was prone to throwing up the occasional false positive result, and that fluorescence in situ hybridization was useful for clarifying the status of tumors with weak staining. Marc Spielmann (Villejuif) reviewed the therapeutic trials in breast cancer from the initial evidence of single-agent efficacy to the large randomized trials in which enhanced response rates were obtained in combination with paclitaxel but not anthracyclines. In vitro data indicating synergy between herceptin and platinum compounds is to be explored in a combination trial in breast cancer despite the relatively poor results of platins reported as single-agents for that indication. Concerns were raised about the incidence of cardiotoxicity with herceptin and the risks of combining it with anthracyclines by H. Roché (Toulouse). Michel Marty (Paris) reviewed the potential of herceptin for indications other than breast cancer; he reported that HER-2 overexpression in ovarian carcinoma was associated with a poor prognosis and outlined a proposed study of combination therapy with paclitaxel and carboplatin in advanced disease.

In a further session on the natural history of breast cancer, M. Hery (Monaco) presented the findings of long-term follow-up of a large cohort (2,683 women) with early-stage breast cancer drawn from several French centers. Established risk factors for early spread were tumor size (>2 cm) and high Scarff, Bloom, and Richardson grades, but the impact of these diminished beyond four years from diagnosis; nonetheless, this represented a simple means of grading patients at presentation according to their subsequent risk of metastatic spread. Continuing the theme of prognostic factors, J. Bonneterre (Lille) explored the complex area of possible interactions between abnormalities of p53 and over-expression of HER-2, but the existing data could not provide a clear conclusion regarding their possible impact on response to chemotherapy. R. Salmon (Paris) reported his considerable surgical experience of the important issue of the sentinel axillary lymph node and showed the value of methylene blue or technetium as guides to the process of node-sampling and dissection.

In two major sessions of the conference, reviews of the treatment of early-stage colorectal cancer by J.F. Seitz (Marseille) and advanced disease by A. de Gramont (Paris) were followed by an open meeting of the Groupe d'Etude et de Recherche en Cancréologie Onco-Radiothérapic (GERCOR) collaborative group. This is an area where major contributions have been made by French oncologists, with the careful sequential evaluation of fluorouracil/folinic acid infusional schedules leading to the incorporation of irinotecan (FOLFIRI) or oxaliplatin (FOLFOX) with improved efficacy; the current studies are exploring the optimal sequence and duration of the newer combination. Other ongoing GERCOR studies encompass a dose-escalation study of two-weekly gemcitabine with fixed dose cisplatin in advanced non-small cell lung cancer (NSCLC) reported by P. Terrioux (Paris) which was still recruiting; he also outlined a proposal for a similar study of gemcitabine with docetaxel. J.L. Wendling (Toulon) reported the group's experience with a combination of vinorelbine and mitoxantrone (NONA) in hormone-refractory prostate cancer, a study which was also still accruing patients; he felt that this schedule might have a role as adjuvant therapy in high-risk patients. Breast cancer trials exploring drug dose optimization and schedule of taxanes were described by J. Gligorov (Paris) with interesting pharmacoeconomic and quality-of-life data under investigation.

In a session reporting the results of recent studies with vinorelbine (Navelbine^®), S. Oudard (Paris) reported a study of single-agent vinorelbine in hormone-resistant prostate cancer in 47 patients, 49% of whom achieved a partial response or stabilization and 26% demonstrated clinical benefit; a phase III trial comparing vinorelbine plus hormonotherapy versus hormonotherapy is ongoing. In the clinical setting of relapsed/refractory myeloma J.L. Harrousseau (Nantes) reviewed trials of both vinorelbine as a single agent and also in combination with dexamethasone in which a response rate of 49% was achieved; a phase III study comparing dexamethasone alone or with vinorelbine is currently ongoing. Concomitant chemoradiotherapy of esophageal carcinoma was presented by A. Adenis (Lille) who had undertaken a dose-escalation study which established that vinorelbine 20 mg/m²/week could be combined with radiotherapy given at 50 Gy/25 fractions followed by a 14 Gy boost to the tumor bed. Safety data for oral vinorelbine in the treatment of NSCLC were presented by A. Depierre (Besançon) who has shown that an initial dose of 60 mg/m²/week could be easily escalated to 80 mg/m²/week in the majority of patients with few problems caused by toxicity.

The subject of concomitant chemoradiotherapy for NSCLC was also covered. Ph. Colin (Reims) reported a phase I study integrating paclitaxel with radiotherapy which had resulted in serious esophagitis and was proposing to add carboplatin while reducing the dose of paclitaxel; this GERCOR study would then randomize responders to the possibility of four cycles of consolidation chemotherapy. Broader reviews of the place of chemotherapy and future directions in the treatment of NSCLC were supplied by M. Perol (Lyon) and J.F. Morere (Paris).

In a final major session on breast cancer, controversies about the role of neoadjuvant and adjuvant treatments were explored. P. Fumoleau (Nantes) presented the results of a randomized study comparing neoadjuvant, doxorubicin-paclitaxel and doxorubicin-cyclophosphamide; the doxorubicin-cyclophosphamide arm was closed early because the rate of histological complete remission (pathological complete response [pCR]) was only 10%, while the other combination produced pCRs in 23% with 58% of patients benefiting from conservative surgery. P. Pouillart (Paris) reviewed the St. Gallen's Consensus Conference recommendations, and although accepting the general principles, found it lacking in its appreciation of the benefits of neoadjuvant treatment, a point of view which was largely supported by M. Namer (Nice).

To summarize, the conference took the opportunity to look at a number of major problems in oncology squarely in the eye. There are diseases which are difficult to treat, but in which some glimmers of hope can be seen, such as hormone-refractory prostate cancer, while cautious progress is being made in others such as colorectal cancer with the help of relatively newly introduced active agents. The place of some more established agents seems to be shifting, and the introduction of monoclonal antibody therapy to the treatment of breast cancer raises new problems related to its possible synergy with cytotoxic drugs. The role of high-dose therapy was not considered as a topic and alongside the sessions reporting the results of treatment trials, there was a major program covering aspects of psychological support for the cancer patient. And all presented with characteristic gallic flair.

Received February 25, 2000; accepted for publication April 21, 2000.

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