Publication of april  2025

  • Entre savoir médical et conscience sociale

 

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Oncologie

The ongoing revolution in oncology for the benefit of patients

Recent developments in the treatment of cancer patients have been driven by major technological and therapeutic advances. First, precision medicine has emerged to detect and target genetic and molecular abnormalities. Thanks to the sequencing of a patient’s tumor, it is now possible to personalize treatment according to the patient’s profile and tumor. This approach has enabled the development of targeted therapies that reduce adverse effects and improve clinical efficacy. In 2024, further significant advances have been achieved, including the emergence of new forms of hormone therapy, which make it possible to further delay the use of conventional chemotherapy in certain patients. 

Second, and in parallel, immunotherapy via immune checkpoint blockade, for example with anti-PD-1/L1 antibodies, has taken a central place in the oncologist’s treatment armamentarium. These antibodies have shown spectacular results in melanoma, lung and kidney cancers, and gynecological malignancies. There is talk of curing patients with metastatic disease with the 10-year hindsight of the first clinical studies in cutaneous melanoma. New indications for anti-PD-1/L1 antibodies and new molecules, such as anti-LAG3 antibodies, were approved in 2024. 

Another new therapeutic advance is the advent of antibody-drug conjugates (ADC). This approach combines the specificity of a monoclonal antibody targeting a protein on the surface of tumor cells with the efficacy of a potent chemotherapeutic agent that is often toxic at high doses, but is delivered more selectively with this combination. A growing number of new ADCs are significantly improving patient prognosis, but at the cost of new toxicities. 

These treatment strategies are combined with increasingly sophisticated imaging modalities, sometimes with therapeutic intent. Radioligand therapy is a good example of this. It combines a ligand for a protein receptor overexpressed by tumor cells with a beta radiation-emitting radioisotope. 117Lu-PSMA is a radioligand that targets PSMA, which is primarily overexpressed on prostate cancer cells. It has been successfully used in prostate cancer.

All these new therapies not only allow for more precise and less invasive treatment, but also increase patients’ chances of long-term survival. However, these advances also pose new challenges, such as the emergence of resistance, the sequential combination of these therapies, and the need for careful monitoring of long-term effects, driving ongoing research to further refine and personalize oncology treatments.

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Endocrinologie et Nutrition

Thyroid-associated orbitopathy, review of the literature

Thyroid-associated orbitopathy is the most common extra-thyroid manifestation of Graves’ disease. It affects the orbital and peri-orbital tissues, leading to signs and symptoms such as eyelid edema, exophthalmos, and diplopia. The prevalence varies, affecting approximately 25 to 50% of patients with Graves’ disease. The pathogenesis of thyroid orbitopathy involves, among other factors, autoantibodies directed against TSH receptors present on orbital fibroblasts. Activation of these orbital fibroblasts results in the production of pro-inflammatory cytokines and glycosaminoglycans, causing inflammation and proliferation of orbital connective tissues, as well as adipogenesis. Treatments for orbitopathy in its active phase include general measures such as symptomatic ophthalmologic treatment (artificial tears, sun protection, headboard elevation), rapid and sustained restoration of euthyroidism, and smoking cessation. Depending on the severity, selenium is used for mild cases, while anti-inflammatory and immunosuppressive treatments are used for moderate to severe cases (sometimes with orbital radiotherapy). Decompression surgery is considered for forms that threaten visual prognosis. Despite recent therapeutic advances, the management of thyroid orbitopathy remains complex and requires a multidisciplinary approach. Future research is focused on understanding the underlying immune mechanisms and developing more targeted and effective treatments.

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STOPP/START.v2

The tool STOPP / START.v2 allows evaluation of drug treatments prescribed to patients age 65 and older.

 

This tool, designed for all care settings, stimulates thinking and challenging medication taken by patients, especially drugs forcardiovascular and nervous system.

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