The purpose of the study was to evaluate objective response rate, survival and toxicity of the combination of gemcitabine-docetaxel administered on a biweekly schedule as first-line treatment in advanced/relapsed or metastatic urothelial carcinoma. Treatment consisted of the sequenced administration of gemcitabine 1500 mg/m(2) and docetaxel 60 mg/m(2) (2 h intravenous infusion) on days 1, 14 of a 28-day cycle for 6 months. A total of 33 patients, 22 men and 11 women, were enrolled, aged 41-75 years (median 64 years). The majority of patients had a good performance status (94%; status<2). Thirteen patients had locally advanced disease (39%) and 20 metastasic disease (41%). A total of 178 treatment cycles were administered with a median number of 5.4 cycles for a patients (range 2-8). Toxicity was primarily hematologic with the most frequent grade >2 being neutropenia (11%), with three episodes of febrile neutropenia. Anemia and thrombocytopenia were milder and had a lower incidence. The most frequent nonhematological toxicities were alopecia, followed by asthenia. Cardiac and pulmonary toxicity was minimal. No toxic deaths were recorded during study and follow-up. Overall response rate was 53.1%, including four complete responses (12.5%) and 13 partial responses (40.6%), whereas six patients (18.8%) had disease stabilization. Median time to progression was 10.2 months (95% confidence interval: 5.1-13.7), with a median survival of 14.8 months (95% confidence interval: 9.4-20.2) after an observation of 30 months (range 4-30+). The results of this study suggested that combination therapy with gemcitabine and docetaxel administered twice a week is particularly active and well tolerated as first-line treatment in advanced and/or metastatic urothelial carcinoma. Once data are confirmed in a larger study and longer follow-up, the favorable toxicity profile of this regimen may offer an interesting alternative to the cisplatin-based regimen.

Eribulin maintains its activity out of clinical trials, without unexpected toxicities.

The treatment of early and intermediate stage hepatocellular carcinoma (HCC) is still debated. Surgical treatments are considered to be the only curative procedures available, and only for a minority of patients. Percutaneous ethanol injection (PEI) is an established technique for the ablation of HCC nodules, and shows survival rates similar to those of resection. The efficacy of PEI in patients with biopsy-proven viral cirrhosis and small to intermediate inoperable HCC was evaluated. One hundred twenty-seven patients (85 men, 42 women, mean age 63 years, range 51 to 92 years, 115 hepatitis C virus-positive, 12 hepatitis B virus-positive) were enrolled between January 1993 and December 2002. They all underwent a standard PEI procedure and were prospectively followed-up. Overall median survival rate was 28 months (range six to 112 months). The following parameters were associated with a significantly longer survival: nodule diameter smaller than 30 mm (P=0.0480), the presence of a perinodular boundary (P=0.0008), serum alpha-fetoprotein less than 20 ng/mL (P=0.0104), a Child-Pugh A class score (P<0.0001) or a Cancer of the Liver Italian Program score of 0 (P<0.0001) and the presence or absence of small esophageal varices (P=0.013). The 19 patients with all these favourable characteristics showed an overall median survival of 61 months. An alpha-fetoprotein below 20 ng/mL was associated with significantly longer disease-free survival (P=0.0009). The Child-Pugh and Cancer of the Liver Italian Program scores were effective in predicting prognosis of these patients. In conclusion, PEI still represents a safe and economically sound treatment for HCC.

Depuis 2016 seulement, il est possible d’introduire une action de groupe en matière de discriminations et de cibler celles fondées sur l’âge non seulement dans l’emploi, mais aussi dans l’accès aux biens et services, autrement dit, dans les rapports contractuels du consommateur âgé. Le Défenseur des droits avait déjà pointé une série d’entraves à l’accès aux biens et aux services : prêt bancaire, location de voiture, assurance... À défaut d’une mobilisation du droit par les principaux intéressés, une enquête auprès de ces personnes semble attester d’une combinaison de discriminations directes et indirectes révélatrice de discriminations systémiques fondées sur l’âge. Cette étude souhaite donc éclairer les discriminations auxquelles peuvent être exposés les consommateurs âgés parfois exclus du champ contractuel, quels que soient leurs moyens financiers. Elle vise aussi à présenter l’intérêt relatif de l’action de groupe récente à la fois comme mécanisme de détection des discriminations systémiques empêchant de mobiliser le droit et comme catalyseur d’inclusion. L’étude de ces discriminations se heurte à leur difficile conscientisation et à la faible visibilité des personnes qu’elles visent. Les discriminations fondées sur l’âge peuvent revêtir un caractère systémique empruntant les canaux du numérique pour innerver la société tout entière. C’est le cas des algorithmes utilisés par les établissements de crédit. L’action de groupe pourrait être conçue comme un mécanisme à double détente particulièrement pertinent. Dans sa phase précontentieuse, elle permet la détection et la prévention des discriminations. Le juge est, à cet égard, doté d’un nouveau pouvoir d’injonction de cessation du manquement. Dans sa phase contentieuse, elle permettrait de rationaliser le contentieux des discriminations et de favoriser l’inclusion sociale par un accès mutualisé au droit des consommateurs âgés, représentés par des associations, sous réserve des limites procédurales du droit français.