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 Tous les cancers du rein ne sont pas pareils.

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Denis
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Nombre de messages : 15757
Date d'inscription : 23/02/2005

MessageSujet: Re: Tous les cancers du rein ne sont pas pareils.   Dim 25 Nov 2012 - 16:36

(Nov. 21, 2012) — Kidney tumours may be smarter than we thought. New research has found there are several different ways that kidney tumours can achieve the same result -- namely, grow.

Les cancers du pourraient bien être plus rusés qu'on ne le pense. Une nouvelle recherche a découvert que que les tumeurs rénales se servent de différents moyens pour arriver à leur but : croître.

Scientists have been trying to figure out how different people have kidney tumours with the same histology, or shape, although the genetic changes can vary among individual tumours.

Les scientifiques ont essayé de savoir comment différents personnes peuvent avoir des tumeurs avec la même histologie ou la même forme, même si les changements génétiques peuvent varier selon les tumeurs individuelles.

Solving that puzzle could have implications for the diagnosis and treatment if kidney cancer, which has 35 per cent mortality rate and is becoming more common. Despite advances in early detection and treatment, the mortality rate hasn't changed in decades.

For the first time, researchers at St. Michael's Hospital have looked at multiple different levels of changes at the same time. Dr. George Yousef, a laboratory pathologist, said researchers have looked at three different ways cancer cells can grow and survive:

Pour la première fois, les chercheurs ont regardé à différents niveaux de changements en même temps. Les chercheurs ont observés trois moyens différents avec lesquels les cellules cancéreuses peuvent survivre et croitre.

the tumour can amplify (or replicate) its chromosomes, the packages of DNA and proteins found in cells
the tumour can alter a process that controls the on-off switch for genes needed for cell growth and differentiation, known as methylation
or the tumour can drive gene activation through another gene

1- la tumeur peut amplifier (ou reproduire) ses chromosomes, les paquets de l'ADN et des protéines dans les cellules
2- la tumeur peut modifier un processus qui commande le commutateur de marche-arrêt pour les gènes nécessaires à la croissance et la différenciation cellulaires, processus connu sous le nom de méthylation
3- ou la tumeur peut entraîner l'activation du gène par un autre gène.


Dr. Yousef said they found that looking at all these changes in the same setting simultaneously can provide a much better understanding of tumour behaviour and how the apparently different changes can produce the same results.

Le docteur Yousef a dit qu'ils avaient trouvé qu'en regardant tous ces changements dans la même configuration simultanément cela pouvait fournir une meilleure compréhension du comportement de la tumeur et de la façon dont des changements apparemment différents peuvent produire les mêmes résultats.

His research appears in the journal Cancer Research, one of the leading journals of in the field of cancer.

Using a high resolution microarray there were also able to identify very specific regions of the chromosomes where genetic alterations happen in kidney cancer to a much higher resolution than before. Combining information from chromosomal changes, methylation and gene expression provided a much clearer understanding of the mechanism of kidney cancer development.

En utilisant une puce à haute résolution, il y avait également en mesure d'identifier les régions très spécifiques des chromosomes où se produisent des altérations génétiques dans le cancer du rein à une résolution beaucoup plus élevée que par le passé. En combinant des renseignements provenant des modifications chromosomiques, de la méthylation et de l'expression génique cela a permis de comprendre beaucoup plus clairement le mécanisme de développement d'un cancer du rein.

"Now we look at the mechanism rather than the individual change," Dr. Yousef said. "Regardless of the apparent differences of the tumour, the outcome will be the same. Eventually, we may be able to target treatment based on the 'mechanism' that is affected rather than the individual genes that are changed."

"Maintenant, nous regardons le mécanisme plutôt que le changement individuel», a déclaré le Dr Yousef. "Quelles que soient les différences apparentes de la tumeur, le résultat sera le même. Finalement, nous pouvons être en mesure de cibler le traitement sur la base du« mécanisme »qui est touchée plutôt que sur les gènes individuels qui ont été modifiés."

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MessageSujet: Tous les cancers du rein ne sont pas pareils.   Sam 1 Nov 2008 - 12:16

A study of nearly 1,500 patients treated for kidney cancer at UCLA in the last 15 years shows that an aggressive, tailored treatment approach results in better survival rates and uncovered subsets of kidney cancer that behave differently and need to be treated accordingly.

Une étude sur 1500 patients avec le cancer du sur les derniers 15 ans montre qu'un traitement personnel et agressif résulte en un taux de survie améliorée et met en évidence qu'il y a divers sous-groupe de cancer du qui se comportent différemment et ont besoin de traitement différent.

The one-size-fits-all approach traditionally used in kidney cancer treatment should be changed based on the results of the study, the longest to date to analyze kidney cancer patients and their outcomes, said Dr. Arie Belldegrun, senior author of the study, a professor of urology and a researcher at UCLA's Jonsson Comprehensive Cancer Center.

L'approche "mur-à-mur" des traitements traditionnels ne suffit plus et devrait être changée selon les résultats de cette étude.

"This is the most important work that we've done out of the kidney cancer program at UCLA," Belldegrun said. "We outline the foundation for personalized kidney cancer therapy. We have shown that not all kidney cancer patients are the same, not all localized kidney cancers are the same and not all metastatic kidney cancers are the same."


The study appears in the Nov. 1, 2008 issue of Cancer, the peer-reviewed journal of the American Cancer Society.
The study found that patients with localized kidney cancer, cancer that has not spread to other organs, could have either low, intermediate or high risk cancers based on the chance for recurrence. Patients with cancers that have already spread also fell into similarly different subsets. Some have better outcomes while others may have very aggressive cancers that may not warrant treatment.

Quelques cancers offrent de meilleurs chances de survie alors que certains, même avec un traitement agressif, peuvent entrainer la mort.


"We showed for the first time, using an integrated staging system developed at UCLA, that we can identify which patients with localized disease fall into the low, intermediate and high risk subsets and which patients with metastasized cancers are either low, intermediate or high risk patients," Belldegrun said. "Now we can make treatment decisions based on that."

"Avec un système intégré développé à l'université de Los Angele, nous pouvons identifié lequels patients avec un cancer localisé sont à bas ou à hauts risques, de même que ceux dans un risque intermédiaires et pour les patients avec des métastases aussi nous pouvons dire si le risque est faible ou élevé. Nous pouvons alors prendre des décisions de traitements basé là-dessus."

If a patient with localized cancer is identified as low risk, his five-year survival rate is expected to be 97 percent, while his 10-year survival rate is 92 percent. An intermediate risk patient with localized disease would have a five-year survival rate of 81 percent and a 10-year survival rate of 61 percent. A high risk patient has a five-year survival rate of 62 percent, with a 10-year survival of 41 percent.

Un patient avec un risque faible a un taux de 97% de survie après 5 ans et 92% de survie à 10 ans. etc.

"All of these patients with cancers that have not spread present to their doctors with presumably localized disease and in the past they may have been treated the same way," Belldegrun said. "They need to be treated individually according to their risk levels."

"Tous ces patients auraient traités de façon semblable..."

The study showed that a patient with low-risk, localized kidney cancer could be treated only with surgery and expect an excellent outcome. Such a move would spare the patient from having to undergo radiation or immunotherapy, which result in harsh side effects. However, for a patient with high-risk, localized kidney cancer, surgery would not be enough. Additional therapy such as targeted treatments or immunotherapy should be considered in order to give the patient the best possible outcome.

In metastatic patients, someone with low-risk cancer should get very aggressive treatment, Belldegrun said, because there's a good chance the therapy will help the patient. Those with high-risk, metastatic disease won't get much, if any, benefit from treatment and may want to forego surgery and the toxic therapies.

"Our paper identifies, very precisely, which patients should get which therapies," Belldegrun said.
The study represents 15 years of experience in UCLA's leading-edge kidney cancer program, an interdisciplinary approach to treating cancer that brings together medical oncologists, urologists, surgeons, clinical trials experts and scientists under one roof, a concept that was first conceptualized at UCLA. The study analyzed the first 1,492 patients treated in the program and "demonstrated that outstanding results can be achieved using this approach," Belldegrun said.

About 25 percent of the patients with metastatic kidney cancer achieved long-term responses – five to 15 year survivals – from their therapy, Belldegrun said. Less than 5 percent of metastatic kidney cancer patient typically achieve long term survivals or a cure when treated with conventional treatments.

"This is by far the best survival data in such a difficult group of patients," Belldegrun said. "This can be achieved today only in kidney cancer centers of excellence like we are operating at UCLA, where we have all the expertise at hand, the best scientists, clinicians and surgeons working together."

The results of the study come as new targeted therapies are being introduced specifically for kidney cancer. The U.S. Food & Drug Administration has recently approved three such drugs. Belldegrun said the survival rates detailed in their paper should be used as a benchmark to which these new therapies should be compared.

"While the field of kidney cancer is undergoing dramatic changes it is as yet still unclear how these changes are affecting patient outcome," the study states. "A critical assessment of the potential improvement in the new treatment era necessitates a comparison to a known benchmark. We present long-term, single institution data to provide a thorough understanding of the results that have been achieved until now using a consistent, aggressive approach for localized and metastatic disease. For future patient care, it will be important to select patients that will do best using existing therapies, and those who should be treated using the newly approved treatments."
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