Sébastien Lamy

Background: Due to the increasing life expectancy of patients with cancer, palliative care services are increasingly solicited to provide follow-up for individuals living at home. The implementation of teleconsultations represents a potential solution to extend access to palliative care follow-up to a larger number of patients. The aim of this study is to demonstrate the a priori acceptance of teleconsultations among all patients admitted to palliative care, as well as the feasibility of their implementation. We therefore initially explored whether a specific patient profile might limit acceptance or feasibility of teleconsultations (e.g., older patients, patients unfamiliar with digital technologies, gender differences, social status, economic status, or place of residence), and we identified patients’ expectations and concerns regarding teleconsultation. The secondary objective is to describe the contribution of monthly remote consultations (telemedicine), conducted in parallel with quarterly day-hospital follow-up by a palliative care team, for patients with cancer, in anticipating potential deterioration in their overall clinical condition. Methods: We included 36 patients at the time of their first admission to the palliative care day hospital. Upon enrollment, participants completed a questionnaire on demographic characteristics as well as their expectations and/or reluctance regarding teleconsultations. Patients were scheduled to receive monthly teleconsultations (at 1 and 2 months), followed by an in-person visit at 3 months. Results: With regard to feasibility and acceptability, our findings indicate that age, sex, socioeconomic status, or underlying disease did not influence patient adherence or the successful conduct of teleconsultations. Patients expressed few negative preconceptions regarding their inclusion in the study. Concerning the clinical contribution of monthly consultations, interviewed patients reported a perceived benefit of monthly teleconsultations for both their psychological support and clinical management, and expressed a desire to continue monthly follow-up by teleconsultation beyond the three-month study period. Conclusions: In the absence of the possibility of monthly in-person consultations, we highlight the relevance of developing teleconsultations for patients receiving palliative oncological care, regardless of their profile.

Literature shows heterogeneous impact of recommendations to deal with sars-cov-2 infection on AML management during the 2020 Covid-19 pandemic. Available French data only rely on monocentric observations or simulations. From the DATAML cohort, including all AML patients cared for in the centers of South-West France, we compared the characteristics of patients diagnosed in two periods: 2020 and 2015–2019. We use time series approach to describe the monthly proportion of patients with extreme values on hemoglobin, white blood cells, platelets, and blasts counts, as well as early deaths. We found a slight impact of the first lockdown on hemoglobin and platelets, with statistical significance reached only for platelets distribution gap between the two periods. Similar but less marked patterns were found for WBC and blood blasts. These did not translate in terms of early deaths, which was considered to be likely due to a favorable local conjuncture associating a moderate incidence of sars-cov-2 and the absence of bed closing in oncohematology or ICU dedicated to hematology in any centers providing intensive care for AML patients. Yet, our results might still be seen as an insight of what would have happened in less favorable contexts.

The objective of the present study is to evaluate the impact of remote consultations (telemedicine) conducted on a monthly basis, in conjunction with quarterly inpatient follow-ups conducted by a team specialising in palliative care for cancer patients, in terms of anticipating potential deterioration in patients’ general condition and enhancing their quality of life. The study also investigates whether there is a specific profile of patients who could benefit from teleconsultation and identifies patients’ expectations and concerns regarding teleconsultation. The study enrolled 36 patients on their initial admission to a palliative care day hospital (HDJ), and they completed a questionnaire regarding their demographics, expectations, and reservations concerning teleconsultation. Patients were then scheduled for two monthly teleconsultations and were advised to return to the HDJ at D = 3 months. However, only 13 out of the 36 patients enrolled were able to benefit from the two teleconsultations and return to the HDJ after 3 months. This finding underscores the critical issue of patients being referred to the mobile palliative care team at a late stage. Our study revealed that factors such as age, gender, socio-economic status, and pathology did not influence patient compliance or the efficacy of the teleconsultations. The study emphasised the benefits of monthly teleconsultations for the clinical and psychological management of patients, highlighting that patients had minimal negative preconceptions upon enrolment and expressed a strong desire to continue these monthly consultations after the initial 3-month period. The findings underscore the significance of leveraging teleconsultations for patients receiving palliative care in oncology, particularly in scenarios where face-to-face consultations are not feasible. Telemedicine holds immense potential to enhance the monitoring of a larger patient population, thereby promoting greater equity in healthcare delivery.

We studied both the independent and combined effects of the places of biopsy and treatment on the treatment time interval based on a population‐based study. We analysed the proportion of patients having a treatment time interval higher than the EUSOMA recommendation of 6 weeks, as a function of the number and the type of care centres the patients attended, from a French population‐based regional cohort of women treated in 2015 for an incident invasive non‐metastatic cancer (n = 505). About 33% [95% CI: 27; 38] of patients had a treatment time interval higher than 6 weeks. About 48% of the patients underwent their biopsy and their initial treatment in the different centres. Results from multivariable analyses supported the impact of the type and number of centres attended on the proportion of time intervals over 6 weeks. This proportion was higher among patients with biopsy and treatment in different centres and among patients treated in a university hospital. We pointed out the independent impact of the type and the number of care centres the patients attended, from biopsy to first treatment, on the treatment time interval, which is a well‐known prognosis factor.

Human cancers possess striking ability to develop resistance to Standard of Care (SoC) designed to target specific hallmarks of cancer. This capability to develop resistance is in part due to cancer cell’s ability to activate alternative pathways and modulate tumor microenvironment to enhance cell survival, evade cell death and immunosurveillance. One such mechanism of developing resistance to SoC is the activation of the NOTCH pathway. NOTCH signaling is a developmental pathway which is known to be activated in several human cancers as a key oncogenic hit. In addition to its role as an oncogenic driver, activation of NOTCH is also known to induce resistance to several anti-cancer therapeutics in breast cancer and colorectal cancer. NOTCH signaling is known to cooperate with parallel oncogenic signals to impede activity of several drugs as a single agent. Previous agents targeting the NOTCH pathway upstream of the transcription complex were halted early in clinical development due to dose-limiting toxicities.Here we report activity of a novel first-in-class clinical stage CSL-NICD inhibitor in a panel of cell lines, xenograft and PDX models of human cancers in combination with several chemo and targeted therapies. Guided by in vitro and in vivo studies pre-clinical studies, CB-103 is currently being investigated in clinical trials as a single agent and in combination with SoC. Preliminary pre-clinical and clinical data shows desirable safety and efficacy profile of CB-103 enabling clinical development in combination with several therapeutic agents. Citation Format: Michele Vigolo, Charlotte Urech, Sebastien Lamy, Samarpan Majumder, Lucio Miele, Rajwinder Lehal. Development of a first-in-class notch transcription factor inhibitor CB-103 to overcome resistance to chemotherapy and targeted therapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 408.