Cancer prognosis has steadily improved over recent decades. In 2025, approximately 85% of patients with cancer were in remission. The growing complexity of oncologic treatments has led to substantial gains in progression-free survival, albeit at the cost of increased cardiotoxic risk. Cardiotoxicity most commonly manifests as heart failure or left ventricular dysfunction. Consequently, the cardiovascular mortality of individuals treated for childhood cancers, as well as of older women treated for breast cancer, now equals or even exceeds oncologic mortality.In response, the European Society of Cardiology has issued its first cardio-oncology guidelines, establishing precise thresholds for left ventricular ejection fraction, longitudinal function (as assessed by echocardiographic strain parameters), and selected cardiac biomarkers. Within this framework, it is crucial to develop robust strategies to predict, enable early detection of, and ideally prevent treatment-related adverse cardiac effects. Rigorous control of traditional cardiovascular risk factors remains the cornerstone of preventing oncology-treatment-induced cardiotoxicity.

New therapeutic options for gynecological cancers (in particular, targeted therapies and immunotherapies) are associated with potential cardiovascular toxicities that oncologists should be able to identify, detect and manage together with a cardiologist. The first step consists of evaluating the patient's individual cardiovascular risk, regardless of planned oncologic treatment, to determine whether this treatment can be initiated immediately or if cardiological advice is required. In a second step, the risk of cardiovascular toxicity of the selected treatment must be assessed, considering its intrinsic risk and the patient's comorbidities. Once treatment has started, appropriate monitoring should be implemented during administration, and after discontinuation. Beyond general recommendations, specific situations are detailed for initial workup and surveillance relating to most common protocols of chemotherapy, immunotherapy, targeted therapy and associations used in gynecological oncology. If cardiotoxicity occurs (hypertension, QT interval increase, left ventricular dysfunction, troponin increase, myocarditis), the oncologist must be aware of the principles of management, and distinguish between what he can manage on his own and what requires referring to specialists. Prior to rechallenge after cardiotoxicity, multidisciplinary discussion is mandatory to assess the patient's benefit/risk ratio.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and significantly improved survival in many tumour types. However, blocking the immune system's inhibitory signaling pathways can trigger an excessive immune response against the body's own tissues, leading to immune-related adverse events (irAEs). These can potentially affect any organ system and represent a significant clinical challenge. This article provides a practical overview of irAEs management, with a particular focus on neurological complications. It presents evidence-based strategies for prevention, diagnosis and treatment, and discusses decision criteria for resuming ICI treatment after an irAE.

Although immune-mediated colitis is well known and is one of the most common toxicities of Immune Checkpoint Inhibitors (ICIs), the toxicity of these agents to the upper digestive tract is largely unknown and its incidence is probably underestimated. It can affect the stomach and/or the duodenum, and much more rarely the esophagus. Involvement of several segments is common, as is the association with colitis and possibly extra-digestive toxicity(ies). Severity is extremely variable, but severe forms are possible, particularly due to hydro-electrolytic and nutritional repercussions, possible haemorrhagic complications, and much more rarely, a risk of perforation. Many differential diagnoses must be considered. Therapeutic modalities are partly modeled on those of colitis, and the choices must be discussed and validated in multidisciplinary meetings, taking into account the entire "spectrum" of toxicity. We propose a review of the data available in the literature concerning the toxicity of ICIs on the upper digestive tract, illustrated by a few cases from our center.

The harmonization workshops of the leukemia committee of the Société française des cancers de l'enfant (SFCE) aim to establish practical recommendations based on the one hand, on data from the literature and international recommendations and, on the other hand, by consensus in the absence of formally proven data. Adolescent pubescent girls and young adults undergoing intensive chemotherapy treatment may present with heavy uterine bleeding (HUB). Data collected from 25 French centers showed that there was considerable heterogeneity in the management of HUB either in prophylaxis or curative strategy. Analysis of the literature showed that, given the incidence of spontaneous amenorrhea during chemotherapy treatment, there is no indication for systematic prophylaxis of HUB in patients treated for leukemia. In case of proven HUB, non-hormonal treatment and hormonal treatment can be introduced as a matter of urgency. For secondary prophylaxis, various hormonal treatments aiming at achieving prophylactic amenorrhea may be discussed.

Therapeutics used in cancer treatment can cause vestibular ototoxicity, which is particularly challenging to detect due to the frequent occurrence of nausea and vomiting in patients experiencing significant fatigue and stress. An appropriate diagnosis enables optimal symptom correction, reduces the risk of falls, and improves quality of life.

Immune checkpoint inhibitors are now an essential therapy for lung cancer. These monoclonal antibodies are nevertheless responsible for immune-related adverse events. With particular regards for patients with previous autoimmune disease, less is known about the efficacy and safety of immune checkpoint inhibitors, but also about the consequences of steroids or other specific therapies. The aim of this article is to synthesize available data in the literature on immune checkpoint inhibitors experience in patients with both lung cancer and autoimmune disease.

This review aims to evaluate the incidence, clinical impact, and available therapeutic options for the management of gynecomastia induced by hormonal therapy, particularly in the era of androgen receptor pathway inhibitors, in patients with prostate cancer. We analysed data from clinical trials evaluating the incidence of gynecomastia under androgen receptor pathway inhibitors and the efficacy of both prophylactic and curative strategies, primarily tamoxifen and male breast radiotherapy, in patients receiving bicalutamide. Androgen receptor pathway inhibitors monotherapy is associated with high rates of gynecomastia (34 to 55 %), whereas combining androgen receptor pathway inhibitors with chemical castration significantly reduces this risk. Prophylactic tamoxifen significantly decreases gynecomastia incidence (down to 10 % versus 73 % without treatment) with good overall tolerance; prophylactic breast radiotherapy also shows efficacy. In the curative setting, tamoxifen appears more effective than radiotherapy, while surgery remains an invasive fallback option. However, extrapolating results obtained with bicalutamide to second-generation androgen receptor pathway inhibitors remains uncertain due to pharmacological and clinical differences. Gynecomastia could become a major complication of androgen receptor pathway inhibitors monotherapy. To date, tamoxifen and prophylactic breast radiotherapy are the most validated strategies, with the former appearing more effective. Further studies are needed to confirm their specific efficacy and safety in patients treated with androgen receptor pathway inhibitors.

Breast cancer is the most common cancer among women of childbearing age. Despite potentially gonadotoxic treatments, fertility following breast cancer treatment remains satisfactory. Oncofertility has advanced, and an increasing number of patients benefit from oocyte or embryo cryopreservation techniques. Nevertheless, the majority of pregnancies occur spontaneously. Pregnancy does not increase the risk of recurrence, nor does it decrease the overall survival of women, regardless of nodal status or hormone receptor status. Obstetrically, women treated for breast cancer achieve as many live births as the general population, despite an increased incidence of obstetric complications. Breastfeeding is possible and does not appear to affect survival or increase the risk of recurrence. Thus, the most recent data are reassuring regarding the possibility and safety of pregnancy after breast cancer. However, questions remain concerning the management of treatments in the context of a desire for pregnancy. The benefit of combining GnRH agonists with chemotherapy to improve pregnancy chances is being questioned. The interruption period for tamoxifen in an adjuvant setting needs clarification. Finally, new data are required for patients treated with immunotherapy, PARP inhibitors, or cell cycle cyclin inhibitors.

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of solid tumors. However, they can induce immune-related adverse effects (irAEs) that can affect any organ. These irAEs are different from the side effects of traditional oncological treatments and require specific management. Given the increasing use of ICI, first-line care will increasingly need to manage these irAEs. This article aims to assist in the implementation of the guidelines for managing irAEs, with a particular focus on aspects related to first-line care.

The rapid evolution of oncological treatments in patients with lung cancer has led to the emergence of targeted therapies (TT), immune checkpoint inhibitors (ICI), and antibody-drug conjugates (ADC), which are significantly transforming the management of cancer. However, these advances are associated with complex adverse effects that affect multiple organ systems. This review explores the etiopathogenic mechanisms underlying therapy-related toxicity and describes the major adverse effects: immune-related toxicity of ICIs, "on-target" and "off-target" effects of TTs, and systemic toxicity of ADCs. Systemic toxicities are discussed, with a focus on monitoring strategies and management approaches. A multidisciplinary approach is critical to optimize therapeutic efficacy while minimizing toxicity.

The incidence of ototoxicity in cancer patients is difficult to quantify due to confounding factors such as age, multi-medication, noise exposure and the frequent absence of pre-treatment hearing assessment. Around 40% of cancer survivors report a decline in hearing since their treatment, suggesting that ototoxicity associated with cancer treatment is underestimated. Our understanding of the pathophysiological mechanisms of systemic ototoxicity is essentially based on that of cisplatin. The recent discovery of auditory neuropathies and hidden hearing loss could explain why other anticancer drugs are potentially involved in this toxicity. We describe ways of diagnosing damage to auditory function that should enable such damage to be identified in the future. Strategies for mitigating ototoxicity include, in the case of cisplatin, discussing the indication with the patient, modulating the dose, being vigilant about other ototoxic agents and setting up a network with otologists. Prosthetic solutions, such as hearing aids and cochlear implants, should be considered for early rehabilitation of hearing function in order to reduce their impact on survival and quality of life.

New anticancer strategies increasingly rely on targeted therapies, which maximize anticancer activity while reducing toxicity to healthy cells. These modern anticancer therapies (MATs) mainly include immune checkpoint inhibitors (ICIs), antibody drug conjugates (ADCs) and targeted anticancer therapies (TATs) which inhibit signal transduction pathways. These new molecules are associated with a wide range of ocular adverse events (OAEs), of varying severity: from ocular surface irritation to irreversible vision loss. ICIs can trigger autoimmune responses in all eye tissues. ADCs mainly cause ocular surface toxicity, the most specific of which being microcyst-like epithelial changes (MECs). TATs cause a wide range of OAEs, depending on their class. Oncologists and ophthalmologists will be increasingly confronted to these OAEs - some of which are still poorly characterized - as the number of prescribed NTAs increases. Close collaboration between specialists is essential for their early identification and management, which helps reduce visual and quality of life consequences for these patients. This review addresses the clinical characteristics of the main OAEs linked to MATs, the description of the suspected underlying pathophysiological mechanisms and the key points of their management.

This article reports on new findings on integrative and complementary medicine published in 2024. The implementation of guidelines for the management of pain in cancer patients is discussed. Then, a literature review is presented, that aims to clarify the role of complementary approaches in the management of chemotherapy-induced nausea and vomiting and provides a concrete example of how recommendations are established. Finally, a meta-analysis focusing on the efficacy of Echinacea in the treatment of upper respiratory tract infections is summarized. These articles illustrate the complexity of the path from science to practice and underscore the importance of identifiable centers of reference to support the dissemination of knowledge to health care professionals and promote broad patient access to well-coordinated therapies.

Children and adolescents who are being treated or have been treated for acute leukemia have a secondary immunodeficiency linked to chemotherapy, resulting in an increased risk of infections. Some of which can be prevented by vaccination but its effectiveness is not optimal during chemotherapy. Upon cessation of chemotherapy, the time required for immune reconstitution varies from three months to more than a year, depending on lymphocyte subpopulations, the patient's age, and the intensity of the treatment received. Although they may have regained their immune functions, studies show that most patients have lost part of their vaccine-induced protection post-chemotherapy and require booster doses of vaccines. Most practitioners agree on the importance of vaccinating or revaccinating these children, but practices are heterogeneous among pediatric hematologist-oncologists in France. Based on a practice study and a recent review of the literature, this work aims to propose new French recommendations for the vaccination strategy to be adopted for children and adolescents treated or recently treated for acute leukemia, excluding allogeneic transplant recipients, in 2024. These recommendations specifically include the vaccination protocols for human papillomavirus and meningococcal infections but do not address the COVID-19 vaccination, as its guidelines are subject to rapid changes.

Cancer treatments have been dramatically modified by the introduction and the development of immunological checkpoint inhibitors (ICI). These treatments have many side effects, including acute kidney injury (AKI). Their combination with other treatments makes the diagnosis complex. To provide guidance to physicians treating these patients, the FITC and the SFNDT have developed a set of management guidelines covering pre-treatment assessment, diagnosis of the different types of damage observed, and management of acute interstitial nephritis secondary to ICI. Collaboration between oncologists and nephrologists is mandatory. The development of onconephrology is helping to improve knowledge and identify treatment pathways. The key elements of the diagnostic process are presented. The role of renal biopsy is discussed, as it appears to be underused in relation to the expected benefits. Renal biopsy allows ICI to be continued if AKI is not related to AKI. Treatment based on glucocorticoid therapy is recommended, with regimens depending on the severity of the disease and the renal response to glucocorticoid therapy. Alternative treatments for patients resistant to corticosteroids are discussed, but strong data are lacking. Rechallenge should be discussed since it seems to be associated with a good renal prognosis.

Immunological checkpoint inhibitors are now part of the oncological therapeutic arsenal in many solid cancers and malignant blood diseases, at the cost of immuno-mediated toxicities, of which dermatological disorders are among the most frequent. The most common, following treatment with anti-PD1 or anti-CTLA4, are maculopapular erythema, pruritus, vitiligo, or lichenoid lesions, but other more atypical conditions may lead to the internist being called upon. Here, we present a case series of these less common dermatological manifestations including fasciitis, dermatomyositis, scleroderma, granulomatosis and immune-induced vasculitis. Some manifestations appear similar to the primary forms or seem to correspond to paraneoplastic syndromes, but some diagnostic and therapeutic particularities are specific to ICI toxicity that the internist must be aware of.

The covalent Bruton tyrosine kinase inhibitors (iBTKs) have profoundly transformed the management of B-cell lymphoid malignancies, particularly chronic lymphocytic leukemia (CLL). These targeted therapies, with ibrutinib as the pioneer, have paved the way for significant improvement in the prognosis of many patients. With second-generation iBTKs such as acalabrutinib and zanubrutinib, the therapeutic landscape has expanded, offering potential new options for patients with CLL. This review focuses on the cardiovascular adverse effects associated with these treatments. It delves into the underlying pathophysiological mechanisms of these effects, highlighting the complex interactions between these molecules and the cardiovascular system. Additionally, it examines the frequency of adverse effects according to the type of iBTK, drawing on data from clinical trials and real-world clinical practice. Finally, the importance of close cardio-oncological monitoring is emphasized, with essential collaboration between hematologists and cardiologists. Strategies for screening and managing cardiovascular adverse effects are also discussed, emphasizing the need for a proactive approach in managing these complications. Experts propose a pragmatic follow-up of these patients, through a central illustration and a figure adapted from European cardio-oncology guidelines, to simplify hematologists' practice.

A large body of literature highlights the importance of energy metabolism in the response of haematological malignancies to therapy. In this review, we are particularly interested in acute myeloid leukaemia, where mitochondrial metabolism plays a key role in response and resistance to treatment. We describe the new concept of mitohormesis in the response to therapy-induced stress and in the initiation of relapse in this disease.

Therapeutic options for breast cancer have recently been enriched by new antibody-drug conjugates (ADC), which are now being utilized across all known molecular subtypes. ADCs represent a groundbreaking class of therapies that combine a cytotoxic agent with a monoclonal antibody via a combination molecule (linker). The primary objective is to selectively deliver chemotherapy to cells expressing the target antigen, thereby enhancing the therapeutic index. Trastuzumab-emtansine marked the pioneering use of this approach for HER2-overexpressed breast cancer. More recently, trastuzumab-deruxtecan and sacituzumab-govitecan have demonstrated efficacy in progression-free survival and overall survival in HER2-overexpressed and HER2-low breast cancer for the former, and HER2-non-overexpressed (including HER-low) for the latter. Numerous other ADCs are currently under development in breast cancer. While ADCs were initially designed to widen the therapeutic index and mitigate toxicities, managing ADC-related adverse events in the clinical setting remains a challenge. This review article aims to provide an overview of the toxicity profiles of these drugs already in current clinical practice or under development, drawing from results observed in various studies.