Oral adjuvant hormone therapy for early breast cancer, despite its proven importance in terms of survival and prevention of recurrence, does not fall within the scope of clinical pharmacy programs set up for oral anticancer drugs, even though issues of therapeutic adherence have been clearly identified. The aim of our study was to explore the perception of healthcare professionals regarding the prescription and dispensing of this hormone therapy, in order to identify the risks for these patients and determine the clinical pharmacy actions that could address these risks.

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.

Pembrolizumab, a humanized monoclonal antibody targeting PD-1 (programmed cell death protein 1), is employed for various cancers but can induce immune-related adverse events (irAEs) resembling autoimmune or inflammatory conditions. We present the case of a 44-year-old female with lung cancer treated with pembrolizumab who developed lichen sclerosus (LS). Cases of LS related to immune checkpoint inhibitors (ICIs) have been documented, primarily in women. High-potency topical steroids achieve favorable outcomes without immunotherapy discontinuation. Monitoring the development of malignancies is essential, as LS patients face a high-risk of developping squamous cell carcinoma.

Drug-induced immune thrombocytopenia (DIIT) is a rare cause of immune thrombocytopenia, characterized by the formation of drug-dependent antiplatelet antibodies. DIIT can lead to life-threatening hemorrhage. The diagnosis is difficult, relying on the detection of antiplatelet antibodies in patient's serum exclusively in the presence of the implicated drug. The gold standard test is the monoclonal antibody immobilization of platelet antigens (MAIPA), although other techniques (flow cytometry and Luminex®) can be used.

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.

Lung cancer is a common disease with a high mortality rate. It is often diagnosed at an advanced stage, with a median survival of 12 to 16 months. Immune checkpoint inhibitors are part of the first-line therapeutic armoury in metastatic stages. They have been shown to improve overall survival, including in patients aged 64 to 75, but the results are less clear in older patients, who are underrepresented in clinical trials. Although the management of adverse events associated with these treatments is now well protocolized, the accumulation of toxicities, even low-grade toxicities, can have an adverse impact on the quality of life of the most frail elderly patients. Geriatric assessment is essential for adapting treatments and anticipating adverse effects.

Multiple myeloma (MM) is the 2nd most common haematological malignancy in France, and its treatment has been improved in recent years by the arrival of new therapies such as CAR-T cells and bispecific antibodies. Among the latter, teclistamab, indicated as a 4th-line treatment for relapsed or refractory MM patients, targets the CD3 antigen on the surface of T lymphocytes and the BCMA antigen on the surface of malignant plasma cells. The adverse reactions to teclistamab described in the summary of product characteristics (SPC) mention hypogammaglobulinemia, leading to recurrent infections. Immunosubstitution with normal human immunoglobulin (HN-Ig) is often necessary. However, these drugs are regularly in short supply, and are subject to prioritisation recommendations. Until now, immunosubstitution in myeloma has been a "non-priority" indication, to be assessed according to the criteria of the French National Agency for the Safety of Medicines and Health Products (ANSM). The aim of this study was to analyse the management of hypogammaglobulinaemia in the context of teclistamab treatment in our institution over a one-year period during post-marketing authorisation (MA) early access (AP2). Patient characteristics and clinical data related to treatment with teclistamab and HN-Ig (dose, route of administration, frequency, and time to post-teclistamab initiation for HN-Ig, first infection and its type prior to immunosubstitution and its time to onset relative to teclistamab initiation) were extracted from patient records. In order to analyse compliance with the recommendations for prioritisation of HN Ig indications, blood Ig G levels were recorded (at the time of teclistamab initiation, one month later, 3 months later, and 6 months after the start of teclistamab treatment). The quantities in total grams of Ig HN consumed in hospital and aftercare as part of teclistamab treatment and in all DIS indications combined were also investigated. Among the 35 patients treated with teclistamab, 24 received HN Ig as a replacement after an average of 1 month of treatment. At least one infection occurred in 13 of these patients approximately 1 month after initiation of teclistamab. Bacterial infections accounted for 75 % of these infections, mainly pneumonia, bronchitis and urinary tract infections. In 96 % of patients, HN Ig was administered intravenously at a dose of 0.4g/kg each month. Only one patient was treated with weekly subcutaneous Ig HN at a dose of 0.1g/kg. Only 50 % of patients treated with HN Ig met the prioritisation criteria defined by the ANSM (latest recommendations April 2019). Despite immunosubstitution, IgG levels remained relatively stable over time, with a median of 2.6g/L at the start of teclistamab treatment. The time to initiation of immunosubstitution only shortened over time, from 3 months at the start of the study to 0 months, and then to systematic initiation of IS from the start of teclistamab. In terms of consumption, the use of HN-Ig to compensate for post-teclistamab hypogammaglobulinaemia represented 33 % of the total consumption of HN-Ig for secondary immunodeficiency. In conclusion, the systematic introduction of Ig HN immunosubstitution seems necessary to prevent infections following teclistamab treatment in patients with proven hypogamaglobulinaemia. This new practice is likely to have a major impact on the consumption of these plasma-derived medicinal products, which are already often in short supply.

Lyme borreliosis is suspected when there are compatible symptoms associated with tick exposure. The diagnosis, except for erythema migrans, is based on serology. However, in some cases, serology may be erroneous.

Immune checkpoint inhibitors have revolutionized the management of advanced non-small cell lung cancer (NSCLC). While the proportion of "long-term survivors" is estimated to be between 8% and 16%, this population remains poorly understood.

Cancer chemotherapy doses are often adapted to patients' body surface area and produced individually. Alternatively, dose-banding promotes batch production of clinically defined fixed doses, for which a standard deviation of±5% determines a band incorporating individual doses calculated on the basis of body surface area. The aim is to compare the costs of individualized and batch production of gemcitabine in a centralized chemotherapy reconstitution unit.

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.

New therapeutic agents in oncology are emerging rapidly, both in terms of the number of approved drugs and the technological and biological innovation of new treatments. Antibody-drug conjugates (ADC) offer a promising cancer therapy by specifically targeting tumor cells. ADC are composed of a monoclonal antibody recognizing the tumor cell via specific antigens, coupled with a potent cytotoxic agent that resembles classical chemotherapy. This mechanism of action aims to deliver the cytotoxic agent directly to the tumor cell and spare healthy cells. However, important toxicities have been reported. On the one hand, these toxicities are related to the cytotoxic agents that, once delivered locally, spread to other parts of the body. On the other hand, there are specific toxicities associated with these ADC, which we address in this article.

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.

Immune checkpoint inhibitors (ICIs) are a key component of standard anticancer systemic therapy. While their immune-related adverse effects (irAEs) have been widely described, there are few data on grade≥3 irAEs. The primary aim of our descriptive study was to evaluate their incidence and characteristics.