Favourable outcome of patients with breast cancer brain metastases treated with dual HER2 blockade of trastuzumab and pertuzumab

Background:

Dual human epidermal growth factor receptor 2 (HER2) blockade with trastuzumab and pertuzumab (TP) is a standard therapy of metastatic and localized HER2-positive breast cancer (BC), but its activity in breast cancer brain metastases (BCBM) is unknown.

Methods:

Patients with HER2-positive BCBM were identified from the Vienna Brain Metastasis Registry and clinical data including patient characteristics, therapies and overall survival (OS) were obtained. Patients were grouped into ‘TP’, ‘other-HER2-targeted therapy’ and ‘no-HER2-targeted therapy’ according to received first-line systemic therapy after diagnosis of BCBM. Radiological re-assessment of intracranial lesions was performed in patients treated with TP as systemic first-line therapy according to RANO response criteria for brain metastases (BM).

Results:

A total of 252 HER2-positive BC patients with BM were available for this analysis. Patients treated with TP as systemic first-line therapy after diagnosis of BM had a significantly longer OS compared with treatment with other-HER2-targeted therapy and no-HER2-targeted therapy (44 versus 17 versus 3 months, p < 0.001; log-rank test). Among radiologically re-assessed patients treated with TP as systemic first-line therapy after diagnosis of BM, 5/14 patients (35.7%) had complete intracranial remission (CR), 8/14 patients (57.1%) partial intracranial remission (PR), 1/14 patients (7.1%) stable intracranial disease (SD) and 0/14 patients (0.0%) progressive intracranial disease (PD) as best response resulting in an intracranial objective response rate (iORR) of 92.9% and an intracranial clinical benefit rate (iCBR) of 100.0%.

Conclusion:

First-line therapy with dual HER2-inhibition of TP after BM diagnosis was associated with the longest median OS times in patients with BCBM.

[Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria]

INTRODUCTION

Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH).

METHODS

A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared.

RESULTS

The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20.

CONCLUSION

Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature.

[Treatment of Dupuytren's disease with collagenase - a 1-year follow-up of 37 patients]

INTRODUCTION

The efficiency of collagenase of Clostridium histolyticum (CCH; Xiapex) in the treatment of Dupuytren's contracture has been proved in phase III studies. This retrospective study aims to evaluate our clinical results after the use of CCH.

PATIENTS AND METHODS

The study included 40 Dupuytren's contractures in 37 patients. There were 32 male and 5 female patients; their average age was 66 years. The most affected finger was the ring finger (55%; 22/40), followed by the little finger (30%; 12/40) and the middle finger (15; 6/40). 14 fingers (35%) presented isolated contractures of the metacarpophalangeal joint whereas an isolated contracture of the proximal interphalangeal joint was evident in 8 (20%) fingers. 18 (45%) fingers presented combined MCP and PIP flexion contractures. None of the patients underwent any treatment prior to this study. A retrospective chart review was performed of all patients. Follow-up examinations were performed seven days, fourteen days, three months, six months and one year after the intervention. The follow-up examination included goniometry of each affected finger to assess the range of motion (ROM) before and after cord breaking. Further patient-reported outcome was accessed concerning postinterventional complaints, impairment of sensibility and satisfaction with the treatment.

RESULTS

The range of motion improved in all fingers. Full extension of the affected finger without any contracture could be observed in 93% of the MCP contractures, 38% of the PIP contractures and in 28% of the combined MCP and PIP contractures. Incomplete cord breaking could be observed in 9 (22.5%) fingers. In 8 fingers (20%) skin tears occurred after joint manipulation but healed up without any further surgical intervention. The recurrence rate at the latest follow-up was 2.5% (1/40). Patient satisfaction was high and none of the patients reported any complaints at the latest follow-up.

CONCLUSION

The best results could be achieved in patients with isolated contractures of the MCP joint. Regarding the good functional results, the low complication rates and the high patient satisfaction, CCH represents a simple and effective treatment for Dupuytren's contracture in selected cases.

[Reduction mammaplasty with a superior pedicle - a retrospective 10-year follow-up analysis of 33 patients]

BACKGROUND

Long-term results after reduction mammaplasty with a superior pedicle evaluating the postoperative sensibility, degree of breast ptosis and the patients' satisfaction are rarely found in the literature. This retrospective analysis answers the question whether the resection weight has an influence on the postoperative sensibility of the nipple-areola complex after reduction mammaplasty with a superior pedicle.

PATIENTS AND METHODS

33 patients were enrolled in this retrospective study. Depending on the resection weight, the patients were divided into 3 groups: Group A (<500 g), Group B (500-1,000 g), Group C (>1,000 g). The following parameters were evaluated: age, comorbidities, sensibility of the breast (Semmes-Weinstein monofilament test), jugular notch-to-nipple distance, histological results, degree of ptosis, BMI (body mass index), preoperative physical complaints (visual analogue scale 1-10), postoperative patients' satisfaction based on a questionnaire created by the authors. Furthermore, the complications, corrective revisions and pregnancies were evaluated.

RESULTS

The median age of the patients at the moment of examination was 51 years (range: 29-71). None of the patients had any relevant comorbidities. 97% of the patients complained about preoperative physical problems (visual analogue scale 3-10). Postoperative complications arose in 21% of the patients. Corrective revisions were necessary in 18% of the cases. 97% of the patients were very satisfied or satisfied with the result. With regard to the sensibility we found a reduction of sensibility especially in the inferior and lateral part of the areola. In the group B we recorded a ptosis of degree I in 3 patients. A pseudoptosis was found in 6 patients in particular in group B.

CONCLUSION

Reduction mammaplasty with a superior pedicle turns out to be a reliable method with a high satisfaction of the patients after a follow-up of 10 years. These findings were independent from the resection weight. A reduced sensibility occurred especially in the inferior and lateral part of the areola.