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Ludwig H, Melchardt T, Sormann S, Schreder M, Andel J, Hartmann B, Tinchon C, Zojer N, Gunsilius E, Podar K, Egle A, Willenbacher W, Wöll E, Ruckser R, Bozic B, Krauth MT, Petzer A, Schmitt C, Machherndl-Spandl S, Agis H, Fillitz M, Wang SY, Zabernigg A, Knop S, Paiva B, Greil R. Randomized comparison between KTd and KRd induction therapy followed by maintenance therapy with K or observation in transplant-ineligible patients with newly diagnosed multiple myeloma. Am J Hematol 2024; 99:1008-1011. [PMID: 38425185 DOI: 10.1002/ajh.27280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
Randomized comparison between KTd and KRd induction followed by second randomization to carfilzomib in transplant-ineligable patients with newly diagnosed multiple myeloma.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Clinic Ottakring, Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Siegfried Sormann
- Department of Hematology, University Clinic for Internal Medicine, Graz, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Bernd Hartmann
- Department of Internal Medicine II, LKH Rankweil, Rankweil, Austria
| | - Christoph Tinchon
- Department for Hematology, Oncology and Palliative Care, LKH Hochsteiermark, Standort Leoben, Standort Leoben, Austria
| | - Niklas Zojer
- Department of Medicine I, Clinic Ottakring, Vienna, Austria
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Podar
- Department of Internal Medicine II, University Hospital Krems, Krems an der Donau, Austria
- Molecular Oncology and Hematology Unit, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
- syndena GmbH, Connect to Cure, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Krankenhaus Zams, Zams, Austria
| | | | - Boris Bozic
- Department of Medicine II, Clinic Donaustadt, Vienna, Austria
| | - Maria-Theresa Krauth
- University Clinic for Internal Medicine I, AKH, Medical University of Vienna, Vienna, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, BHS Linz, Linz, Austria
| | - Clemens Schmitt
- Clinic for Internal Medicine 3, Kepler University Clinic Linz, Linz, Austria
| | | | - Hermine Agis
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Michael Fillitz
- Department of Internal Medicine, Hanusch Krankenhaus, Vienna, Austria
| | - Song-Yau Wang
- Medical Clinic and Policlinic I, University Clinic Leipzig, Leipzig, Germany
| | - August Zabernigg
- Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria
| | - Stefan Knop
- Klinik für Innere Medizin 5, Schwerpunkt Onkologie/Hämatologie, Klinikum Nürnberg Nord, Nürnberg, Germany
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, Pamplona, Spain
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
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Nikoloudis A, Buxhofer-Ausch V, Aichinger C, Binder M, Hasengruber P, Kaynak E, Wipplinger D, Milanov R, Strassl I, Stiefel O, Machherndl-Spandl S, Petzer A, Weltermann A, Clausen J. Impact of early cyclosporine A levels on acute graft-versus-host disease in allogeneic hematopoietic stem cell transplantation using in vivo T-cell depletion. Cytotherapy 2024:S1465-3249(24)00049-5. [PMID: 38385908 DOI: 10.1016/j.jcyt.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AIMS Cyclosporin A (CsA) remains a major component of immunosuppressive regimens applied in allogeneic hematopoietic stem cell transplantation (HSCT). The impact of CsA trough levels during the first weeks after HSCT has not yet been investigated specifically in anti-T-lymphocyte globulin (ATLG)-based HSCT from matched related and unrelated donors. METHODS To address this issue, we have retrospectively examined 307 consecutive matched related (n = 145) and unrelated (n = 162) HSCTs, using peripheral blood stem cells or bone marrow. HSCTs for active, uncontrolled malignancies were excluded. The initial three weeks' average mean CsA trough levels were analyzed in landmark and multi-state models, using a cut-off of 200 ng/mL. RESULTS CsA levels >200 ng/mL were associated with a reduced risk of acute graft-versus-host disease (GVHD) grade 3-4 at the first-week landmark (subdistribution hazard ratio [SHR] 0.59, P = 0.03) and the second-week landmark (SHR 0.48, P = 0.004), whereas there was no impact at the third-week landmark (HR 0.87, P = 0.69). This was supported by a multi-state model, in which week 1 (hazard ratio [HR] 0.53, P = 0.006) and week 2 (HR 0.48, P = 0.003), but not week 3 (HR 0.80, P = 0.44) CsA levels >200 ng/mL were associated with a reduced acute GVHD 3-4 risk. Relapse incidence was not significantly affected by week 1 through 3 CsA levels. Despite ATLG's inherent GVHD-preventive properties, week 1 CsA trough levels >200 ng/mL following ATLG-based HSCT (n = 220) were associated with a significantly reduced risk of non-relapse mortality (SHR 0.52, P = 0.02) and improved overall survival (HR 0.61, P = 0.02). CONCLUSIONS Our findings emphasize the continuing importance of ensuring CsA levels ≥200 ng/mL immediately post-transplant in the setting of ATLG-based HSCT.
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Affiliation(s)
- Alexander Nikoloudis
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Christoph Aichinger
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Michaela Binder
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Petra Hasengruber
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Emine Kaynak
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Dagmar Wipplinger
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Robert Milanov
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Irene Strassl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Olga Stiefel
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Sigrid Machherndl-Spandl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Ansgar Weltermann
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Johannes Clausen
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz - Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
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3
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Strassl I, Nikoloudis A, Machherndl-Spandl S, Buxhofer-Ausch V, Binder M, Wipplinger D, Stiefel O, Kaynak E, Milanov R, Aichinger C, Nocker S, Bauer T, Kreissl S, Girschikofsky M, Petzer A, Weltermann A, Clausen J. Allogeneic Stem Cell Transplantation in Multiple Myeloma: Risk Factors and Outcomes in the Era of New Therapeutic Options-A Single-Center Experience. Cancers (Basel) 2023; 15:5738. [PMID: 38136284 PMCID: PMC10742138 DOI: 10.3390/cancers15245738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Despite major treatment advances, multiple myeloma remains incurable. The outcome of patients who are refractory to immunomodulatory agents, proteasome inhibitors, and anti-CD38 monoclonal antibodies is poor, and improved treatment strategies for this difficult-to-treat patient population are an unmet medical need. METHODS This retrospective, unicentric analysis included 38 patients with relapsed/refractory multiple myeloma or plasma cell leukemia who underwent allogeneic stem cell transplantation (allo-HSCT) between 2013 and 2022. Survival outcomes, relapse incidence, and non-relapse mortality were calculated according to remission status, date of allo-HSCT, cytogenetic risk status, timing, and number of previous autologous HSCTs. RESULTS The median PFS was 13.6 months (95% CI, 7.7-30.4) and the median OS was 51.4 months (95% CI, 23.5-NA) in the overall cohort. The cumulative incidence of relapse at 3 years was 57%, and non-relapse mortality was 16%. The median PFS and OS were significantly longer in patients with very good partial remission (VGPR) or better compared to patients with less than VGPR at the time of allo-HSCT (mPFS 29.7 months (95% CI, 13.7-NA) vs. 6.5 months (95% CI, 2.6-17.0); p = 0.009 and mOS not reached vs. 18.6 months (95% CI, 7.0-NA); p = 0.006). CONCLUSION For selected patients, allo-HSCT may result in favorable overall survival, in part by providing an appropriate hemato-immunological basis for subsequent therapies.
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Affiliation(s)
- Irene Strassl
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Alexander Nikoloudis
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sigrid Machherndl-Spandl
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Veronika Buxhofer-Ausch
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Michaela Binder
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Dagmar Wipplinger
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Olga Stiefel
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Emine Kaynak
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Robert Milanov
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Christoph Aichinger
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Stefanie Nocker
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Thomas Bauer
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Stefanie Kreissl
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Michael Girschikofsky
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
| | - Andreas Petzer
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Ansgar Weltermann
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Johannes Clausen
- Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria; (A.N.); (S.M.-S.); (V.B.-A.); (D.W.); (O.S.); (E.K.); (R.M.); (C.A.); (S.N.); (T.B.); (S.K.); (M.G.); (A.P.); (A.W.); (J.C.)
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Doleschal B, Taghizadeh H, Lentner T, Riedl JM, Granitzer J, Morariu D, Decker J, Aichberger KJ, Webersinke G, Kirchweger P, Petzer A, Rumpold H. Bevacizumab mitigates codon-specific effects of trifluridine/tipiracil on efficacy outcome parameters in metastatic colorectal cancer. ESMO Open 2023; 8:102064. [PMID: 37977001 PMCID: PMC10774958 DOI: 10.1016/j.esmoop.2023.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Molecular informed therapy changed treatment patterns of metastatic colorectal cancer (mCRC). Recently KRAS G12, the most prevalent RAS mutation in mCRC, was investigated to be a negative predictive marker for the efficacy of trifluridine/tipiracil (FTD/TPI). Whether this proposed selectivity remains when FTD/TPI is combined with bevacizumab remains elusive. We aimed to describe the efficacy of FTD/TPI + bevacizumab depending on the RAS mutational status in a real-world population. PATIENTS AND METHODS Patients from five different cancer centers in Austria who received FTD/TPI + bevacizumab in any treatment line having available information on their molecular profile were eligible. Data were retrospectively collected by chart review. Survival data were compared using log-rank test. Multivariate Cox regression models included several established covariates. RESULTS One hundred and twenty-three patients with mCRC were included in this study. Median overall survival (OS) was highly similar in the RAS wild type (WT) [9.63 months (95% confidence interval [CI] 8.055-13.775 months)] and the RAS mutant cohorts [8.78 months (95% CI 8.055-11.014 months)], which was confirmed in a multivariable model adjusting for potential confounders; hazard ratio (HR): 1.05 (95% CI 0.618-1.785; P = 0.857). In addition, no effect of KRAS G12 status on patient outcome was observed. In detail, OS was 8.88 months (95% CI 7.332-12.921 months) in patients with KRAS G12 mutation, compared to 9.47 months (95% CI 8.088-11.375 months) in patients with RAS WT/no-KRAS G12 disease [HR: 0.822 (95% CI 0.527-1.282; P = 0.387)]. CONCLUSION This real-world study indicates that the efficacy of FTD/TPI + bevacizumab is independent of RAS mutational status and that bevacizumab may therefore mitigate the potentially limited efficacy of FTD/TPI monotherapy in the KRAS G12-mutated population.
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Affiliation(s)
- B Doleschal
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz.
| | - H Taghizadeh
- Department of Internal Medicine, Universitätsklinikum St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten
| | - T Lentner
- Department of Internal Medicine, Universitätsklinikum St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten
| | - J M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz
| | - J Granitzer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz
| | - D Morariu
- Department of Internal Medicine, State Hospital Wiener Neustadt, Wiener Neustadt
| | - J Decker
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach
| | - K J Aichberger
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach
| | - G Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz
| | - P Kirchweger
- Department of General and Visceral Surgery, Ordensklinikum Linz, Linz; Medical Faculty, Johannes Kepler University Linz, Linz; Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
| | - A Petzer
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz
| | - H Rumpold
- Medical Faculty, Johannes Kepler University Linz, Linz; Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
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5
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Pleyer L, Vaisband M, Drost M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Pichler A, Hartmann B, Petzer A, Schreder M, Schmitt CA, Vallet S, Melchardt T, Zebisch A, Pichler P, Zaborsky N, Machherndl-Spandl S, Wolf D, Keil F, Hasenauer J, Larcher-Senn J, Greil R. Cox proportional hazards deep neural network identifies peripheral blood complete remission to be at least equivalent to morphologic complete remission in predicting outcomes of patients treated with azacitidine-A prospective cohort study by the AGMT. Am J Hematol 2023; 98:1685-1698. [PMID: 37548390 DOI: 10.1002/ajh.27046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
The current gold standard of response assessment in patients with myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) is morphologic complete remission (CR) and CR with incomplete count recovery (CRi), both of which require an invasive BM evaluation. Outside of clinical trials, BM evaluations are only performed in ~50% of patients during follow-up, pinpointing a clinical need for response endpoints that do not necessitate BM assessments. We define and validate a new response type termed "peripheral blood complete remission" (PB-CR) that can be determined from the differential blood count and clinical parameters without necessitating a BM assessment. We compared the predictive value of PB-CR with morphologic CR/CRi in 1441 non-selected, consecutive patients diagnosed with MDS (n = 522; 36.2%), CMML (n = 132; 9.2%), or AML (n = 787; 54.6%), included within the Austrian Myeloid Registry (aMYELOIDr; NCT04438889). Time-to-event analyses were adjusted for 17 covariates remaining in the final Cox proportional hazards (CPH) model. DeepSurv, a CPH neural network model, and permutation-based feature importance were used to validate results. 1441 patients were included. Adjusted median overall survival for patients achieving PB-CR was 22.8 months (95%CI 18.9-26.2) versus 10.4 months (95%CI 9.7-11.2) for those who did not; HR = 0.366 (95%CI 0.303-0.441; p < .0001). Among patients achieving CR, those additionally achieving PB-CR had a median adjusted OS of 32.6 months (95%CI 26.2-49.2) versus 21.7 months (95%CI 16.9-27.7; HR = 0.400 [95%CI 0.190-0.844; p = .0161]) for those who did not. Our deep neural network analysis-based findings from a large, prospective cohort study indicate that BM evaluations solely for the purpose of identifying CR/CRi can be omitted.
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Affiliation(s)
- Lisa Pleyer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Marc Vaisband
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 3rd Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University Vienna, Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine 2, Wiener Gesundheitsverbund, Klinik Donaustadt, Vienna, Austria
| | - Angelika Pichler
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine, Hematology and Internal Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine 2, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Internal Medicine I: Medical Oncology and Hematology, Ordensklinikum Linz GmbH, Barmherzige Schwestern, Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Wiener Gesundheitsverbund, Klinik Ottakring, Vienna, Austria
| | - Clemens A Schmitt
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Internal Oncology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
- Charité-University Medical Center, Molecular Cancer Research Center, Berlin, Germany
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- University Hospital Krems, Department of Internal Medicine 2, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Thomas Melchardt
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Division of Hematology, Medical University of Graz, Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Petra Pichler
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Clinical Department for Internal Medicine, University Hospital St Poelten, Karl Landsteiner University of Health Sciences, St Poelten, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 3rd Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University Vienna, Vienna, Austria
| | - Jan Hasenauer
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | | | - Richard Greil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
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6
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Doleschal B, Kirchweger P, Schwendinger S, Kupferthaler A, Burghofer J, Webersinke G, Jukic E, Wundsam H, Biebl M, Petzer A, Rumpold H. Response prediction by mutation- or methylation-specific detection of ctDNA dynamics in pretreated metastatic colorectal cancer. Ther Adv Med Oncol 2023; 15:17588359231200462. [PMID: 37786537 PMCID: PMC10541738 DOI: 10.1177/17588359231200462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background Serial analysis of circulating tumor DNA (ctDNA) levels is a promising tool for both relapse prediction in the curative setting, as well as predicting clinical benefit from systemic treatment in metastasic colorectal cancer (mCRC). Most data in this context are derived from treatment naive patients. Objective To predict progressive disease (PD) as early as possible through monitoring of changes in ctDNA levels during systemic treatment in pretreated patients with mCRC. Design A prospective, single-center, observational study. Methods Patients treated beyond first-line were prospectively included between February 2020 and September 2021. Blood for ctDNA detection was taken before every treatment cycle from start of treatment until first restaging by CT-scan. ctDNA was detected by mutation- (mut-ctDNA) and methylation-specific ddPCR. Receiver Operating Characteristic (ROC)-analysis was used to describe sensitivity and specificity for prediction of PD at restaging for all time points. Results A total of 42 patients were included who all carried a mutation in tumor tissue. Detection rate of mut-ctDNA was 88.1% and 74.4% for meth-ctDNA. Absolute ctDNA levels before treatment were prognostic in terms of overall survival. Levels of ctDNA were significantly higher in patients with PD at restaging. Median time from start of treatment to restaging was 93 days (95% CI 88.8-96). After a median of 19 days of treatment (95% CI 16.1-20.2), a decline of either mutation- or methylation-specific ctDNA levels of ⩽58% predicted PD at restaging with a sensitivity/specificity of 92.9/85.7% and 85.7/100%, respectively. Median time to restaging was 66 days (95% CI 56.8-75.2). There was no significant increase of sensitivity/specificity at later time points of ctDNA measurements. Conclusion Monitoring early changes of ctDNA levels either by mut- or meth-ctDNA allows for early prediction of PD in pretreated patients with mCRC. This has the potential to complement RECIST-based treatment assessment with the aim to switch potentially insufficient treatments as early as possible, which is of particular interest in higher treatment lines.
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Affiliation(s)
- Bernhard Doleschal
- Department of Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Oberösterreich, Austria
| | - Patrick Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz, Oberösterreich, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | | | - Alexander Kupferthaler
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - Jonathan Burghofer
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz, Austria
| | - Emina Jukic
- Institute of Human Genetics, Medical University of Innsbruck, Austria
| | - Helwig Wundsam
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Matthias Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Oberösterreich, Austria
| | - Holger Rumpold
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Seilerstaette 4, Linz 4010, Austria
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7
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Nikoloudis A, Neumann IJ, Buxhofer-Ausch V, Machherndl-Spandl S, Binder M, Kaynak E, Milanov R, Nocker S, Stiefel O, Strassl I, Wipplinger D, Moyses M, Kerschner H, Apfalter P, Girschikofsky M, Petzer A, Weltermann A, Clausen J. Successful SARS-CoV-2 mRNA Vaccination Program in Allogeneic Hematopoietic Stem Cell Transplant Recipients-A Retrospective Single-Center Analysis. Vaccines (Basel) 2023; 11:1534. [PMID: 37896938 PMCID: PMC10611175 DOI: 10.3390/vaccines11101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: mRNA COVID-19 vaccines are effective but show varied efficacy in immunocompromised patients, including allogeneic hematopoietic stem cell transplant (HSCT) recipients. (2) Methods: A retrospective study on 167 HSCT recipients assessed humoral response to two mRNA vaccine doses, using the manufacturer cut-off of ≥7.1 BAU/mL, and examined factors affecting non-response. (3) Results: Twenty-two percent of HSCT recipients failed humoral response. Non-responders received the first vaccine a median of 10.2 (2.5-88.9) months post-HSCT versus 35.3 (3.0-215.0) months for responders (p < 0.001). Higher CD19 (B cell) counts favored vaccination response (adjusted odds ratio (aOR) 3.3 per 100 B-cells/microliters, p < 0.001), while ongoing mycophenolate mofetil (MMF) immunosuppression hindered it (aOR 0.04, p < 0.001). By multivariable analysis, the time from transplant to first vaccine did not remain a significant risk factor. A total of 92% of non-responders received a third mRNA dose, achieving additional 77% seroconversion. Non-converters mostly received a fourth dose, with an additional 50% success. Overall, a cumulative seroconversion rate of 93% was achieved after up to four doses. (4) Conclusion: mRNA vaccines are promising for HSCT recipients as early as 3 months post-HSCT. A majority seroconverted after four doses. MMF usage and low B cell counts are risk factors for non-response.
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Affiliation(s)
- Alexander Nikoloudis
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | | | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Sigrid Machherndl-Spandl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Michaela Binder
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Emine Kaynak
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Robert Milanov
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Stefanie Nocker
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Olga Stiefel
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Irene Strassl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Dagmar Wipplinger
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Margarete Moyses
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Heidrun Kerschner
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
- Institute for Hygiene, Microbiology and Tropical Medicine, Ordensklinikum, Linz, Austria
| | - Petra Apfalter
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
- Institute for Hygiene, Microbiology and Tropical Medicine, Ordensklinikum, Linz, Austria
| | - Michael Girschikofsky
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Ansgar Weltermann
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
| | - Johannes Clausen
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Ordensklinikum Linz—Elisabethinen, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
- Interdisciplinary Center for Infectious Medicine and Microbiology, Linz, Austria
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8
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Doleschal B, Taghizadeh H, Webersinke G, Piringer G, Schreil G, Decker J, Aichberger KJ, Kirchweger P, Thaler J, Petzer A, Schmitt CA, Prager GW, Rumpold H. Real world evidence reveals improved survival outcomes in biliary tract cancer through molecular matched targeted treatment. Sci Rep 2023; 13:15421. [PMID: 37723192 PMCID: PMC10507096 DOI: 10.1038/s41598-023-42083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
Biliary tract cancers are rare cancers with poor prognosis due to a lack of therapeutic options, especially after the failure of first-line systemic treatment. Targeted treatments for this clinical situation are promising and have entered clinical practice. We aimed to describe the overall survival of matched targeted treatment after first-line treatment in patients with biliary tract cancers in an Austrian real-world multicenter cohort. We performed a multicenter retrospective chart review of patients with biliary tract cancer between September 2015 and January 2022. Data, including comprehensive molecular characteristics-next generation sequencing (NGS) and immunohistochemistry (IHC), clinical history, surgical procedures, ablative treatments, patient history, and systemic chemotherapy, were extracted from the records of the participating institutions. Targeted treatment was matched according to the ESMO scale for the clinical actionability of molecular targets (ESCAT). We identified 159 patients with the available molecular characteristics. A total of 79 patients underwent second-line treatment. Of these, 36 patients received matched targeted treatment beyond the first-line and were compared with 43 patients treated with cytotoxic chemotherapy in terms of efficacy outcomes. For Tier I/II alterations, we observed a progression free survival ratio (PFStargeted/PFSpre-chemotherapy) of 1.86, p = 0.059. The overall survival for patients receiving at least two lines of systemic treatment significantly favored the targeted approach, with an overall survival of 22.3 months (95% CI 14.7-29.3) vs. 17.5 months (95% CI 1.7-19.8; p = 0.048). Our results underscore the value of targeted treatment approaches based on extended molecular characterization of biliary tract cancer to improve clinical outcomes.
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Affiliation(s)
- Bernhard Doleschal
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Seilerstaette 4, 4010, Linz, Austria.
| | - Hossein Taghizadeh
- Department of Internal Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz, Austria
| | - Gudrun Piringer
- Department of Oncology and Hematology, Kepler University Clinic Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Georg Schreil
- Department of Internal Medicine, State Hospital Pyhrn Eisenwurzen, Steyr, Austria
| | - Jörn Decker
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach, Austria
| | - Karl J Aichberger
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach, Austria
| | - Patrick Kirchweger
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of General and Visceral Surgery, Ordensklinikum Linz, Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Andreas Petzer
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Seilerstaette 4, 4010, Linz, Austria
| | - Clemens A Schmitt
- Department of Oncology and Hematology, Kepler University Clinic Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Gerald W Prager
- Division of Oncology, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Holger Rumpold
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
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9
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Doleschal B, Niedersüß-Beke D, Kirchweger P, Petzer A, Thaler J, Rumpold H. Survival Outcome in Early-Onset Metastatic Colorectal Cancer: A Multicenter-Matched Pair Analysis. Oncology 2023; 102:107-113. [PMID: 37699362 DOI: 10.1159/000533429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Survival of patients suffering from metastatic colorectal cancer (mCRC) has increased over the last decades. These benefits appear to be restricted to patients aged 50 and above. However, among the population aged <50, colorectal cancer incidence and mortality rates are significantly rising. The clinical benefit of treatment in this population still is a matter of debate. We aim to compare the clinical outcome between patients aged 50 and younger. METHODS In this retrospective, observational study, we analyzed data from 1,077 patients treated for mCRC at three cancer centers in Austria from January 2005 to December 2019. Patients were divided into two groups based on age at diagnosis: <50 years (eo-CRC) and >50 years (regular-onset CRC, ro-CRC). Propensity score matching was used to control for potential biases, and survival outcomes were compared between the two groups. RESULTS The differences in tumor characteristics between eo-CRC and ro-CRC in the overall population were primarily related to tumor sidedness and disease-free survival following intended curative resection. Our data show that eo-CRC patients underwent metastases resection more often and received significantly more lines of treatment in the palliative setting. Overall survival was superior in eo-CRC compared to ro-CRC, even after adjusting for sidedness, timing of metastases, sex, number of treatment lines, and resection of metastases by propensity scoring. CONCLUSION Our study suggests that younger patients benefit at least to the same magnitude or even more from mCRC-treatment than patients aged 50 or above.
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Affiliation(s)
- Bernhard Doleschal
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | | | - Patrick Kirchweger
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of General and Visceral Surgery, Ordensklinikum Linz, Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Holger Rumpold
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
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10
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Nikoloudis A, Buxhofer-Ausch V, Aichinger C, Binder M, Hasengruber P, Kaynak E, Wipplinger D, Milanov R, Strassl I, Stiefel O, Machherndl-Spandl S, Petzer A, Weltermann A, Clausen J. Impact of the Recipient's Pre-Treatment Blood Lymphocyte Count on Intended and Unintended Effects of Anti-T-Lymphocyte Globulin in Allogeneic Hematopoietic Stem Cell Transplantation. Cells 2023; 12:1831. [PMID: 37508496 PMCID: PMC10378354 DOI: 10.3390/cells12141831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Background: In allogeneic hematopoietic stem cell transplantation (HSCT), Anti-T-Lymphocyte Globulin (ATLG) may be used for the prevention of severe graft-versus-host disease (GVHD). ATLG targets both the recipient's lymphocytes and those transferred with the graft. Assuming an inverse relation between the recipient's absolute lymphocyte count (ALC) and exposure of remaining ATLG to the graft, we aim to evaluate the impact of the recipient's ALC before the first ATLG administration on the benefits (prevention of GVHD and GVHD-associated mortality) and potential risks (increased relapse incidence) associated with ATLG. Methods: In recipients of HLA-matched, ATLG-based HSCT (n = 311), we assessed the incidence of acute GVHD, GVHD-related mortality and relapse, as well as other transplant-related outcomes, in relation to the respective ALC (divided into tertiles) before ATLG. Results: The top-tertile ALC group had a significantly increased risk of aGVHD (subhazard ratio (sHR) 1.81; [CI 95%; 1.14-2.88]; p = 0.01) and aGVHD-associated mortality (sHR 1.81; [CI 95%; 1.03-3.19]; p = 0.04). At the highest ATLG dose level (≥45 mg/kg), recipients with lowest-tertile ALC had a trend towards increased relapse incidence (sHR 4.19; [CI 95%; 0.99-17.7]; p = 0.05, n = 32). Conclusions: ATLG dosing based on the recipient's ALC may be required for an optimal balance between GVHD suppression and relapse prevention.
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Affiliation(s)
- Alexander Nikoloudis
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Veronika Buxhofer-Ausch
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Christoph Aichinger
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Michaela Binder
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Petra Hasengruber
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Emine Kaynak
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Dagmar Wipplinger
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Robert Milanov
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
| | - Irene Strassl
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Olga Stiefel
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Sigrid Machherndl-Spandl
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Andreas Petzer
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Ansgar Weltermann
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Johannes Clausen
- Ordensklinikum Linz-Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
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11
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Nikoloudis A, Buxhofer-Ausch V, Aichinger C, Binder M, Hasengruber P, Kaynak E, Wipplinger D, Milanov R, Strassl I, Stiefel O, Machherndl-Spandl S, Petzer A, Weltermann A, Clausen J. Adverse impact of a high CD4/CD8 ratio in the allograft may be overcome by methotrexate- but not mycophenolate- or posttransplant cyclophosphamide-based graft versus host disease prophylaxis. Eur J Haematol 2023; 110:715-724. [PMID: 36941654 DOI: 10.1111/ejh.13956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION A high CD4/CD8 T cell ratio in hematopoietic stem cell transplant (HSCT) allografts was observed to predict graft-versus-host disease (GVHD) and non-relapse mortality (NRM) but has not been comparatively examined in settings of various GVHD-prophylaxis regimens. METHODS This retrospective monocentric study included all consecutive HSCT performed with peripheral blood stem cells (PBSC) between January 2000 and June 2021. The impact of the graft CD4/CD8 ratio was analyzed in three cohorts with different GVHD-prophylaxis platforms. RESULTS In the cyclosporine/mycophenolate-mofetil (CSA/MMF) cohort (n = 294, HLA-matched HSCT), a high (> 75th percentile) CD4/CD8 ratio was associated with increased overall mortality (HR 1.56; P=0.01), increased NRM (HR 1.85; P=0.01) and GVHD-associated mortality (HR 2.13; P=0.005). In the post-transplant cyclophosphamide (PTCy)/tacrolimus/MMF cohort (n = 113, haploidentical-related or mismatched-unrelated HSCT), a high CD4/CD8 ratio was associated with increased overall mortality (HR 2.07; P=0.04) and aGVHD3-4 (HR 2.24; P=0.02). By contrast, in the CSA/methotrexate (CSA/MTX) cohort (n = 185, HLA-matched HSCT) the CD4/CD8 ratio had no significant impact on any of the investigated endpoints. CONCLUSION A high CD4/CD8 ratio in the allograft has an adverse impact on GVHD and survival in CSA/MMF- and PTCy-based HSCT, while MTX-based prophylaxis may largely alleviate this important risk factor.
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Affiliation(s)
- A Nikoloudis
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - V Buxhofer-Ausch
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - C Aichinger
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - M Binder
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - P Hasengruber
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - E Kaynak
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - D Wipplinger
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - R Milanov
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
| | - I Strassl
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - O Stiefel
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - S Machherndl-Spandl
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - A Petzer
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - A Weltermann
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
| | - J Clausen
- Ordensklinikum Linz - Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Johannes Kepler University, Medical Faculty, Linz, Austria
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12
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Rinnerthaler G, Gampenrieder SP, Tinchon C, Petzer A, Balic M, Heibl S, Sandholzer M, Zabernigg AF, Egle D, Hager C, Pichler P, Roitner F, Andel J, Strasser-Weippl K, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P3-05-49: Number of involved organs at baseline is prognostic for overall survival in patients with metastatic breast cancer: Results from the AGMT_MBC-Registry. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-05-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Hormone-receptor (HR) status, HER2 Status, de novo metastatic disease, distant recurrence-free interval (DRFI), and visceral disease are known prognostic factors in metastatic breast cancer (MBC). Therefore, in the majority of clinical trials, randomization is stratified for these parameters. Whether the number of involved organs at baseline has an additional prognostic value was examined in this analysis.
Patients and methods: The AGMT-MBC-Registry is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. In this analysis, patients with known HR status, HER2 status, and available survival data were included. Multivariable hazard ratios were estimated by COX proportional hazard models. For variable selection a backward stepwise model selection using the Akaike information criterion was performed.
Results: As of 04/05/2022, 2,235 patients have been included in the registry, of which 1,840 patients fulfilled the inclusion criteria. In two different multivariable COX proportional hazard models for overall survival, the number of involved organs was a highly statistically significant independent prognostic factor: (1) a model including the number of involved organs at baseline together with known prognostic factors (see Table 1); (2) a stepwise selection model additionally including menopausal status and involved metastatic organ sites (bone, liver, lung, brain, and lymph nodes) separately. This effect was maintained in sensitivity analysis taking different breast cancer subtypes as well as visceral and non-visceral disease into account.
Conclusion: The number of involved organs at baseline is an independent prognostic factor in MBC and should be considered as a stratification factor in randomized trials.
Table 1. Multivariable Model for overall survival.
Citation Format: Gabriel Rinnerthaler, Simon P. Gampenrieder, Christoph Tinchon, Andreas Petzer, Marija Balic, Sonja Heibl, Margit Sandholzer, August F. Zabernigg, Daniel Egle, Christopher Hager, Petra Pichler, Florian Roitner, Johannes Andel, Kathrin Strasser-Weippl, Michael Knauer, Michael Hubalek, Christian F. Singer, Richard Greil. Number of involved organs at baseline is prognostic for overall survival in patients with metastatic breast cancer: Results from the AGMT_MBC-Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-49.
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Affiliation(s)
- Gabriel Rinnerthaler
- 1Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Simon P. Gampenrieder
- 2Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Christoph Tinchon
- 3Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- 4Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marija Balic
- 5Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- 6Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Margit Sandholzer
- 7Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - August F. Zabernigg
- 8Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- 9Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Christopher Hager
- 10Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Petra Pichler
- 11University Hospital St.Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | - Florian Roitner
- 12Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- 13Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | | | - Michael Knauer
- 15Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- 16Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F. Singer
- 17Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Richard Greil
- 18Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
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13
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Sandholzer M, Zabernigg AF, Egle D, Hager C, Pichler P, Roitner F, Andel J, Strasser-Weippl K, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P4-01-27: Prognosis and treatment landscape of HER2-positive metastatic breast cancer (MBC) before the availability of tucatinib and trastuzumab-deruxtecan: Results from the Austrian AGMT_MBC-Registry. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: New anti-HER2 drugs such as tucatinib and trastuzumab deruxtecan (T-DXd) have shown to improve survival of HER2+ MBC in clinical phase III trials. To allow a future confirmation of this survival advantage in real world, we evaluated the prognosis of HER2+ MBC patients before the availability of tucatinib and T-DXd in Austria. Furthermore, we analyzed the treatment landscape and the drop-out rate between subsequent lines of therapy as documented in the MBC-Registry of the Austrian Study Group of Medical Tumor Therapy (AGMT).
Patients and methods: The AGMT-MBC-Registry is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. In this analysis, patients with known HER2 status, available survival data, at least one treatment line and diagnosis of metastatic disease after 01/04/2013 (pertuzumab available) were included. Follow-up was censored at Dec 31, 2020, when tucatinib und T-DXd became available.
Results: As of 04/05/2022, 2,235 patients have been included in the registry. Out of 2,000 evaluable patients, 362 (18.1%) were HER2+, of which 171 (47.2%) fulfilled the inclusion criteria. Out of them 69.0% were hormone-receptor positive. In patients with metachronous metastatic disease (53.2%), 61.5% had received trastuzumab-based treatment for early breast cancer. Median overall survival (OS) for all patients was 50.1 months (95%CI 40.7-73.0), and 66.1 months (95%CI 50.1-NA) for those who received a pertuzumab combination as first-line treatment. The drop-out rate from 1st- to 5th-line was 26.9%, 24.4%, 28.3% and 36.7%, respectively. This yields an estimated percentage of patients that received at least 3, 4, and 5 treatment lines for advanced disease of 55.2%, 39.6% and 25.1%, respectively. In first line, 50.9% received trastuzumab plus pertuzumab and 11.1% T- DM1. In second line, 38.9% were treated with T-DM1 and 35.6% with trastuzumab-based chemotherapy or endocrine therapy. In third line, 11.3%, 17.0% and 49.1% received T-DM1, lapatinib-based and trastuzumab-based therapy, respectively. Outcomes according to treatment line are shown in Table 1.
Conclusion: Median overall survival of HER2+ MBC in Austria who received a pertuzumab combination treatment is comparable to the results reported in the registration CLEOPATRA trial. In this analysis, only ~40% of patients are estimated to receive more than three treatment lines and treatment benefit diminished from line to line. This underlines the importance of investigating and ultimately using the most effective compounds in early treatment lines in order to allow more patients to benefit from these life prolonging drugs.
Table 1: Outcome according to treatment line
Citation Format: Simon P. Gampenrieder, Gabriel Rinnerthaler, Christoph Tinchon, Andreas Petzer, Marija Balic, Sonja Heibl, Margit Sandholzer, August F. Zabernigg, Daniel Egle, Christopher Hager, Petra Pichler, Florian Roitner, Johannes Andel, Kathrin Strasser-Weippl, Michael Knauer, Michael Hubalek, Christian F. Singer, Richard Greil. Prognosis and treatment landscape of HER2-positive metastatic breast cancer (MBC) before the availability of tucatinib and trastuzumab-deruxtecan: Results from the Austrian AGMT_MBC-Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-27.
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Affiliation(s)
- Simon P. Gampenrieder
- 1Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Gabriel Rinnerthaler
- 2Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Christoph Tinchon
- 3Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- 4Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marija Balic
- 5Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- 6Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Margit Sandholzer
- 7Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - August F. Zabernigg
- 8Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- 9Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Christopher Hager
- 10Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Petra Pichler
- 11University Hospital St.Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | - Florian Roitner
- 12Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- 13Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | | | - Michael Knauer
- 15Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- 16Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F. Singer
- 17Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Richard Greil
- 18Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
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14
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Gampenrieder SP, Dezentjé V, Lambertini M, de Nonneville A, Marhold M, Le Du F, Cortés Salgado A, Alpuim Costa D, Vaz Batista M, Chic Ruché N, Tinchon C, Petzer A, Blondeaux E, Del Mastro L, Targato G, Bertucci F, Gonçalves A, Viret F, Bartsch R, Mannsbart C, Deleuze A, Robert L, Saavedra Serrano C, Gion Cortés M, Sampaio-Alves M, Vitorino M, Pecen L, Singer C, Harbeck N, Rinnerthaler G, Greil R. Influence of HER2 expression on prognosis in metastatic triple-negative breast cancer-results from an international, multicenter analysis coordinated by the AGMT Study Group. ESMO Open 2023; 8:100747. [PMID: 36563519 PMCID: PMC10024122 DOI: 10.1016/j.esmoop.2022.100747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is associated with poor prognosis, and new treatment options are urgently needed. About 34%-39% of primary TNBCs show a low expression of human epidermal growth factor receptor 2 (HER2-low), which is a target for new anti-HER2 drugs. However, little is known about the frequency and the prognostic value of HER2-low in metastatic TNBC. PATIENTS AND METHODS We retrospectively included patients with TNBC from five European countries for this international, multicenter analysis. Triple-negativity had to be shown in a metastatic site or in the primary breast tumor diagnosed simultaneously or within 3 years before metastatic disease. HER2-low was defined as immunohistochemically (IHC) 1+ or 2+ without ERBB2 gene amplification. Survival probabilities were calculated by the Kaplan-Meier method, and multivariable hazard ratios (HRs) were estimated by Cox regression models. RESULTS In total, 691 patients, diagnosed between January 2006 and February 2021, were assessable. The incidence of HER2-low was 32.0% [95% confidence interval (CI) 28.5% to 35.5%], with similar proportions in metastases (n = 265; 29.8%) and primary tumors (n = 425; 33.4%; P = 0.324). The median overall survival (OS) in HER2-low and HER2-0 TNBC was 18.6 and 16.1 months, respectively (HR 1.00; 95% CI 0.83-1.19; P = 0.969). Similarly, in multivariable analysis, HER2-low had no significant impact on OS (HR 0.95; 95% CI 0.79-1.13; P = 0.545). No difference in prognosis was observed between HER2 IHC 0/1+ and IHC 2+ tumors (HR 0.89; 95% CI 0.69-1.17; P = 0.414). CONCLUSIONS In this large international dataset of metastatic TNBC, the frequency of HER2-low was 32.0%. Neither in univariable nor in multivariable analysis HER2-low showed any influence on OS.
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Affiliation(s)
- S P Gampenrieder
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - V Dezentjé
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Lambertini
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - A de Nonneville
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - M Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - F Le Du
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - A Cortés Salgado
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Alpuim Costa
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal; NOVA Medical School, (NMS), Faculdade de Ciências Médicas (FCM), Lisbon, Portugal; Centro de Medicina Subaquática e Hiperbárica (CMSH), Marinha Portuguesa, Lisbon, Portugal
| | - M Vaz Batista
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - N Chic Ruché
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - C Tinchon
- Department for Haemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - A Petzer
- Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern-Elisabethinen, Linz, Austria
| | - E Blondeaux
- U.O. Epidemiology Unit, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy
| | - L Del Mastro
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - G Targato
- Dipartimento di Oncologia, Ospedale Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - F Viret
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - R Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - C Mannsbart
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Deleuze
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - L Robert
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - C Saavedra Serrano
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Gion Cortés
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Sampaio-Alves
- Faculdade de Medicina, Universidade do Porto (FMUP), Oporto, Portugal
| | - M Vitorino
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - L Pecen
- Institute of Computer Science, Czech Academy of Sciences, Praha, Czech Republic; Faculty of Medicine in Pilsen - Charles University, Pilsen, Czech Republic
| | - C Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany
| | - G Rinnerthaler
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Greil
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
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15
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Petzer A. ASCO update-best of the best. Memo 2022; 15:255-256. [PMID: 36531131 PMCID: PMC9735157 DOI: 10.1007/s12254-022-00851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Andreas Petzer
- Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Barmherzige Schwestern, Elisabethinen, Seilerstätte 4, 4010 Linz, Austria
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16
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Doleschal B, Petzer A, Rumpold H. Current concepts of anti-EGFR targeting in metastatic colorectal cancer. Front Oncol 2022; 12:1048166. [PMID: 36465407 PMCID: PMC9714621 DOI: 10.3389/fonc.2022.1048166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2023] Open
Abstract
Anti-EGFR targeting is one of the key strategies in the treatment of metastatic colorectal cancer (mCRC). For almost two decades oncologists have struggled to implement EGFR antibodies in the mCRC continuum of care. Both sidedness and RAS mutational status rank high among the predictive factors for the clinical efficacy of EGFR inhibitors. A prospective phase III trial has recently confirmed that anti-EGFR targeting confers an overall survival benefit only in left sided RAS-wildtype tumors when given in first line. It is a matter of discussion if more clinical benefit can be reached by considering putative primary resistance mechanisms (e.g., HER2, BRAF, PIK3CA, etc.) at this early stage of treatment. The value of this procedure in daily routine clinical utility has not yet been clearly delineated. Re-exposure to EGFR antibodies becomes increasingly crucial in the disease journey of mCRC. Yet re- induction or re-challenge strategies have been problematic as they relied on mathematical models that described the timely decay of EGFR antibody resistant clones. The advent of liquid biopsy and the implementation of more accurate next-generation sequencing (NGS) based high throughput methods allows for tracing of EGFR resistant clones in real time. These displays the spatiotemporal heterogeneity of metastatic disease compared to the former standard radiographic assessment and re-biopsy. These techniques may move EGFR inhibition in mCRC into the area of precision medicine in order to apply EGFR antibodies with the increase or decrease of EGFR resistant clones. This review critically discusses established concepts of tackling the EGFR pathway in mCRC and provides insight into the growing field of liquid biopsy guided personalized approaches of EGFR inhibition in mCRC.
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Affiliation(s)
- Bernhard Doleschal
- Department of Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
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17
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Rinnerthaler G, Singer C, Petru E, Egle D, Petzer A, Pluschnig U, Gampenrieder SP, Pfeiler G, Gnant M, Grünberger B, Krippl P, Strasser-Weippl K, Suppan C, Brunner C, Pusch R, Sandholzer M, Balic M, Bartsch R. Austrian treatment algorithms in HER2-positive metastatic breast cancer: a 2022 update. Wien Klin Wochenschr 2022; 134:683-692. [PMID: 36149495 PMCID: PMC9606043 DOI: 10.1007/s00508-022-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
In the past 12 months a plethora of relevant novel data for the treatment of metastatic HER2 positive breast cancer were published. To bring this new evidence into a clinical perspective, a group of Austrian breast cancer specialists updated their previously published treatment algorithm for those patients. For this consensus paper a total of eight scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.
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Affiliation(s)
- Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Andreas Petzer
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine and Hematology and Internal Oncology, Klagenfurt Hospital, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Simon Peter Gampenrieder
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Birgit Grünberger
- Department of Internal Medicine and Hematology and Internal Oncology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Peter Krippl
- Department of Internal Medicine (location Fürstenfeld), Landeskrankenhaus Feldbach-Fürstenfeld, Krankenhausgasse 1, 8280, Fürstenfeld, Austria
| | - Kathrin Strasser-Weippl
- First Medical Department, Center for Oncology and Hematology, Klinik Ottakring, Montleartstr. 36, 1160, Vienna, Austria
| | - Christoph Suppan
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christine Brunner
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Renate Pusch
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Margit Sandholzer
- Second Medical Department, Center for Oncology and Hematology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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18
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Kirchweger P, Kupferthaler A, Burghofer J, Webersinke G, Jukic E, Schwendinger S, Wundsam H, Biebl M, Petzer A, Rumpold H. Prediction of response to systemic treatment by kinetics of circulating tumor DNA in metastatic pancreatic cancer. Front Oncol 2022; 12:902177. [PMID: 36110940 PMCID: PMC9468369 DOI: 10.3389/fonc.2022.902177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Pretherapeutic detectable circulating tumor DNA (ctDNA) represents a promising prognostic biomarker for predicting relapse and overall survival in patients with metastatic pancreatic cancer. However, the prognostic value of ctDNA dynamics during treatment has not been studied thus far. We aimed to investigate the correlation between the change of ctDNA levels and response to treatment in patients treated by systemic therapy. Material and methods CtDNA detection using liquid biopsy (droplet digital PCR (ddPCR) utilizing KRAS G12/13 and, if negative, Q61 commercial test kits) was prospectively performed on patients with stage IV pancreatic cancer i) prior to initiation of systemic chemotherapy and ii) serially every 2 weeks until restaging. Detection rates, levels of ctDNA, and the course of the relative ctDNA change (ctDNA kinetics) were correlated to treatment response and clinical outcome. Results The detection rate at baseline was 64.3% (45/70), and complete serial measurement records were available for 32 ctDNA-positive patients. Reduction of ctDNA levels below 57.9% of its baseline value at week 2 after treatment initiation was significantly predictive of response to treatment (area under the curve (AUC) = 0.918, sensitivity 91.67%, and specificity 100%) and was associated with prolonged overall survival (OS) (5.7 vs. 11.4 months, p = 0.006) and progression-free survival (PFS) (2.5 vs. 7.7 months, p < 0.000) regardless of treatment line. Pretherapeutic ctDNA detection was independently associated with worse OS in patients receiving a first-line regimen (7 vs. 11.3 months, p = 0.046) and regardless of treatment line (11.4 vs. 15.9 months, p = 0.045) as well as worse PFS (3.4 vs. 10.8 months, p = 0.018). Conclusion The change in magnitude of ctDNA during systemic treatment allows the prediction of treatment response and is associated with both OS and PFS. This finding adds significant clinical potential to the already established prognostic value of ctDNA positivity in metastatic pancreatic cancer.
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Affiliation(s)
- Patrick Kirchweger
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Kupferthaler
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - Jonathan Burghofer
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz, Austria
| | - Emina Jukic
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Schwendinger
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Helwig Wundsam
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Matthias Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Andreas Petzer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- *Correspondence: Holger Rumpold,
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Grigor’eva AI, Shetnev AA, Kotov AD, Ivanovskii SA, Petzer A, Petzer JP. Synthesis and Antimonoamine Oxidase Activity of 2-(3-Iminoisoindol-1-ylidene)-2-arylacetonitriles. Russ J Org Chem 2022. [DOI: 10.1134/s1070428022050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Udovica S, Müser N, Pechlaner A, Reichinger A, Aichinger C, Strasser-Weippl K, Rumpold H, Petzer A, Wöll E, Hilbe W, Müldür E. High mortality in patients with active malignancy and severe COVID-19. memo 2022. [DOI: 10.1007/s12254-022-00814-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Leisch M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Tinchon C, Hartmann B, Petzer A, Schreder M, Kiesl D, Vallet S, Egle A, Melchardt T, Piringer G, Zebisch A, Machherndl-Spandl S, Wolf D, Keil F, Drost M, Greil R, Pleyer L. Adverse Events in 1406 Patients Receiving 13,780 Cycles of Azacitidine within the Austrian Registry of Hypomethylating Agents-A Prospective Cohort Study of the AGMT Study-Group. Cancers (Basel) 2022; 14:cancers14102459. [PMID: 35626063 PMCID: PMC9140081 DOI: 10.3390/cancers14102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Azacitidine is thus far the only drug shown to prolong overall survival and is, therefore, the recommended (backbone) treatment in patients diagnosed with myelodysplastic syndromes, chronic myelomonocytic leukemia and acute myeloid leukemia who are not eligible for intensive chemotherapy. Detailed reports on adverse events are often lacking. We performed a thorough analysis of the adverse events that occur during treatment with azacitidine in the largest cohort of patients treated with this drug published so far. We also compared the frequency of adverse events documented in our cohort to published data from randomized clinical trials with an azacitidine monotherapy arm. Adverse event documentation in the Austrian Registry was high. Hematologic adverse events occurred at a similar rate compared to published trials, whereas gastrointestinal toxicities were significantly less commonly reported. Our data complement results from clinical trials with real-world evidence and form a reference for future combination strategies with azacitidine. Abstract Background: Azacitidine is the treatment backbone for patients with acute myeloid leukemia, myelodysplastic syndromes and chronic myelomonocytic leukemia who are considered unfit for intensive chemotherapy. Detailed reports on adverse events in a real-world setting are lacking. Aims: To analyze the frequency of adverse events in the Austrian Registry of Hypomethylating agents. To compare real-world data with that of published randomized clinical trials. Results: A total of 1406 patients uniformly treated with a total of 13,780 cycles of azacitidine were analyzed. Hematologic adverse events were the most common adverse events (grade 3–4 anemia 43.4%, grade 3–4 thrombopenia 36.8%, grade 3–4 neutropenia 36.1%). Grade 3–4 anemia was significantly more common in the Registry compared to published trials. Febrile neutropenia occurred in 33.4% of patients and was also more common in the Registry than in published reports. Other commonly reported adverse events included fatigue (33.4%), pain (29.2%), pyrexia (23.5%), and injection site reactions (23.2%). Treatment termination due to an adverse event was rare (5.1%). Conclusion: The safety profile of azacitidine in clinical trials is reproducible in a real-world setting. With the use of prophylactic and concomitant medications, adverse events can be mitigated and azacitidine can be safely administered to almost all patients with few treatment discontinuations.
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Affiliation(s)
- Michael Leisch
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, Klinik Donaustadt, 1220 Vienna, Austria
| | - Christoph Tinchon
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine, Landeskrankenhaus Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Medical Oncology and Hematology, Internal Medicine I, Ordensklinikum Linz GmbH Barmherzige Schwestern, 4020 Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, 1160 Vienna, Austria
| | - David Kiesl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Hematology and Medical Oncology, Kepleruniversitätsklinikum, 4020 Linz, Austria
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Gudrun Piringer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria;
| | - Richard Greil
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Lisa Pleyer
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Correspondence:
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Kirchweger P, Kupferthaler A, Burghofer J, Webersinke G, Jukic E, Schwendinger S, Weitzendorfer M, Petzer A, Függer R, Rumpold H, Wundsam H. Circulating tumor DNA correlates with tumor burden and predicts outcome in pancreatic cancer irrespective of tumor stage. Eur J Surg Oncol 2022; 48:1046-1053. [PMID: 34876329 DOI: 10.1016/j.ejso.2021.11.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Circulating tumor DNA (ctDNA) represents a promising tool for diagnosis, prognosis and treatment monitoring of several malignancies. Its association with tumor burden in pancreatic ductal cancer (PDAC), especially in localized disease, is not fully explored yet. We aimed to investigate the association of pretherapeutic ctDNA levels in localized and metastatic PDAC with tumor volume and clinical outcomes. MATERIAL AND METHODS Liquid biopsy for ctDNA detection was prospectively obtained from patients with localized or disseminated PDAC prior to either resection or systemic treatment. Detection rates and levels of ctDNA (digital droplet PCR) were correlated to tumor volume, relapse rate and survival. RESULTS 60 patients with localized and 47 patients with metastatic PDAC were included. ctDNA was detected in 10% of localized and 57.4% of metastasized PDAC samples. In localized disease, ctDNA detection significantly correlated with the numbers of involved locoregional lymph nodes (p = 0.030). Primary tumor volume did not correlate with ctDNA levels in neither localized (p = 0.573) nor metastasized disease (p = 0.878). In disseminated disease, ctDNA levels correlated with total tumor volume (p = 0.026) and especially with liver metastases volume (p = 0.004), but not with other metastases. Detection of pretherapeutic ctDNA was associated with shorter DFS in localized (3.3 vs. 18.1 months, p = 0.000), whereas ctDNA levels were associated with worse survival in metastatic PDAC (5.7 vs. 7.8 months, p = 0.036). CONCLUSION ctDNA positivity indicates major nodal involvement or even presence of undetected distant metastases associated with early recurrence in localized PDAC. Moreover, it predicts worse clinical outcome in both localized and metastatic disease.
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Affiliation(s)
- Patrick Kirchweger
- Gastrointestinal Cancer Center, Linz, Austria; Department of Surgery, Ordensklinikum Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | | | - Jonathan Burghofer
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Austria
| | - Emina Jukic
- Institute of Human Genetics, Medical University of Innsbruck, Austria
| | | | | | - Andreas Petzer
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria; Department of Internal Medicine I for Hematology with Stem Cell Transplantaation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Austria
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Holger Rumpold
- Gastrointestinal Cancer Center, Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
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23
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Thieblemont C, Dickinson M, Martinez-Lopez J, Kolstad A, Butler J, Ghosh M, Popplewell L, Chavez JC, Bachy E, Kato K, Harigae H, Kersten MJ, Andreadis C, Riedell PA, Ho PJ, Pérez-Simón JA, Chen AI, Nastoupil LJ, von Tresckow B, María Ferreri AJ, Teshima T, Patten PEM, McGuirk JP, Petzer A, Offner F, Viardot A, Zinzani PL, Malladi R, Zia A, Bodoni CL, Masood A, Schuster SJ, Fowler NH, Dreyling M. Efficacy of Tisagenlecleucel in Adult Patients (Pts) with High Risk Relapsed/Refractory Follicular Lymphoma (r/r FL): Subgroup Analysis of the Phase 2 Elara Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Zabernigg AF, Egle D, Sandholzer M, Roitner F, Andel J, Pichler P, Hager C, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P1-21-08: Brain metastases (BM) from breast cancer: Real-word data from the Austrian AGMT_MBC-registry. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-21-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BM are generally associated with poor prognosis and with neurological impairments making BM a major limitation of life expectancy and quality of life in MBC. Real-world data are needed in order to quantify and better characterize this special clinical situation. Here, we present data from the MBC registry of the Austrian Study Group for Medical Tumor Therapy (AGMT-MBC-Registry). Methods: The AGMT-MBC-Registry is an ongoing multicenter registry for MBC patients in Austria. Patients with available hormone receptor and HER2 status and sufficient outcome data were included in this analysis. Unadjusted, univariate overall survival (OS) probabilities were calculated by the Kaplan-Meier method and compared by the log-rank test; multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. HR were estimated with diagnosis of BM as time-dependent variable. Logistic regression was performed to investigate the probability of developing BM. Multivariable analyses included the following parameters: breast cancer subtype (luminal-like vs. HER2+ vs. TNBC), age at diagnosis of metastatic disease (continuous, in Cox regression as interaction with menopausal status), DFS (de novo metastatic or ≥ 24 months vs. < 24 months), visceral disease (yes vs. no) and number of metastatic sites (1 vs 2-3 vs. ≥4) at diagnosis of metastatic disease. Results: As of 15/04/2021, 2024 patients were included in the registry. Out of 1691 evaluable patients, 306 (18.1%) had documented BM. The incidence at diagnosis of metastatic disease and the overall incidence during the course of disease was significantly higher in HER2+ (9.5% [13/137] and 36.5% [50/137]) and triple-negative tumors (11.9% [38/318] and 27.7% [88/318]) compared to luminal-like tumors (3.3% [41/1236] and 13.6% [168/1236]) (both P<0.001). Besides subtype, ≥4 metastatic sites at diagnosis of metastatic disease and age were statistically significant associated with BM in logistic regression analysis.Median time to BM calculated from the date of diagnosis of metastatic disease was 11.3 months (95%CI 9.3-13.3) in the total population with BM, 12.7 months (95%CI 7.3-16.0) in HER2+, 5.2 months (95%CI 1.8-10.3) in triple-negative and 15.4 months (95%CI 8.4-19.5) in luminal disease, respectively. Interestingly, 13.7% of patients (42/306) had BM as first metastatic site without extracranial disease. The median number of systemic therapy-lines before and after diagnosis of BM was 1 (range 0-8) and 1 (range 0-10), respectively. Most of the patients with BM (80.1%) received radiotherapy; 12.7% focal radiotherapy, 69.8% whole brain irradiation and 9.0% both types of radiotherapy (8.5% unknown). After a median follow-up of 72.3 months (95%-CI 68.6-80.0), patients with BM had a significantly shorter median OS (7.5 months) compared to patients without BM (38.4 months) both in univariate (HR 3.58; 95%CI 3.11-4.11; P<.001) and multivariable analysis (HR 3.70; 95%CI 3.18-4.32; P<.001). OS in patients with BM differed significantly between the three breast cancer subtypes with a median OS of 36.3 months (95%CI 30.5-47.9), 33.5 months (95%CI 22.9-45.5) and 13.2 months (95%CI 11.1-18.4) in luminal, HER2+ and TNBC, respectively (overall log-rank P<0.001). Similarly, the time from diagnosis of BM and death was significantly shorter in TNBC (4.1 months; 95%CI 3.4-6.3) compared to luminal (9.7 months; 95%CI 6.8-13.7) and HER2+ breast cancer (10.7 months; 95%CI 9.1-26.2) (overall log-rank P<0.001). Conclusion: Almost 20% of patients with MBC develop BM during their course of disease, with a higher incidence in HER2+ and triple-negative disease. Besides effective prevention strategies improved systemic and local therapies are needed to minimize morbidity and improve outcome in these patients.
Citation Format: Simon Peter Gampenrieder, Gabriel Rinnerthaler, Christoph Tinchon, Andreas Petzer, Marij Balic, Sonja Heibl, August F Zabernigg, Daniel Egle, Margit Sandholzer, Florian Roitner, Johannes Andel, Petra Pichler, Christopher Hager, Michael Knauer, Michael Hubalek, Christian F Singer, Richard Greil. Brain metastases (BM) from breast cancer: Real-word data from the Austrian AGMT_MBC-registry [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-21-08.
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Affiliation(s)
- Simon Peter Gampenrieder
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Tinchon
- Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marij Balic
- Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - August F Zabernigg
- Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Margit Sandholzer
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Florian Roitner
- Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- Department of Internal Medicine II, Landeskrankenhaus Steyr, Steyr, Austria
| | - Petra Pichler
- University Hospital St. Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
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25
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Bartsch R, Gampenrieder SP, Rinnerthaler G, Petru E, Egle D, Petzer A, Balic M, Pluschnig U, Sliwa T, Singer C. Updated Austrian treatment algorithm in HER2+ metastatic breast cancer. Wien Klin Wochenschr 2022; 134:63-72. [PMID: 35089396 PMCID: PMC8813714 DOI: 10.1007/s00508-021-01987-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/21/2022]
Abstract
A group of Austrian breast cancer specialists met in December 2020 to establish a comprehensive clinical benefit-risk profile of available HER2-targeted therapies based on recent data and to develop an updated treatment algorithm by consensus over several months in 2021. A total of four scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Simon Peter Gampenrieder
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Edgar Petru
- University Hospital for Gynecology and Obstetrics, Clinical Department of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Andreas Petzer
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine and Hematology and Internal Oncology, Klagenfurt Hospital, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hematology and Oncology, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Christian Singer
- Department of Gynecology, Breast Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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26
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Rumpold H, Hackl M, Petzer A, Wolf D. Improvement in colorectal cancer outcomes over time is limited to patients with left-sided disease. J Cancer Res Clin Oncol 2022; 148:3007-3014. [PMID: 34977964 DOI: 10.1007/s00432-021-03868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Incidence and mortality of colorectal cancer (CRC) declined over the last decades. However, survival depends on the primary tumor location. It is unknown if all progress in outcomes vary depending on left-sided (LCRC) versus right-sided (RCC) colorectal cancer. We compare incidence and mortality rates over time according to the primary tumor location. METHODS Data from the Austrian National Cancer Registry spanning from 1983 to 2018 were used to calculate annual incidence and mortality rates and survival stratified by primary tumor localization and stage. Joinpoint regression with linear regression models were used on different subgroups to identify significant changes of incidence- and mortality slopes. RESULTS A total of 168,260 (incidence dataset) and 87,355 cases (mortality dataset) were identified. Survival of disseminated RCC was worse compared to LCRC (HR 1.14; CI 1.106-1.169). Total and LCRC incidence and mortality rates declined steadily over time, whereas the rates of RCC did not. Incidence of disseminated RCC declined significantly less (slope - 0.07; CI - 0.086; - 0.055) than in LCRC (slope - 0.159; CI - 0.183; - 0.136); mortality rate of RCC was unchanged over time. Incidence and mortality of localized RCC remained unchanged over time, whereas both rates declined independently of stage in LCRC. CONCLUSION Colorectal cancer outcomes during the last 35 years have preferentially improved in LCRC but not in RCC, indicating that the progress made is limited to LCRC. It is necessary to define RCC as a distinct form of CRC and to focus on specific strategies for its early detection and treatment.
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Affiliation(s)
- Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Seilerstaette 4, 4010, Linz, Austria. .,Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - M Hackl
- National Cancer Registry, Statistics Austria, Vienna, Austria
| | - A Petzer
- Department of Medical Oncology and Hematology, Ordensklinikum Linz, Linz, Austria
| | - D Wolf
- Internal Medicine 5, Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
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27
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Schmitt C, Zabernigg AF, Egle D, Sandholzer M, Singer CF, Roitner F, Hager C, Andel J, Hubalek M, Knauer M, Greil R. Landscape of HER2-low metastatic breast cancer (MBC): results from the Austrian AGMT_MBC-Registry. Breast Cancer Res 2021; 23:112. [PMID: 34906198 PMCID: PMC8670265 DOI: 10.1186/s13058-021-01492-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background About 50% of all primary breast cancers show a low-level expression of HER2 (HER2-low), defined as immunohistochemically 1+ or 2+ and lack of HER2 gene amplification measured by in situ hybridization. This low HER2 expression is a promising new target for antibody–drug conjugates (ADCs) currently under investigation. Until now, little is known about the frequency and the prognostic value of low HER2-expression in metastatic breast cancer (MBC). Patients and methods The MBC-Registry of the Austrian Study Group of Medical Tumor Therapy (AGMT) is a multicenter nationwide ongoing registry for MBC patients in Austria. Unadjusted, univariate survival probabilities of progression-free survival (PFS) and overall survival (OS) were calculated by the Kaplan–Meier method and compared by the log-rank test. Multivariable adjusted hazard ratios were estimated by Cox regression models. In this analysis, only patients with known HER2 status and available survival data were included. Results As of 11/15/2020, 1,973 patients were included in the AGMT-MBC-Registry. Out of 1,729 evaluable patients, 351 (20.3%) were HER2-positive, 608 (35.2%) were HER2-low and 770 (44.5%) were completely HER2-negative (HER2-0). Low HER2-expression was markedly more frequent in the hormone-receptor(HR)+ subgroup compared to the triple-negative subgroup (40% vs. 23%). In multivariable analysis, low HER2 expression did not significantly influence OS neither in the HR+ (HR 0.89; 95% CI 0.74–1.05; P = 0.171) nor in the triple-negative subgroup (HR 0.92; 95% CI 0.68–1.25; P = 0.585), when compared to completely HER2-negative disease. Similar results were observed when HER2 IHC 2+ patients were compared to IHC 1+ or 0 patients. Conclusion Low-HER2 expression did not have any impact on prognosis of metastatic breast cancer in this real-world population. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01492-x.
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Affiliation(s)
- Simon Peter Gampenrieder
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Christoph Tinchon
- Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Andreas Petzer
- Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Marija Balic
- Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Clemens Schmitt
- Department of Hematology and Internal Oncology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | | | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Margit Sandholzer
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian Fridolin Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Roitner
- Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Pyrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Michael Hubalek
- Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Richard Greil
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria. .,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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Rinnerthaler G, Gampenrieder SP, Petzer A, Hubalek M, Petru E, Sandholzer M, Andel J, Balic M, Melchardt T, Hauser-Kronberger C, Schmitt CA, Ulmer H, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: results of a phase II trial (AGMT MBC-6). Ther Adv Med Oncol 2021; 13:17588359211042301. [PMID: 34691243 PMCID: PMC8529308 DOI: 10.1177/17588359211042301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Bendamustine, a medication approved for the treatment of indolent non-Hodgkin
lymphoma, has already shown anticancer activity in metastatic breast cancer
(MBC). Here, we present the results of a phase II trial of bendamustine in
combination with capecitabine in pre-treated patients with MBC. Patients and methods: AGMT MBC-6 is a multicentre, open-label, single-arm phase II study in
HER2-negative MBC. All patients were pre-treated with anthracyclines and/or
taxans and had measurable disease. Patients received per os
1000 mg/m2 capecitabine twice daily on days 1 to 14 in
combination with 80 mg/m2 bendamustine intravenously on days 1
and 8 of a 3-week cycle for a maximum of eight cycles, followed by a
capecitabine maintenance therapy. The primary endpoint was overall response
rate (ORR). Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian
centres. The median age was 60 years (range 29–77). Twenty-five per cent of
patients had triple-negative breast cancer (TNBC) and 93% showed visceral
involvement. With 17 partial and one complete remission, ORR was 46%. Median
progression-free survival (PFS) was 7.5 months [95% confidence interval (CI)
6.1–10.7]. The most common non-haematological adverse events (AEs) of grade
3 were hand-foot syndrome (13%), fatigue (10%), nausea (8%), and dyspnoea
(8%). One grade 4 non-haematological AE (hepatic failure) and three grade 4
haematological AEs (neutropenia) were observed. One patient died of
restrictive cardiomyopathy, in which a relationship to capecitabine cannot
be excluded, but seems unlikely. Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and
moderate toxicity. Further evaluation of this drug combination is
warranted. The clinical trial AGMT MBC-6 was registered at ClinicalTrials.gov,
(https://clinicaltrials.gov/; identifier: NCT01891227).
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Affiliation(s)
- Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Internal Department I for Medical Oncology and Hematology, Barmherzige Schwestern Hospital/Linz, Linz, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - Margit Sandholzer
- Department of Oncology, Hematology and Gastroenterology, Infectiology, Academic Teaching Hospital Feldkirch, Austria
| | - Johannes Andel
- Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, AustriaSalzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | | | - Clemens A Schmitt
- Department of Internal Medicine 3 - Hematology and Oncology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
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Fowler NH, Dickinson M, Martinez‐Lopez J, Kolstad A, Schuster SJ, Dreyling M, Ghosh M, Harigae H, Kersten MJ, Bachy E, Popplewell L, Chavez JC, Ho PJ, Butler J, Kato K, Tresckow B, Ferreri AJM, Simón JAP, Patten PEM, Andreadis C, Riedell PA, McGuirk JP, Nastoupil LJ, Teshima T, Offner F, Petzer A, Viardot A, Zinzani PL, Malladi R, Zhang J, Tiwari R, Bollu V, Masood A, Thieblemont C. PATIENT‐REPORTED QUALITY OF LIFE (QOL) FOLLOWING TISAGENLECLEUCEL (TISA‐CEL) INFUSION IN ADULT PATIENTS (PTS) WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA (R/R FL). Hematol Oncol 2021. [DOI: 10.1002/hon.178_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N. H. Fowler
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - M. Dickinson
- Royal Melbourne Hospital Peter MacCallum Cancer Centre Melbourne Australia
| | | | - A. Kolstad
- Oslo University Hospital Department of Oncology Oslo Norway
| | - S. J. Schuster
- University of Pennsylvania Lymphoma Program Philadelphia Pennsylvania USA
| | - M. Dreyling
- LMU Klinikum Medizinische Klinik III Munich Germany
| | - M. Ghosh
- University of Michigan Michigan Medicine Ann Arbor Michigan USA
| | - H. Harigae
- Tohoku University Hospital Department of Hematology and Rheumatology Sendai Japan
| | - M. José Kersten
- Amsterdam UMC University of Amsterdam on behalf of HOVON/LLPC Department of Hematology Amsterdam Netherlands
| | - E. Bachy
- Université Claude Bernard Lyon 1 Hospices Civils de Lyon Lyon France
| | - L. Popplewell
- City of Hope National Medical Center Department of Hematology & Hematopoietic Cell Transplantation Duarte California USA
| | - J. C. Chavez
- Moffitt Cancer Center Department of Malignant Hematology Tampa Florida USA
| | - P. J. Ho
- Royal Prince Alfred Hospital and University of Sydney Institute of Haematology Camperdown Australia
| | - J. Butler
- Royal Brisbane Hospital Haematology and Bone Marrow Transplant Unit Herston Australia
| | - K. Kato
- Kyushu University Hospital Hematology, Oncology, & Cardiovascular Medicine Fukuoka Japan
| | - B. Tresckow
- University Hospital Essen University of Duisburg‐Essen Clinic for Hematology and Stem Cell Transplantation West German Cancer Center Essen Germany
| | - A. J. M. Ferreri
- IRCCS Ospedale San Raffaele Department of Onco‐hematology Milan Italy
| | - J. A. P. Simón
- University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla (IBIS / CSIC / CIBERONC) Universidad de Sevilla Department of Hematology Sevilla Spain
| | - P. E. M. Patten
- King’s College Hospital and King’s College London Division of Cancer Studies London UK
| | - C. Andreadis
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center San Francisco California USA
| | - P. A. Riedell
- University of Chicago Medical Center Department of Medicine Chicago Illinois USA
| | - J. P. McGuirk
- University of Kansas Medical Center Division of Hematologic Malignancies and Cellular Therapeutics Kansas City Kansas USA
| | - L. J. Nastoupil
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - T. Teshima
- Hokkaido University Hospital Department of Hematology Sapporo Japan
| | - F. Offner
- UZ Gent Department of Hematology Gent Belgium
| | - A. Petzer
- Ordensklinikum Linz GmbH Elisabethinen Internal Medicine I Linz Austria
| | - A. Viardot
- University Hospital of Ulm Department of Internal Medicine III Ulm Germany
| | - P. L. Zinzani
- University of Bologna Institute of Hematology “Seràgnoli” Bologna Italy
| | - R. Malladi
- Cambridge University Hospitals NHS Foundation Trust Centre for Clinical Haematology Cambridge UK
| | - J. Zhang
- Novartis Pharmaceuticals Corporation Global Value and Access East Hanover New Jersey USA
| | - R. Tiwari
- Novartis Healthcare Pvt. Ltd Biostatistics Hyderabad India
| | - V. Bollu
- Novartis Pharmaceuticals Corporation Health Economics and Outcomes Research East Hanover New Jersey USA
| | - A. Masood
- Novartis Pharmaceuticals Corporation Clinical Development East Hanover New Jersey USA
| | - C. Thieblemont
- Hôpital Saint‐Louis‐Université de Paris Service d'Hématologie‐Oncologie Paris France
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Nikoloudis A, Wagner H, Machherndl-Spandl S, Buxhofer-Ausch V, Strassl I, Stiefel O, Wipplinger D, Milanov R, Kaynak E, Hasengruber P, Binder M, Weltermann A, Petzer A, Wolf D, Nachbaur D, Clausen J. Relapse Protection Following Early Cytomegalovirus Reactivation after Hematopoietic Stem Cell Transplantation Is Limited to HLA-C Killer Cell Immunoglobulin-Like Receptor Ligand Homozygous Recipients. Transplant Cell Ther 2021; 27:686.e1-686.e9. [PMID: 33991724 DOI: 10.1016/j.jtct.2021.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Although the risk for nonrelapse mortality (NRM) associated with early cytomegalovirus (CMV) reactivation (CMVR) after allogeneic hematopoietic stem cell transplantation (HSCT) is well established, debate is ongoing on whether CMVR may reduce the risk of primary disease relapse. The aim of this study was to evaluate relapse protection following early CMV reactivation after HSCT in the context of the recipient HLA-C killer cell immunoglobulin-like receptor ligands (KIRLs). In this retrospective bicentric study, 406 matched related or unrelated donor transplantations for acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) were stratified by HLA-C KIRL group (homozygous versus heterozygous) and analyzed separately for the impact of early CMVR on the cumulative incidences of relapse, NRM, and acute and chronic graft-versus-host-disease (GVHD) using landmark and multistate analyses. By landmark analysis of patients alive and relapse-free at 45 days post-HSCT, HLA-C KIRL homozygous recipients (C1/1 or C2/2) had a lower risk of subsequent relapse if CMVR occurred before this landmark (subhazard ratio [sHR], 0.36; P = .002). In contrast, in HLA-C KIRL heterozygous (C1/2) recipients, early CMVR had no impact on subsequent relapse (sHR, 0.88; P = .63). NRM (sHR, 3.31; P < .001) and grade III-IV acute GVHD (sHR, 2.60; P = .04) were significantly increased after early CMVR in the homozygous cohort, but not in the heterozygous cohort (NRM: sHR, 1.23; P = .53; grade III-IV acute GVHD: sHR, 1.40; P = .50). Multivariable landmark analyses and a multistate model confirmed the limitation of the relapse-protective effect of early CMVR to the homozygous cohort. Chronic GVHD and overall survival were not influenced in neither cohort. An antileukemic effect of early CMVR after HSCT for AML/MDS was significant but strictly limited to recipients homozygous for HLA-C KIRL. However, particularly in this cohort, CMVR had an adverse impact on aGVHD and NRM.
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Affiliation(s)
- Alexander Nikoloudis
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - Helga Wagner
- Department of Applied Statistics: Medical Statistics and Biometry and Competence Center for Clinical Studies, Johannes Kepler University, Linz, Austria
| | - Sigrid Machherndl-Spandl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Irene Strassl
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Olga Stiefel
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Dagmar Wipplinger
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Robert Milanov
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Emine Kaynak
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Petra Hasengruber
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Michaela Binder
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Ansgar Weltermann
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Dominik Wolf
- University Hospital of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Nachbaur
- University Hospital of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Clausen
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University, Linz, Austria
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31
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Niedersüß-Beke D, Orlinger M, Falch D, Heiler C, Piringer G, Thaler J, Hilbe W, Petzer A, Rumpold H. Clinical Effectiveness of Oncological Treatment in Metastatic Colorectal Cancer Is Independent of Comorbidities and Age. Cancers (Basel) 2021; 13:cancers13092091. [PMID: 33925931 PMCID: PMC8123394 DOI: 10.3390/cancers13092091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Colorectal cancer (CRC) is the third most common cancer worldwide. As with many other cancers, the risk for CRC increases with age. This is also true for comorbidities, which may hamper sufficient treatment of the cancer. Due to restrictive inclusion criteria, older patients and patients with comorbidities are underrepresented in clinical trials. Comprehensive knowledge about modern effectiveness of oncological treatments in older and/or comorbid patients is sparse. Due to the lack of clinical trials, this issue is investigated in real-life settings predominantly. In our retrospective study we show that patients benefit from oncological treatments irrespective of comorbidities, measured by the age-adjusted Charlson Comorbity (aaCCI) index, and age. Differences found in treatment outcomes are marginal and are likely due to less intense treatment of comorbid or elderly patients. Balancing risk and benefit for treatment decisions should take potential under-treatment of comorbid and older patients into account. Abstract We aimed to investigate the effectiveness of oncological treatments in metastatic CRC related to comorbidities and age. This retrospective study included 1105 patients from three oncological centers. aaCCI and CCI was available from 577 patients. An aaCCI > 3 was of the highest predictive value compared to other aaCCI-levels, CCI or age (p < 0.001 for all). Treatment (best supportive care (BSC), systemic treatment only (STO) and resection of metastases (ROM)) significantly prolonged survival in patients with aaCCI > 3 (STO: HR 0.39, CI 0.29–0.51; ROM: HR 0.16, CI 0.10–0.24) and patients older than 70 years (STO: HR 0.56, CI 0.47–0.66; ROM: HR 0.23, 0.18–0.30). Median overall survival was shorter in patients with aaCCI or age > 70 years and interaction for treatment type not significant for aaCCI, but significant for age older or younger than 70 years (STO: p = 0.01; ROM p = 0.02). BSC is more often considered as optimal care for patients with an aaCCI > 3 (37.6% vs. 12.4%; p < 0.001) or age > 70 years (35.7% vs. 11.2%; p < 0.001). Older patients or patients with comorbidities benefit from cancer-specific therapy independently of their age and comorbidities.
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Affiliation(s)
- Dora Niedersüß-Beke
- Department of Internal Medicine I, Wilhelminenspital, 1160 Vienna, Austria; (D.N.-B.); (D.F.); (C.H.); (W.H.)
| | - Manuel Orlinger
- Department of Hematology and Medical Oncology, Ordensklinikum Linz, 4010 Linz, Austria; (M.O.); (A.P.)
| | - David Falch
- Department of Internal Medicine I, Wilhelminenspital, 1160 Vienna, Austria; (D.N.-B.); (D.F.); (C.H.); (W.H.)
| | - Cordula Heiler
- Department of Internal Medicine I, Wilhelminenspital, 1160 Vienna, Austria; (D.N.-B.); (D.F.); (C.H.); (W.H.)
| | - Gudrun Piringer
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, 4600 Wels, Austria; (G.P.); (J.T.)
- Medical Faculty, Johannes Kepler University Linz, 4020 Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, 4600 Wels, Austria; (G.P.); (J.T.)
| | - Wolfgang Hilbe
- Department of Internal Medicine I, Wilhelminenspital, 1160 Vienna, Austria; (D.N.-B.); (D.F.); (C.H.); (W.H.)
| | - Andreas Petzer
- Department of Hematology and Medical Oncology, Ordensklinikum Linz, 4010 Linz, Austria; (M.O.); (A.P.)
| | - Holger Rumpold
- Medical Faculty, Johannes Kepler University Linz, 4020 Linz, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, 4010 Linz, Austria
- Correspondence:
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32
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Ludwig H, Hausmann B, Schreder M, Pönisch W, Zojer N, Knop S, Gunsilius E, Egle A, Petzer A, Einsele H, Hajek R, Weisel K, Krenosz KJ, Lang A, Lechner D, Greil R, Berry D. Reduced alpha diversity of the oral microbiome correlates with short progression-free survival in patients with relapsed/refractory multiple myeloma treated with ixazomib-based therapy (AGMT MM 1, phase II trial). EJHaem 2021; 2:99-103. [PMID: 35846090 PMCID: PMC9176146 DOI: 10.1002/jha2.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 01/03/2023]
Abstract
Alterations in the human microbiome have been linked to several malignant diseases. Here, we investigated the oral microbiome of 79 patients with relapsed/refractory multiple myeloma (MM) treated with ixazomib‐thalidomide‐dexamethasone. Increased alpha diversity (Shannon index) at the phylum level was associated with longer progression‐free survival (PFS) (10.2 vs 8.5 months, P = .04), particularly in patients with very long (>75% quartile) PFS . Additionally, alpha diversity was lower in patients with progressive disease (P < .05). These findings suggest an interrelationship between the oral microbiome and outcome in patients with MM and encourage a novel direction for diagnostic and/or therapeutic strategies.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute Vienna Austria
| | - Bela Hausmann
- Joint Microbiome Facility (JMF) Medical University of Vienna & University of Vienna Vienna Austria.,Department of Laboratory Medicine Medical University of Vienna Vienna Austria
| | - Martin Schreder
- Division of Hematology and Medical Oncology Department of Internal Medicine II Würzburg University Medical Center Würzburg Germany
| | - Wolfram Pönisch
- Department of Hematology University of Leipzig Leipzig Germany
| | - Niklas Zojer
- Department of Medicine I Wilhelminenspital Vienna Austria
| | - Stefan Knop
- Division of Hematology and Medical Oncology Department of Internal Medicine II Würzburg University Medical Center Würzburg Germany
| | - Eberhard Gunsilius
- Department of Internal Medicine V Medical University Innsbruck Innsbruck Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology Medical Oncology, Hemostaseology Infectiology and Rheumatology Oncologic Center Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR) Paracelsus Medical University Cancer Cluster Salzburg Salzburg Austria
| | - Andreas Petzer
- Department of Internal Medicine I Ordensklinikum Linz BHS-EKH, Linz Linz Austria
| | - Hermann Einsele
- Division of Hematology and Medical Oncology Department of Internal Medicine II Würzburg University Medical Center Würzburg Germany
| | - Roman Hajek
- Department of Hematooncology University Hospital Ostrava Ostrava Czech Republic
| | | | - Karl Jochen Krenosz
- Department of Internal Medicine 3 Kepler Universitätsklinikum GmbH Med Campus III Linz Austria
| | - Alois Lang
- Innere Medizin II LKH Feldkirch Feldkirch Austria
| | - Daniel Lechner
- Department of Medicine I - Hematology with Stem Cell Transplantation Hemostaseology and Medical Oncology Ordensklinikum Linz Elisabethinen Linz Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology Medical Oncology, Hemostaseology Infectiology and Rheumatology Oncologic Center Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR) Paracelsus Medical University Cancer Cluster Salzburg Salzburg Austria
| | - David Berry
- Joint Microbiome Facility (JMF) Medical University of Vienna & University of Vienna Vienna Austria.,Division of Microbial Ecology Department of Microbiology and Ecosystem Science Centre for Microbiology and Environmental Systems Science University of Vienna Vienna Austria
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Prager GW, Oehler L, Gerger A, Mlineritsch B, Andel J, Petzer A, Wilthoner K, Sliwa T, Pichler P, Winder T, Heibl S, Gruenberger B, Laengle F, Hubmann E, Korger M, Pecherstorfer M, Djanani A, Neumann HJ, Philipp-Abbrederis K, Wöll E, Trondl R, Arnold-Schrauf C, Eisterer W. Comparison of nab-paclitaxel plus gemcitabine in elderly versus younger patients with metastatic pancreatic cancer: Analysis of a multicentre, prospective, non-interventional study. Eur J Cancer 2020; 143:101-112. [PMID: 33296830 DOI: 10.1016/j.ejca.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatic cancer (PC) ranks among the deadliest malignancies worldwide. In the MPACT study, first-line nab-paclitaxel plus gemcitabine (nab-P/G) demonstrated activity (median overall survival [OS], 8.7 months) and tolerability in patients with metastatic PC (mPC). However, the clinical evidence of nab-P/G in the elderly (>70 years), who account for the majority of patients with mPC, is limited. This is the first prospective, multicentre, non-interventional study evaluating the tolerability and effectiveness of nab-P/G in younger (≤70 years) versus elderly (>70 years) patients with mPC in the daily clinical routine. METHODS Eligible patients with mPC were treated with nab-P/G and observed until disease progression or unacceptable toxicity. The primary objectives were safety and tolerability of nab-P/G, and the secondary objectives were efficacy and real-life dosing. RESULTS A total of 317 patients with mPC (median age, 70 years) were recruited, of which 299, aged ≤70 (n = 162) and >70 (n = 137) years, were eligible for analysis. Baseline characteristics and the safety profile were comparable between the groups. However, fatigue (22.8% versus 13.0%) and decreased appetite (8.8% versus 1.2%) were more frequent in elderly patients. Younger versus elderly patients equally benefited in terms of objective response rate (36% versus 48%), median progression-free survival (5.6 versus 5.5 months; hazard ratio [HR] = 1.03; p = 0.81) and OS (10.6 versus 10.2 months; HR = 0.89; p = 0.4). In addition, the median treatment duration (5 versus 4 cycles), relative dose intensity (70% versus 74%) or reasons for treatment discontinuation were similar. Most patients (56.2% versus 47.4%) benefited from a second-line therapy. CONCLUSION This prospective real-world analysis confirms the feasibility and tolerability of nab-P/G treatment and reveals OS data similar for younger patients and elderly patients aged >70 years. CLINICALTRIALS. GOV REGISTRATION NCT02555813. AUSTRIAN NIS REGISTRY NIS005071.
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Affiliation(s)
- Gerald W Prager
- Medical University of Vienna, Department of Oncology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Leopold Oehler
- Sankt Josef Krankenhaus, Internal Medicine 2, Auhofstraße 189, 1130, Vienna, Wien, Austria.
| | - Armin Gerger
- Medical University of Graz, Clinical Institute of Oncology, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Brigitte Mlineritsch
- Universitätsklinik Salzburg, University Clinic for Internal Medicine III, Müllner Haupstraße 48, 5020, Salzburg, Austria.
| | - Johannes Andel
- Pyhrn-Eisenwurzen Klinikum, Internal Medicine II, Sierningerstraße 170, 4400, Steyr, Austria.
| | - Andreas Petzer
- Ordensklinikum Linz BHS - EKH, Internal Medicine I, Medical Oncology and Hematology, Seilerstätte 4, 4010, Linz Austria.
| | - Klaus Wilthoner
- Landeskrankenhaus Vöcklabruck, Vöcklabruck, Internal Medicine, Hemato-Oncology, Dr. Wilhelm-Bock-Straße 1, 4840 Vöcklabruck, Austria.
| | - Thamer Sliwa
- Hanuschkrankenhaus, Medicine III for Hematology and Oncology, Heinrich-Collin-Straße 30, 1140, Wien, Vienna, Austria.
| | - Petra Pichler
- Universitätsklinikum St. Pölten, Internal Medicine I, Dunant-Platz 1, 3100, Sankt Pölten, Austria.
| | - Thomas Winder
- Landeskrankenhaus Feldkirch, Internal Medicine II, Carinagasse 47, 6807, Feldkirch, Austria.
| | - Sonja Heibl
- Klinikum Wels-Grieskirchen, Internal Medicine IV, Grieskirchner Straße 42, 4600, Wels, Austria.
| | - Birgit Gruenberger
- Landesklinikum Wiener Neustadt, Internal Medicine for Hematology and Internal Oncology, Corvinusring 2-5, 2700, Wiener Neustadt, Austria.
| | - Friedrich Laengle
- Landesklinikum Wiener Neustadt, Department of Surgery, Corvinusring 2-5, 2700, Wiener Neustadt, Austria.
| | - Eva Hubmann
- Krankenhaus der Barmherzigen Brüder, Internal Medicine, Marschallgasse 12, 8020, Graz, Austria.
| | - Markus Korger
- Krankenhaus der Barmherzigen Brüder, Internal Medicine II, Johannes von Gott-Platz 1, 7000, Eisenstadt, Austria.
| | - Martin Pecherstorfer
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine, University Hospital, 3500, Krems an der Donau, Austria.
| | - Angela Djanani
- Medical University of Innsbruck, Institute of Gastroenterology, Internal Medicine I, Institute of Gastroenterology, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Hans-Joerg Neumann
- Krankenhaus der Elisabethinen, Internal Medicine, Völkermarkter Straße 15-19, 9020, Klagenfurt, Austria.
| | - Kathrin Philipp-Abbrederis
- Medical University of Innsbruck, Institute of Hematology and Oncology, Internal Medicine V, Institute of Hematology and Oncology, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Ewald Wöll
- Krankenhaus Zams, Internal Medicine, Sanatoriumstraße 43, 6511, Zams, Austria.
| | - Robert Trondl
- Celgene Austria GmbH, EuroPlaza Building E, Technologiestraße 10, 1120, Vienna, Austria.
| | | | - Wolfgang Eisterer
- Klinikum Klagenfurt Am Wörthersee, Internal Medicine and Oncology, Feschnigstraße 11, 9020, Klagenfurt, Austria.
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Buxhofer-Ausch V, Heibl S, Sliwa T, Beham-Schmid C, Wolf D, Geissler K, Krauth MT, Krippl P, Petzer A, Wölfler A, Melchardt T, Gisslinger H. Austrian recommendations for the management of essential thrombocythemia. Wien Klin Wochenschr 2020; 133:52-61. [PMID: 33215234 DOI: 10.1007/s00508-020-01761-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
According to the World Health Organization (WHO) classification, essential (primary) thrombocythemia (ET) is one of several Bcr-Abl negative chronic myeloproliferative neoplasms (MPN). The classical term MPN covers the subcategories of MPN: ET, polycythemia vera (PV), primary myelofibrosis (PMF), and prefibrotic PMF (pPMF). ET is marked by clonal proliferation of hematopoietic stem cells, leading to a chronic overproduction of platelets. At the molecular level a JAK2 (Janus Kinase 2), calreticulin, or MPL mutation is found in the majority of patients. Typical ongoing complications of the disease include thrombosis and hemorrhage. Primary and secondary prevention of these complications can be achieved with platelet function inhibitors and various cytoreductive drugs including anagrelide, hydroxyurea and interferon. After a long follow up, in a minority of ET patients the disease transforms into post-ET myelofibrosis or secondary leukemia. Overall, life expectancy with ET is only slightly decreased.
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Affiliation(s)
- Veronika Buxhofer-Ausch
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020, Linz, Austria. .,Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Austria.
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Dominik Wolf
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Geissler
- 5th Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - Maria Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine with Hematology and Oncology, Steiermärkische Krankenanstaltengesellschaft m. b. H. Krankenhausverbund Feldbach-Fürstenfeld, Fürstenfeld, Austria
| | - Andreas Petzer
- Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Austria.,Departments of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
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Wundsam HV, Doleschal B, Prommer R, Venhoda C, Schmitt C, Petzer A, Metz-Gercek S, Rumpold H. Clinical Outcome in Patients with Carcinoma of the Esophagogastric Junction Treated with Neoadjuvant Radiochemotherapy or Perioperative Chemotherapy: A Two-Center Retrospective Analysis. Oncology 2020; 98:706-713. [PMID: 32516775 DOI: 10.1159/000507706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adenocarcinoma of the esophagogastric junction (AEG) is a rare but rising tumor entity in the Western world. Treatment is complex, as multimodality is key to optimal results. However, trials solely including AEG are rare, and the question if neoadjuvant radiochemotherapy (NRCT) or neoadjuvant/perioperative chemotherapy (NACT) is superior remains unanswered. PATIENTS AND METHODS Patients with AEG I-III treated between October 2010 and August 2019 at the Ordensklinikum Linz or the Kepler University Hospital were identified either from a monitored tumor registry or by chart review. Time-to-event data were analyzed by Kaplan-Meier product limit estimation. The Kruskal-Wallis test and Fisher's exact test were used for comparing continuous and categorical data, respectively. RESULTS A total of 85 patients (median age 63 years; median Charlson Comorbidity Index 3; 98.8% ECOG PS 0-1) were analyzed. Of these, 52 patients received NRCT (81% CROSS protocol) and 33 NACT (65% EOX and 35% FLOT protocol). There was a significantly higher pathological complete response rate in the NRCT group (30 vs. 12%; p = 0.010); distant relapse rates were higher in the NRCT group and local relapse rates were higher in the NACT group (both not significant). These differences, however, did not translate into a different disease-free survival (20 months; 95% CI: 13-34) or overall survival (44 months; 95% CI: 33-NA). Patients >65 years old had the same advantage from treatment as patients <65 years of age. CONCLUSIONS Although treatment of AEG is complex, the progress documented over the last centuries can be reproduced in our real-life setting. Data regarding the superiority of either type of neoadjuvant/perioperative treatment are sparse. We assume no difference between EOX-based NACT and NRCT.
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Affiliation(s)
| | - Bernhard Doleschal
- Department of Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria
| | - Regina Prommer
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
| | - Clemens Venhoda
- Department of Radiation Oncology, Ordensklinikum Linz, Linz, Austria
| | - Clemens Schmitt
- Department of Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria
| | - Andreas Petzer
- Department of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | | | - Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria,
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Riedl JM, Posch F, Prager G, Eisterer W, Oehler L, Sliwa T, Wilthoner K, Petzer A, Pichler P, Hubmann E, Winder T, Burgstaller S, Korger M, Andel J, Greil R, Neumann HJ, Pecherstorfer M, Philipp-Abbrederis K, Djanani A, Gruenberger B, Laengle F, Wöll E, Gerger A. The AST/ALT (De Ritis) ratio predicts clinical outcome in patients with pancreatic cancer treated with first-line nab-paclitaxel and gemcitabine: post hoc analysis of an Austrian multicenter, noninterventional study. Ther Adv Med Oncol 2020; 12:1758835919900872. [PMID: 32313566 PMCID: PMC7153180 DOI: 10.1177/1758835919900872] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background: The pretreatment De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)] has been shown to be an adverse prognostic marker in various cancer entities. However, its relevance to advanced pancreatic ductal adenocarcinoma (PDAC) has not yet been studied. In the present study we investigated the AST/ALT ratio as a possible predictor of treatment response and disease outcome in patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel. Methods: A post hoc analysis of a prospective, multicenter, noninterventional study was performed. A total of 202 patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel for whom the AST/ALT ratio was measured were included in this analysis. Results: Median and 1-year progression-free survival estimates were 4.8 months and 5.1%, respectively in patients with an AST/ALT ratio above the 75th percentile of its distribution, and 6.0 months and 18.7%, respectively in patients with an AST/ALT ratio less than or equal to this cutoff, respectively (log-rank p = 0.004). In univariable Cox regression, a doubling of the AST/ALT ratio was associated with a 1.4-fold higher relative risk of progression or death [hazard ratio = 1.38, 95% confidence interval (CI): 1.06–1.80, p = 0.017]. The prognostic association was also found in multivariable analysis adjusting for Eastern Cooperative Oncology Group performance status and lung metastases (hazard ratio per AST/ALT ratio doubling = 1.32, 95% CI: 1.00–1.75, p = 0.047). In treatment response analysis, a doubling of the AST/ALT ratio was associated with a 0.5-fold lower odds of objective response (odds ratio = 0.54, 95% CI: 0.31–0.94, p = 0.020). Conclusions: The pretreatment serum AST/ALT ratio predicts poor disease outcome and response rate in patients with advanced PDAC treated with gemcitabine/nab-paclitaxel and might represent a novel and inexpensive marker for individual risk assessment in the treatment of pancreatic cancer.
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Affiliation(s)
- Jakob Michael Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Eisterer
- Department of Internal Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße Sarcoma Platform Austria, Austria
| | - Leopold Oehler
- Department of Medicine, St. Joseph Hospital, Vienna, Vienna, Austria
| | - Thamer Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Andreas Petzer
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Petra Pichler
- Universitätsklinikum St. Pölten, Sankt Pölten, Austria
| | - Eva Hubmann
- Department of Internal Medicine 1, Hospital of the Brothers of St. John of God, Graz, Austria
| | - Thomas Winder
- Division of Oncology, Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Sonja Burgstaller
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Korger
- Krankenhaus der barmherzigen Brüder, Eisenstadt, Austria
| | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
| | | | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Kathrin Philipp-Abbrederis
- Department of Internal Medicine I, Gastroenterology, Hepatology, Metabolism & Endocrinology, Medical University Innsbruck, Innsbruck, Austria
| | - Angela Djanani
- Department of Internal Medicine I, Gastroenterology, Hepatology, Metabolism & Endocrinology, Medical University Innsbruck, Innsbruck, Austria
| | - Birgit Gruenberger
- Department of Surgery, Landesklinikum Wr. Neustadt, Wr. Neustadt, Austria
| | - Friedrich Laengle
- Department of Surgery, Landesklinikum Wr. Neustadt, Wr. Neustadt, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital Zams, Sanatoriumstrasse, Zams, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Tinchon C, Fuchs D, Balic M, Heibl S, Rumpold H, Egle D, Zabernigg AF, Singer CF, Andel J, Hubalek M, Knauer M, Greil R. Abstract P5-06-29: Prognosis of triple negative metastatic breast cancer (MBC): Results from the AGMT_MBC-Registry. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-06-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. In recent years, major progress has been made in the treatment of metastatic breast cancer (MBC), especially for hormone receptor (HR) positive and HER2 positive MBC. In contrast, for most TNBC patients no targeted treatment options are available. Population-based data on overall survival (OS) of triple negative MBC are scarce and were totally missing for the Austrian population. Here, we present the overall survival (OS) results of triple-negative breast cancer patients included the MBC registry of the Austrian Study Group for Medical Tumor Therapy (AGMT). Patients and methods: The AGMT_MBC-Registry is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. Unadjusted, univariate survival probabilities of OS were calculated by the Kaplan-Meier method and multivariate hazard ratios (HR) were estimated by Cox regression models. In this analysis only patients with triple-negative MBC with available survival data were included. Results: As of 31/01/2019, 1,253 patients were included in the AGMT-MBC-Registry. Out of 1,219 evaluable patients with available survival data, 192 (17.8%) were triple-negative. Mean age at diagnosis of MBC was 59 (range 27-89), 44 patients (22.9%) were diagnosed with de novometastatic disease, 89 patients (46.4%) with metachronous MBC had a disease free survival (DFS) < 24 months, 134 (69.8%) were treated with (neo)adjuvant therapy, 114 (59.4%) had visceral disease at diagnosis of MBC, and number of involved metastatic sites at diagnosis was 1 in 102 (53.1%), 2 in 49 (25.5%), 3 in 24 (12.5%) and > 3 sites in 17 (8.9%) patients. Fifty-nine patients (49.5%) received at least one treatment-line which included bevacizumab. Bevacizuamb was combined with capecitabine, paclitaxel and gemcitabine in 38, 68 and 5 patients, respectively. Median OS of TNBC was 15.2 months (95% CI 11.4-18.9), compared to 32.9 months (95% CI 29.7-35.7) in the overall cohort. In multivariate analysis including established risk factors and clinically relevant variables, only three variables were significantly associated with OS in TNBC patients: disease free survival (<24 months vs ≥ 24 months or de novo MBC: HR 1.80 [95% CI 1.29-2.51]), visceral disease (yes vs no: HR 1.75 [95% CI 1.22-2.52]), and number of metastatic sites at initial diagnosis (2-3 vs 1: HR 1.81 [95% CI 1.26-2.60], > 3 vs 1: HR 3.05 [95% CI 1.66-5.61]). Conclusion: The poor prognosis of TNBC was confirmed in this population-based analysis. Besides known prognostic factors like de novo metastatic disease, DFS and visceral disease, the number of metastatic sites at initial diagnosis was identified as a novel independent prognostic factor in TNBC.
Citation Format: Gabriel Rinnerthaler, Simon P Gampenrieder, Andreas Petzer, Christoph Tinchon, David Fuchs, Marija Balic, Sonja Heibl, Holger Rumpold, Daniel Egle, August F Zabernigg, Christian F Singer, Johannes Andel, Michael Hubalek, Michael Knauer, Richard Greil. Prognosis of triple negative metastatic breast cancer (MBC): Results from the AGMT_MBC-Registry [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-29.
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Affiliation(s)
| | | | - Andreas Petzer
- 2Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | | | | | | | - Sonja Heibl
- 6Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Holger Rumpold
- 7Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Daniel Egle
- 8Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Michael Knauer
- 13Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Richard Greil
- 1Paracelsus Medical University Salzburg, Salzburg, Austria
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Gampenrieder SP, Rinnerthaler G, Petzer A, Tinchon C, Fuchs D, Balic M, Heibl S, Rumpold H, Egle D, Zabernigg AF, Singer CF, Andel J, Hubalek M, Knauer M, Greil R. Abstract P3-08-29: Landscape of HER2-low metastatic breast cancer (MBC): Results from the AGMT-MBC-Registry. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: About 50% of all primary breast cancers show a low-level expression of HER2 (HER2-low), defined as immunohistochemically 1+ or 2+ and lack of HER2 gene amplification measured by in-situ hybridization. This low HER2 expression is a promising new target for antibody-drug conjugates (ADCs) currently under development. Until now, little is known about the frequency and the prognostic value of low HER2-expression in metastatic breast cancer (MBC). Patients and methods: The MBC-Registry of the Austrian Study Group of Medical Tumor Therapy (AGMT) is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. Unadjusted, univariate survival probabilities of PFS and OS were calculated by the Kaplan-Meier method and compared by the log-rank test, multivariate hazard ratios (HR) were estimated by Cox regression models. In this analysis patients with known HER2 status and available survival data were included. Results: As of 31/01/2019, 1,253 patients were included in the AGMT-MBC-Registry. Out of 1,079 evaluable patients, 262 (24.3%) were HER2-positive, 372 (34.5%) were HER2-low and 445 (41.2%) were completely HER2-negative (HER2-0). The distribution of hormone receptor (HR) expression is shown in Table 1. Median OS and median first-line PFS for these three subgroups in dependency of HR expression is presented in Table 2. Neither in univariate (p=0.821) nor in multivariate analysis including HR status, disease-free survival (DFS), age and visceral disease (p=0.590, HR 1.06), low HER2 expression had a significant impact on prognosis compared to completely HER2-negative disease. Overall 13/372 (3.5%) of the HER2-low and 11/445 (2.5%) of the HER2-0 patients received anti-HER2 treatment. In the HER2+ cohort 200/262 (76.3%) were treated with trastuzumab, 106 (40.5%) with pertuzumab and 49 (18.7%) with T-DM1. In the HR+ subgroup, 11/162 (6.8%), 78/302 (25.8%) and 89/323 (27.6%) patients were treated with a CDK4/6 inhibitor in the HER2+, HER2-low and HER2-0 subgroup, respectively. Conclusion: Low-HER2 expression did not have any impact on prognosis or choice of treatment in metastatic breast cancer in this real-world population.
Table 1HER2-positive (IHC 3+ or ISH+)HER2-low (IHC1+ or 2+ and ISH-)completely HER2-negative (IHC 0)All (n=1,079)262 (24.3%)372 (34.5%)445 (41.2%)HR+ (n=787)162 (20.6%)302 (38.4%)323 (41.0%)HR- (n=292)100 (34.2%)70 (24.0%)122 (41.8%)
Table 2HER2+ months (95%CI)HER2-low months (95%CI)HER2-0 months (95%CI)Log-rankPMedian OSAll (n=1,079)42.7 (32.5-52.9)32.2 (27.3-37.1)30.8 (26.0-35.7)0.007HR+ (n=787)49.6 (40.1-59.1)35.8 (31.4-40.2)40.5 (35.4-45.5)0.120HR- (n=292)26.4 (19.9-33.0)16.8 (12.9-20.7)14.3 (10.0-18.6)< 0.001Median 1st-line PFS All (n=913)*12.4 (10.1-14.8)11.0 (9.3-12.7)11.3 (9.6-12.9)0.123HR+ (n=684)*14.6 (10.8-18.4)12.4 (10.3-14.5)14.7 (12.1-17.4)0.348HR- (n=229)*11.0 (8.2-13.9)5.6 (3.9-7.2)6.0 (4.4-7.5)< 0.001* only patients with at least one line of therapy for metastatic disease and sufficiently documented medical records allowing calculation of PFS were included.
Citation Format: Simon Peter Gampenrieder, Gabriel Rinnerthaler, Andreas Petzer, Christoph Tinchon, David Fuchs, Marija Balic, Sonja Heibl, Holger Rumpold, Daniel Egle, August Felix Zabernigg, Christian Fridolin Singer, Johannes Andel, Michael Hubalek, Michael Knauer, Richard Greil. Landscape of HER2-low metastatic breast cancer (MBC): Results from the AGMT-MBC-Registry [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-29.
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Affiliation(s)
| | - Gabriel Rinnerthaler
- 1Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- 2Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | | | - David Fuchs
- 4Department of Hematology and Internal Oncology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Marija Balic
- 5Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- 6Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Holger Rumpold
- 7Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Daniel Egle
- 8Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Christian Fridolin Singer
- 10Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Johannes Andel
- 11Department of Internal Medicine II, Landeskrankenhaus Steyr, Steyr, Austria
| | - Michael Hubalek
- 12Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Michael Knauer
- 13Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Richard Greil
- 1Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
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Gampenrieder S, Rinnerthaler G, Petzer A, Tinchon C, Fuchs D, Balic M, Heibl S, Rumpold H, Egle D, Zabernigg A, Singer C, Andel J, Hubalek M, Knauer M, Greil R. Impact of pertuzumab and T-DM1 on prognosis of HER2-positive metastatic breast cancer (MBC) and factors affecting their efficacy: Results from the AGMT_MBC-registry. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ludwig H, Poenisch W, Knop S, Egle A, Schreder M, Lechner D, Hajek R, Gunsilius E, Krenosz KJ, Petzer A, Weisel K, Niederwieser D, Einsele H, Willenbacher W, Melchardt T, Greil R, Zojer N. Ixazomib-Thalidomide-Dexamethasone for induction therapy followed by Ixazomib maintenance treatment in patients with relapsed/refractory multiple myeloma. Br J Cancer 2019; 121:751-757. [PMID: 31558804 PMCID: PMC6889132 DOI: 10.1038/s41416-019-0581-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Ixazomib-revlimid-dexamethason showed significant activity in relapsed/refractory multiple myeloma (RRMM). Here, we evaluate ixazomib in combination with thalidomide and dexamethasone for induction treatment followed by ixazomib maintenance therapy in RRMM patients. Methods Ninety patients have been included. Ixazomib–thalidomide–dexamethasone (4 mg, day 1, 8, 15; 100 mg daily; and 40 mg weekly) was scheduled for eight cycles followed by maintenance with ixazomib for one year. Results The overall response rate was 51.1%, 23.3% achieved CR or VGPR and 10% MR resulting in a clinical benefit rate of 61.1%. In patients completing ≥2 cycles, the rates were 60.5%, 27.6% and 68.4%, respectively. Median progression-free survival (PFS) was 8.5 months in all, and 9.4 months in those completing ≥2 cycles. Response rates, PFS and overall survival (OS) were similar in patients with and without t(4;14) and/or del(17p), but PFS and OS was significantly shorter in patients with gain of 1q21. Multivariate regression analysis revealed gain of 1q21 as the most important factor associated with OS. Ixazomib maintenance resulted in an upgrade in the depth of response in 12.4% of patients. Grade 3/4 toxicities were relatively rare. Conclusions Ixazomib–thalidomide–dexamethasone followed by ixazomib maintenance therapy is active and well tolerated in patients with RRMM. Trial registration number NCT02410694
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria.
| | - Wolfram Poenisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Martin Schreder
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria
| | - Daniel Lechner
- Department of Medicine I-Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Roman Hajek
- Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Karl Jochen Krenosz
- Department of Internal Medicine 3, Kepler Universitaetsklinikum GmbH, Med Campus III, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Linz-Barmherzige Schwestern, Linz, Austria
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany and University of Tuebingen, Tuebingen, Germany
| | | | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.,Oncotyrol, Center for personalized Cancer Medicine, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Niklas Zojer
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria
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Ludwig H, Pönisch W, Knop S, Egle A, Hinke A, Schreder M, Lechner D, Hajek R, Gunsilius E, Petzer A, Weisel K, Niederwieser D, Einsele H, Willenbacher W, Rumpold H, Pour L, Jelinek T, Krenosz KJ, Meckl A, Nolte S, Melchardt T, Greil R, Zojer N. Quality of life in patients with relapsed/refractory multiple myeloma during ixazomib-thalidomide-dexamethasone induction and ixazomib maintenance therapy and comparison to the general population. Leuk Lymphoma 2019; 61:377-386. [PMID: 31556753 DOI: 10.1080/10428194.2019.1666381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This trial evaluated quality of life (QoL) using the EORTC QLQ-C30 and the EORTC QLQ-MY20 instruments in 90 patients with relapsed/refractory multiple myeloma during induction and maintenance therapy with eight cycles of ixazomib-thalidomide-dexamethasone, followed by 12 months of ixazomib maintenance therapy. When patient's baseline QoL was compared with data of the general population, a significant impairment in health-related QoL, physical, role, and social functioning and several other dimensions, as well as more pain and fatigue, was noted. Induction therapy resulted in significant improvement of pain and worsening of neuropathy, with no significant variation of other parameters. During maintenance treatment, scores for most dimensions including health-related QoL, physical functioning and pain, improved, while for neuropathy no improvement was observed. Time to deterioration (≥10 score points) of health-related QoL, physical functioning, pain, and neuropathy was distinctly shorter than time to progression. Health-related QoL and physical functioning at baseline correlated with overall survival.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Wolfram Pönisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Martin Schreder
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Daniel Lechner
- Department of Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Roman Hajek
- Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Linz - Barmherzige Schwestern, Linz, Austria
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.,Oncotyrol, Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Karl Jochen Krenosz
- Department of Internal Medicine 3, Kepler Universitaetsklinikum GmbH, Med. Campus III, Linz, Austria
| | - Angela Meckl
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Sandra Nolte
- Medical Department, Division of Psychosomatic Medicine, Charité- Universitätsmedizin, Berlin, Germany
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Niklas Zojer
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
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42
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Haslbauer F, Petzer A, Safanda M, Tomova A, Porubska M, Bajory Z, Niepel D, Jaeger C, Bjorklof K, Kalinin D, Greil R. Prospective observational study to evaluate the persistence of treatment with denosumab in patients with bone metastases from solid tumors in routine clinical practice: final analysis. Support Care Cancer 2019; 28:1855-1865. [PMID: 31350601 PMCID: PMC7036060 DOI: 10.1007/s00520-019-04988-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/08/2019] [Indexed: 11/01/2022]
Abstract
PURPOSE In the integrated analysis of phase III head-to-head trials in patients with advanced solid tumors, denosumab demonstrated superiority over zoledronic acid in preventing skeletal-related events (SREs). Regular and continued drug use (persistence) is a precondition of clinical efficacy; persistence in real-life is yet undetermined for denosumab. METHODS This was a single-arm, prospective, observational, non-interventional study in 598 patients with bone metastases from breast, prostate, lung, or other solid tumors treated with denosumab every four weeks in real-world clinical practice in Austria, Czech Republic, Hungary, Slovakia, and Bulgaria. Persistence was defined as denosumab administration at ≤ 35-day intervals over 24 or 48 weeks, respectively. RESULTS Previous SREs were found in 10.9% of patients. 62.6% were persistent over 24 weeks and 40.1% over 48 weeks. The Kaplan-Meier median (95% CI) time to non-persistence was 274.0 days (232.0, 316.0). The most frequent reason for non-persistence was delayed administration. There was a trend towards weaker analgesics over time, with approximately 60% of patients not requiring any analgesics. Serum calcium remained within the normal range throughout the study. Adjudicated osteonecrosis of the jaw was documented in three patients with an incidence per patient-year (95% CI) of 0.012 (0.004, 0.029). CONCLUSIONS Most patients received denosumab regularly once every four weeks over 24 weeks of treatment. Non-persistence was mainly due to delayed administration. The incidence of adverse drug reactions, especially of osteonecrosis of the jaw, was in line with expectations from previous studies.
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Affiliation(s)
- Ferdinand Haslbauer
- Abteilung für Innere Medizin, Salzkammergut Klinikum Vöcklabruck, Dr.-Wilhelm-Bock-Straße 1, A-4840, Vöcklabruck, Austria.
| | - Andreas Petzer
- Ordensklinikum Linz Barmherzige Schwestern/Elisabethinen, Linz, Austria
| | | | | | | | | | - Daniela Niepel
- Global Medical Affairs, Amgen GmbH, Europe HQ, Rotkreuz, Switzerland
| | | | - Katja Bjorklof
- Medical Affairs, Amgen (Europe North East), Rotkreuz, Switzerland
| | | | - Richard Greil
- Paracelsus Medizinische Privatuniversität, Salzburger Landeskliniken - Universitätsklinikum Salzburg, Salzburg Cancer Research Institute, Salzburg, Austria
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43
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Geissler K, Jäger E, Barna A, Gurbisz M, Marschon R, Graf T, Graf E, Borjan B, Jilch R, Geissler C, Hoermann G, Esterbauer H, Schwarzinger I, Nösslinger T, Pfeilstöcker M, Tüchler H, Reisner R, Sliwa T, Keil F, Bettelheim P, Machherndl-Spandl S, Doleschal B, Zach O, Weltermann A, Heibl S, Thaler J, Zebisch A, Sill H, Stauder R, Webersinke G, Petzer A, Kusec R, Ulsperger E, Schneeweiss B, Berger J, Öhler L, Germing U, Sperr WR, Knöbl P, Jäger U, Valent P. The Austrian biodatabase for chronic myelomonocytic leukemia (ABCMML) : A representative and useful real-life data source for further biomedical research. Wien Klin Wochenschr 2019; 131:410-418. [PMID: 31321531 PMCID: PMC6748886 DOI: 10.1007/s00508-019-1526-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022]
Abstract
In the Austrian biodatabase for chronic myelomonocytic leukemia (ABCMML) clinicolaboratory real-life data have been captured from 606 CMML patients from 14 different hospitals over the last 30 years. It is the only large biodatabase worldwide in which functional methods such as semisolid in vitro cultures complement modern molecular methods such as next generation sequencing. This provides the possibility to comprehensively study the biology of CMML. The aim of this study was to compare patient characteristics with published CMML cohorts and to validate established prognostic parameters in order to examine if this real-life database can serve as a representative and useful data source for further research. After exclusion of patients in transformation characteristics of 531 patients were compared with published CMML cohorts. Median values for age, leukocytes, hemoglobin, platelets, lactate dehydrogenase (LDH) and circulating blasts were within the ranges of reported CMML series. Established prognostic parameters including leukocytes, hemoglobin, blasts and adverse cytogenetics were able to discriminate patients with different outcome. Myeloproliferative (MP) as compared to myelodysplastic (MD)-CMML patients had higher values for circulating blasts, LDH, RAS-pathway mutations and for spontaneous myelomonocytic colony growth in vitro as well as more often splenomegaly. This study demonstrates that the patient cohort of the ABCMML shares clinicolaboratory characteristics with reported CMML cohorts from other countries and confirms phenotypic and genotypic differences between MP-CMML and MD-CMML. Therefore, results obtained from molecular and biological analyses using material from the national cohort will also be applicable to other CMML series and thus may have a more general significance.
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Affiliation(s)
- Klaus Geissler
- Sigmund Freud University, Vienna, Austria. .,Department of Internal Medicine V with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Wolkersbergenstraße 1, 1130, Vienna, Austria.
| | - Eva Jäger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Agnes Barna
- Blood Transfusion Service, Blood Transfusion Service for Upper Austria, Austrian Red Cross, Linz, Austria
| | - Michael Gurbisz
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Renate Marschon
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Temeida Graf
- Department of Internal Medicine V with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Elmir Graf
- Department of Internal Medicine V with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Bojana Borjan
- Internal Medicine V with Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ruth Jilch
- Department of Laboratory Medicine, Hospital Hietzing, Vienna, Austria
| | | | - Gregor Hoermann
- Central Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Esterbauer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Nösslinger
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | | | - Heinz Tüchler
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | - Regina Reisner
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | - Thamer Sliwa
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | - Felix Keil
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | - Peter Bettelheim
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Sigrid Machherndl-Spandl
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Bernhard Doleschal
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Otto Zach
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Ansgar Weltermann
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Armin Zebisch
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Sill
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Reinhard Stauder
- Internal Medicine V with Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerald Webersinke
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I with Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Rajko Kusec
- School of Medicine, University of Zagreb, University Hospital Dubrava, Zagreb, Croatia
| | - Ernst Ulsperger
- Department of Internal Medicine, Hospital Horn, Horn, Austria
| | - Bruno Schneeweiss
- Department of Internal Medicine, Hospital Kirchdorf, Kirchdorf, Austria
| | - Jörg Berger
- Department of Internal Medicine, Hospital Schwarzach, Schwarzach, Austria
| | - Leopold Öhler
- Department of Internal Medicine/Oncology, St. Josef Hospital, Vienna, Austria
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology (LBI HO), Medical University of Vienna, Vienna, Austria
| | - Paul Knöbl
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jäger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology (LBI HO), Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology (LBI HO), Medical University of Vienna, Vienna, Austria
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Riedl J, Posch F, Prager G, Eisterer W, Öhler L, Thamer S, Wilthoner K, Petzer A, Pichler P, Hubmann E, Winder T, Burgstaller S, Korger M, Andel J, Greil R, Pecherstorfer M, Philipp-Abbrederis K, Djanani A, Gruenberger B, Längle F, Wöll E, Gerger A. The AST/ALT (De Ritis) ratio predicts clinical outcome in pancreatic cancer patients treated with first-line nab-paclitaxel and gemcitabine: post-hoc analysis of an Austrian multicenter, non-interventional study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Viljoen FP, Preez JLD, Petzer A, Wessels JC, Petzer J, Aucamp ME. Development and validation of a HPLC electrochemical detection method to measure COMT activity as a tool in drug development. Pharmazie 2019; 74:270-276. [PMID: 31109396 DOI: 10.1691/ph.2019.8218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The determination of catechol-O-methyltransferase (COMT) activity is considered valuable for various pharmaceutical and biomedical research projects. A specific high performance liquid chromatography-coulometric electrochemical detection method, for the assay of COMT activity was developed by measuring the formation of normetanephrine from norepinephrine. The chromatographic separation was achieved on a C18 reversed phase column with a mobile phase consisting of 10 mM sodium dihydrogen phosphate buffer, 4 mM sodium 1-octanesulfonate, 0.17 mM ethylenediaminetetra-acetic acid disodium salt, 6 % methanol and 4 % acetonitrile (pH ± 4.0). The detection of normetanephrine was achieved through electrochemical detection, with a coulometric cell potential setting of +450 mV. The flow rate was at 1 ml/min and the total run time was 45 min. The method was validated according to validation guidelines (Shabir 2006; European Medicines Agency 2011; US FDA 2018). The method was found to be linear (R² > 0.99) over the analytical range (100 to 2500 ng/ml) for all the analytes. All the other validation parameters (sensitivity, precision, accuracy, recovery and stability) were acceptable and within range. The method was applied for the determination of COMT activity in rat liver homogenate test samples. The known selective COMT inhibitor entacapone was used as test inhibitor. The results confirmed the ability of entacapone to inhibit COMT activity by decreasing the production of all the metabolites of norepinephrine.
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Egle A, Melchardt T, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Voskova D, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Weiss L, Magnes T, Pleyer L, Klingler A, Mayer J, Greil R. Rituximab maintenance overcomes the negative prognostic factor of obesity in CLL: Subgroup analysis of the international randomized AGMT CLL-8a mabtenance trial. Cancer Med 2019; 8:1401-1405. [PMID: 30888118 PMCID: PMC6488104 DOI: 10.1002/cam4.1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022] Open
Abstract
No data are available regarding obesity and outcome in Chronic Lymphocytic Leukemia (CLL). We analyzed 263 patients from the AGMT CLL‐8a Mabtenance trial for the impact of obesity. The trial included patients after rituximab‐containing induction treatment in first or second line that had achieved at least a PR. A randomization to rituximab maintenance treatment (375 mg/m2 q3 months for 2 years) vs observation was performed. In this cohort 22% of the patients (58/263) were classified as obese. The baseline response to induction treatment was inferior in obese patients with a lower CR rate (43.1% vs 60.5% in obese vs non‐obese, P = 0.018) and with a lower rate of patients achieving MRD negativity after chemoimmunotherapy induction treatment (19.6% vs 35.8%, P = 0.02). The PFS outcome of obese patients was significantly worse in the observation group of the trial (24 vs 39 months median PFS, P = 0.03). However, in the rituximab maintenance group the outcome for obese vs non‐obese was not different (P = 0.4). In summary, obesity was overall associated with a worse outcome of chemoimmunotherapy induction. However, rituximab maintenance treatment seems to be able to overcome this negative effect.
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Affiliation(s)
- Alexander Egle
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine - Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Eva Mikušková
- Department of Hemato-oncology 2, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina Varna, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute Bratislava, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Vienna, Austria
| | - Daniela Voskova
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III., Linz, Austria
| | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta Banská Bystrica, Banska Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University Plovdiv, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Ordensklinikum Linz GmbH, Linz, Austria
| | - Georgi Mihaylov
- Hematological Clinic NSHATHD Sofia, Queen Joanna University Hospital, Sofia, Bulgaria
| | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy Sofia, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | - August Zabernigg
- Innere Medizin II, Bezirkskrankenhaus Kufstein, Kufstein, Austria
| | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | - Stanislav Palášthy
- Department of Clinical Hematology, FNsP, J A Reimana Prešov, Prešov, Slovakia
| | - Olga Stehlíková
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Michael Doubek
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Petra Altenhofer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Teresa Magnes
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract OT3-07-01: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Recently, the PARP inhibitor olaparib was approved as first targeted treatment beyond antiVEGF therapy for the BRCA1/2 mutated subgroup of TNBC. However, cytotoxic agents still remain the mainstay of treatment for this breast cancer subtype. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated as treatment of multiple myeloma. In a preclinical cell line model for TNBC the first-generation proteasome inhibitor bortezomib showed synergistic efficacy with cisplatin. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity (47% and 38% response rate, respectively) and good tolerability. In solid tumors cytotoxic effect of proteasome inhibitors is thought to be mediated through different mechanisms: (1) Inhibition of the Fanconi Anemia and BRCA1 DNA repair mechanism (2) Inhibition of p53 degradation (3) Inhibition of NF-kappa B signaling cascade. Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the oral second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study.Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - S Burgstaller
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Voskova
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Rossmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Egle
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Rumpold
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - CF Singer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
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Krauth MT, Burgstaller S, Buxhofer-Ausch V, Gastl G, Geissler K, Keil F, Krippl P, Melchardt T, Petzer A, Rumpold H, Sliwa T, Wöhrer S, Wölfler A, Gisslinger H. Correction to: Ruxolitinib therapy formyelofibrosis in Austria : Consensus on therapy management. Wien Klin Wochenschr 2018; 131:47. [PMID: 30542777 DOI: 10.1007/s00508-018-1428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Correction to:Wien Klin Wochenschr 2018 https://doi.org/10.1007/s00508-018-1365-5 The original version of this article unfortunately contained a mistake. Table Nr. 1 was inconsistent. The corrected version of Table 1 is given below. We apologize for any inconveniences this may have ….
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Affiliation(s)
- Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria.
| | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Günther Gastl
- Department of Internal Medicine V, Division Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine, LKH Fürstenfeld, Krankenhausverbund Feldbach, Fürstenfeld, Austria
| | - Thomas Melchardt
- Third Medical Department, Division Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Holger Rumpold
- Internal Medicine II, Medical Oncology, Hematology, Gastroenterology and Rheumatology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thamer Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Stefan Wöhrer
- Permedio Center for Personalized Medicine and Sanatorium Hera Vienna, Vienna, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Fuchs D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Bartsch R, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple-negative breast cancer, a phase I/II trial of the AGMT (AGMT MBC-10 trial). BMC Cancer 2018; 18:1074. [PMID: 30400780 PMCID: PMC6220453 DOI: 10.1186/s12885-018-4979-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Up to now, no targeted treatment beyond anti-VEGF therapy has been approved for TNBC and cytotoxic agents remain the mainstay of treatment. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated in the treatment of multiple myeloma. In a preclinical study TNBC cells were treated with the first-generation proteasome inhibitor bortezomib in combination with cisplatin and synergistic efficacy was demonstrated. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity and good tolerability (Mol Cancer 11:26 2012, J Thorac Oncol 4:87–92 2009, J Thorac Oncol 7:1032–1040, 2012). Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Methods Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease according to RECIST criteria 1.1 are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study utilizes an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), the efficacy and safety of the combination will be further evaluated (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include progression-free survival, safety, and quality of life. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within 2 years. Discussion Based on preclinical and clinical findings an ixazomib and carboplatin combination is thought to be effective in metastatic TNBC patients. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. Trial registration EudraCT Number: 2016–001421-13 received on March 31, 2016, ClinicalTrials.gov Identifier: NCT02993094 first posted on December 15, 2016. This trial was registered prospectively.
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Affiliation(s)
- Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Internal Department I for Medical Oncology and Hematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Sonja Burgstaller
- IVth Department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Wels, Austria
| | - David Fuchs
- Department of Internal Medicine 3 - Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Dieter Rossmann
- 2nd Medical Department, County Hospital Steyr, Steyr, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology, Clinical Department of Gynecology, Medical University Graz, Graz, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Mlineritsch
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. .,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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Egle A, Steurer M, Melchardt T, Weiss L, Gassner FJ, Zaborsky N, Geisberger R, Catakovic K, Hartmann TN, Pleyer L, Voskova D, Thaler J, Lang A, Girschikofsky M, Petzer A, Greil R. Correction to: Fludarabine and rituximab with escalating doses of lenalidomide followed by lenalidomide/rituximab maintenance in previously untreated chronic lymphocytic leukaemia (CLL): the REVLIRIT CLL-5 AGMT phase I/II study. Ann Hematol 2018; 97:1745. [PMID: 29934835 PMCID: PMC6828337 DOI: 10.1007/s00277-018-3403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article contained a mistake. The name of Tanja Nicole Hartman should have been Tanja Nicole Hartmann. The original article has been corrected.
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Affiliation(s)
- Alexander Egle
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Michael Steurer
- Division of Hematology and Oncology, Laboratory for Molecular Genetics and Diagnostics, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Franz Josef Gassner
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Roland Geisberger
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Kemal Catakovic
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Tanja Nicole Hartmann
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Daniela Voskova
- Centre for Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria
| | - Josef Thaler
- Department for Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Alois Lang
- Internal Medicine, Hospital, Feldkirch, Austria
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Andreas Petzer
- Department for Internal Medicine IV, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria.
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria.
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