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Müller V, Banys-Paluchowski M, Friedl TWP, Fasching PA, Schneeweiss A, Hartkopf A, Wallwiener D, Rack B, Meier-Stiegen F, Huober J, Rübner M, Hoffmann O, Müller L, Janni W, Wimberger P, Jäger B, Pantel K, Riethdorf S, Harbeck N, Fehm T. Prognostic relevance of the HER2 status of circulating tumor cells in metastatic breast cancer patients screened for participation in the DETECT study program. ESMO Open 2021; 6:100299. [PMID: 34839105 PMCID: PMC8637493 DOI: 10.1016/j.esmoop.2021.100299] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/11/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) have been reported to predict clinical outcome in metastatic breast cancer (MBC). Biology of CTCs may differ from that of the primary tumor and HER2-positive CTCs are found in some patients with HER2-negative tumors. PATIENTS AND METHODS Patients with HER2-negative MBC were screened for participation in DETECT III and IV trials before the initiation of a new line of therapy. Blood samples were analyzed using CELLSEARCH. CTCs were labeled with an anti-HER2 antibody and classified according to staining intensity (negative, weak, moderate, or strong staining). RESULTS Screening blood samples were analyzed in 1933 patients with HER2-negative MBC. As many as 1217 out of the 1933 screened patients (63.0%) had ≥1 CTC per 7.5 ml blood; ≥5 CTCs were detected in 735 patients (38.0%; range 1-35 078 CTCs, median 8 CTCs). HER2 status of CTCs was assessed in 1159 CTC-positive patients; ≥1 CTC with strong HER2 staining was found in 174 (15.0%) patients. The proportion of CTCs with strong HER2 staining among all CTCs of an individual patient ranged between 0.06% and 100% (mean 15.8%). Patients with estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were more likely to harbor ≥1 CTC with strong HER2 staining. CTC status was significantly associated with overall survival (OS). Detection of ≥1 CTC with strong HER2 staining was associated with shorter OS [9.7 (7.1-12.3) versus 16.5 (14.9-18.1) months in patients with CTCs with negative-to-moderate HER2 staining only, P = 0.013]. In multivariate analysis, age, ER status, PR status, Eastern Cooperative Oncology Group performance status, therapy line, and CTC status independently predicted OS. CONCLUSION CTC detection in patients with HER2-negative disease is a strong prognostic factor. Presence of ≥1 CTC with strong HER2 staining was associated with shorter OS, supporting a biological role of HER2 expression on CTCs.
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Affiliation(s)
- V Müller
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - M Banys-Paluchowski
- Gynecology and Obstetrics Department, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Schneeweiss
- Division Gynecologic Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - A Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - D Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - F Meier-Stiegen
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - J Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - M Rübner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - O Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - L Müller
- OnkologieUnterEms, Leer, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus Dresden, TU Dresden, Germany; National Center for Tumor Diseases (NCT), Dresden, Germany
| | - B Jäger
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - K Pantel
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Riethdorf
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
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Jäger B, Ruckhäberle E, Mucke J, Schneider M, Fehm T. Fallbericht einer Patientin mit TNBC und Antiphospholipid-Syndrom: Atezolizumab-Therapie unter Abschirmung mit Rituximab. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718357] [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: 10/23/2022] Open
Affiliation(s)
- B Jäger
- Frauenklinik des Universitätsklinikums Düsseldorf
| | | | - J Mucke
- Poliklinik und Funktionsbereich für Rheumatologie des Universitätsklinikums Düsseldorf
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie des Universitätsklinikums Düsseldorf
| | - T Fehm
- Frauenklinik des Universitätsklinikums Düsseldorf
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Jäger B, Honisch E, Volkmer AK, Vesper AS, Ruckhäberle E, Niederacher D, Fehm T. „Next-Generation-Sequencing basierte BigData Management Plattform“ für die personalisierte Therapie bei fortgeschrittenen gynäkologischen Tumoren und beim metastasierten Mammakarzinom. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718148] [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: 10/23/2022] Open
Affiliation(s)
- B Jäger
- Frauenklinik des Universitätsklinikums Düsseldorf
| | - E Honisch
- Frauenklinik des Universitätsklinikums Düsseldorf, Forschungslabore
| | - A.-K Volkmer
- Frauenklinik des Universitätsklinikums Düsseldorf
| | - A.-S Vesper
- Frauenklinik des Universitätsklinikums Düsseldorf
| | | | - D Niederacher
- Frauenklinik des Universitätsklinikums Düsseldorf, Forschungslabore
| | - T Fehm
- Frauenklinik des Universitätsklinikums Düsseldorf
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Krawczyk N, Volkmer A, Gantert D, Martignoni F, Jäger B, Kaleta T, Fehm T. Urogenitale Metastasierung beim Mammakarzinom: Fallvorstellung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714580] [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: 03/22/2023] Open
Affiliation(s)
| | - A Volkmer
- Frauenklinik der Universität Düsseldorf
| | - D Gantert
- Frauenklinik der Universität Düsseldorf
| | | | - B Jäger
- Frauenklinik der Universität Düsseldorf
| | - T Kaleta
- Frauenklinik der Universität Düsseldorf
| | - T Fehm
- Frauenklinik der Universität Düsseldorf
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - A Bültemann
- Wundcentrum/Gefäßchirurgie, Askelpios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
| | - V Gerber
- Schulung und Beratung im Wundmanagement, Anne-Frank-Str. 10, 48480, Spelle, Deutschland
| | - B Jäger
- Nds. Justizvollzugskrankenhaus Lingen, Kaiserstraße 5, 49809, Lingen, Deutschland
| | - C Münter
- Gemeinschaftspraxis Bramfeld, Bramfelder Chaussee 200, 22177, Hamburg, Deutschland
| | - K Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
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Jäger B, Spaniol K, der Ahe M, Ozga AK, Mohrmann S, Guthoff R, Fehm T. Einfluss einer endokrinen Therapie mit Tamoxifen auf Visus und Sehqualität – Ergebnisse einer Querschnittsstudie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671529] [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: 10/28/2022] Open
Affiliation(s)
- B Jäger
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - K Spaniol
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M der Ahe
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - AK Ozga
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - S Mohrmann
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - R Guthoff
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - T Fehm
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Della Morte M, Francis A, Gérardin A, Gülpers V, Herdoíza G, von Hippel G, Horch H, Jäger B, Meyer H, Nyffeler A, Wittig H. A lattice calculation of the hadronic vacuum polarization contribution to (g – 2)µ. EPJ Web Conf 2018. [DOI: 10.1051/epjconf/201817506031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present results of calculations of the hadronic vacuum polarisation contribution to the muon anomalous magnetic moment. Specifically, we focus on controlling the infrared regime of the vacuum polarisation function. Our results are corrected for finite-size effects by combining the Gounaris-Sakurai parameterisation of the timelike pion form factor with the Lüscher formalism. The impact of quark-disconnected diagrams and the precision of the scale determination is discussed and included in our final result in two-flavour QCD, which carries an overall uncertainty of 6%. We present preliminary results computed on ensembles with Nf = 2 + 1 dynamical flavours and discuss how the long-distance contribution can be accurately constrained by a dedicated spectrum calculation in the iso-vector channel.
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Guth HJ, Zschiesche M, Panzig E, Rudolph PE, Jäger B, Kraatz G. Which Organic Acids does Hemofiltrate Contain in the Presence of Acute Renal Failure? Int J Artif Organs 2018. [DOI: 10.1177/039139889902201205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is not generally possible to measure most organic acids in the serum of critically ill patients, due to rapid metabolism and methodological problems. Only the regular measurement of lactic acid and the arterial ketone body ratio (acetoacetate/beta-hydroxybutyrate, AKBR) have been introduced in clinical practice, but these parameters can represent only a part of the disturbed metabolism. In pediatric patients, a chromatographical urine analysis has been established for detection of inborn errors of metabolism, which allows the determination of more than 50 organic acids simultaneously (gas chromatographic (GC) analysis in combination with mass spectrometry (MS)]. In continuous treatment of acute renal failure, hemofiltrate is always available, but it contains only low protein concentrations and after the filtration process, metabolism is rapidly stopped. The sieving coefficient of lactic acid is nearly one in hemofiltration. The aim of our study was to compare results of the regular and CG/MS methods in blood and hemofiltrate for lactic acid, and to find other organic acids of possible clinical importance. We investigated serum (lactic acid) and hemofiltrate of 40 critically ill patitens, similar to the urine analysis method for infants. All patients suffered from acute renal failure and were treated by continuous veno-venous hemofiltration (CVVH). The conditions of treatment were standardized (spontaneous ultrafiltration in the first hour), and the material (blood/hemofiltrate) was taken one hour after the beginning of extracorporeal circulation. Statistical methods included correlation analysis, nonparametric ANOVA with Wilcoxon scores (ranks of data), and stepwise discriminant analysis. Regular and GC/MS methods in hemofiltrate showed a good correlation for lactic acid. The best correlation with lactic acid was found for 4-hydroxy-phenyllactic acid (n=20, r=0.866), 2-hydroxy-valeric acid (n=22, r=0.7491) and 2-hydroxybutyric acid (n=32, r=0.5148). Age, sex, diagnosis, and APACHE II score play a subordinate role, but the presence of glyceric and citric acid possibly have prognostic importance [nonparimetric ANOVA with Wilcoxon scores (ranks of data)], as does the combination of 3-hydroxypropionic acid, glyceric acid, and threonic-acid-4-lacton (stepwise discriminant analysis). It can be concluded that in acute renal failure, the measurement of lactic acid and AKBR can reflect only a small part of disturbed metabolism. Hemofiltrate can be a useful medium in describing metabolic processes in critically ill patients with acute renal failure. Some inherited metabolic diseases in infants (phenylketonuria, maple syrup disease) and ketoacidosis show similar metabolic modifications.
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Affiliation(s)
- H.-J. Guth
- Department of Internal Medicine A, Ernst-Moritz-Arndt-University, Greifswald
| | - M. Zschiesche
- Institute of Medical Genetics, Ernst-Moritz-Arndt-University, Greifswald
| | - E. Panzig
- Institute of Clinical Chemistry, Ernst-Moritz-Arndt-University, Greiswald
| | - P. E. Rudolph
- Research Institute for the Biology of Farm Animals, Dummerstorf
| | - B. Jäger
- Institute of Biometrics and Medical Informatics, Greifswald - Germany
| | - G. Kraatz
- Department of Internal Medicine A, Ernst-Moritz-Arndt-University, Greifswald
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10
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Binzel K, Adelaja A, Wright CL, Scharre D, Zhang J, Knopp MV, Teoh EJ, Bottomley D, Scarsbrook A, Payne H, Afaq A, Bomanji J, van As N, Chua S, Hoskin P, Chambers A, Cook GJ, Warbey VS, Chau A, Ward P, Miller MP, Stevens DJ, Wilson L, Gleeson FV, Scheidhauer K, Seidl C, Autenrieth M, Bruchertseifer F, Apostolidis C, Kurtz F, Horn T, Pfob C, Schwaiger M, Gschwend J, D'Alessandria C, Morgenstern A, Uprimny C, Kroiss A, Decristoforo C, von Guggenberg E, Nilica B, Horninger W, Virgolini I, Rasul S, Poetsch N, Woehrer A, Preusser M, Mitterhauser M, Wadsak W, Widhalm G, Mischkulnig M, Hacker M, Traub-Weidinger T, Wright CL, Binzel K, Wuthrick EJ, Miller ED, Maniawski P, Zhang J, Knopp MV, Rep S, Hocevar M, Vaupotic J, Zdesar U, Zaletel K, Lezaic L, Mairinger S, Filip T, Sauberer M, Flunkert S, Wanek T, Stanek J, Okamura N, Langer O, Kuntner C, Fornito MC, Balzano R, Di Martino V, Cacciaguerra S, Russo G, Seifert D, Kleinova M, Cepa A, Ralis J, Hanc P, Lebeda O, Mosa M, Vandenberghe S, Mikhaylova E, Borys D, Viswanath V, Stockhoff M, Efthimiou N, Caribe P, Van Holen R, Karp JS, Binzel K, Zhang J, Wright CL, Maniawski P, Knopp MV, Haller PM, Farhan C, Piackova E, Jäger B, Knoll P, Kiss A, Podesser BK, Wojta J, Huber K, Mirzaei S, Traxl A, Komposch K, Glitzner E, Wanek T, Mairinger S, Sibilia M, Langer O, Fornito MC, Russello M, Russo G, Balzano R, Sorko S, Gallowitsch HJ, Kohlfuerst S, Matschnig S, Rieser M, Sorschag M, Lind P, Ležaič L, Rep S, Žibert J, Frelih N, Šuštar S, Binzel K, Adelaja A, Wright CL, Scharre D, Zhang J, Knopp MV, Baum RP, Langbein T, Singh A, Shahinfar M, Schuchardt C, Volk GF, Kulkarni HR, Fornito MC, Cacciaguerra S, Balzano R, Di Martino GV, Russo G, Thomson WH, Kudlacek M, Karik M, Farhan C, Rieger H, Pokieser W, Glaser K, Mirzaei S, Petz V, Tugendsam C, Buchinger W, Schmoll-Hauer B, Schenk IP, Rudolph K, Krebs M, Zettinig G, Zoufal V, Wanek T, Krohn M, Mairinger S, Stanek J, Sauberer M, Filip T, Pahnke J, Langer O, Weitzer F, Pernthaler B, Salamon S, Aigner R, Koranda P, Henzlová L, Kamínek M, Váchalová M, Bachleda P, Summer D, Garousi J, Oroujeni M, Mitran B, Andersson KG, Vorobyeva A, Löfblom JN, Orlova A, Tolmachev V, Decristoforo C, Kaeopookum P, Summer D, Orasch T, Lechner B, Petrik M, Novy Z, Rangger C, Haas H, Decristoforo C. Abstracts of the 33rd International Austrian Winter Symposium : Zell am See, Austria. 24-27 January 2018. EJNMMI Res 2018; 8:5. [PMID: 29362999 PMCID: PMC5780335 DOI: 10.1186/s13550-017-0354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Adelaja
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Scharre
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - E J Teoh
- Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Bottomley
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Scarsbrook
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College London, London, UK
| | - A Afaq
- University College London, London, UK
| | - J Bomanji
- University College London, London, UK
| | - N van As
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Chua
- The Royal Marsden NHS Foundation Trust, London, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, London, UK
| | | | - G J Cook
- King's College London, London, UK
| | | | - A Chau
- Blue Earth Diagnostics, Oxford, UK
| | - P Ward
- Blue Earth Diagnostics, Oxford, UK
| | | | | | - L Wilson
- Blue Earth Diagnostics, Oxford, UK
| | - F V Gleeson
- Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Scheidhauer
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - C Seidl
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - M Autenrieth
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | | | | | - F Kurtz
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - T Horn
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - C Pfob
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - M Schwaiger
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | - J Gschwend
- TU München, Klinikum rechts der Isar, Urologie, München, Germany
| | - C D'Alessandria
- TU München, Klinikum rechts der Isar, Nuklearmedizin, München, Germany
| | | | - C Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - A Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - E von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - B Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - W Horninger
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - I Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - S Rasul
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - N Poetsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - A Woehrer
- Clinical Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Clinical University of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- CBmed GmbH, Center for Biomarker Research in Medicine, Graz, Austria
| | - G Widhalm
- Clinical University of Neuro-surgery, Medical University of Vienna, Vienna, Austria
| | - M Mischkulnig
- Clinical University of Neuro-surgery, Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - T Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - C L Wright
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - K Binzel
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - E J Wuthrick
- Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - E D Miller
- Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - P Maniawski
- Clinical Science, Philips Healthcare, Cleveland, OH, USA
| | - J Zhang
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
| | - Sebastijan Rep
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Oncological Surgery, Oncology Institute Ljubljana, Ljubljana, Slovenia
| | | | - Urban Zdesar
- Institute of Occupational Safety Ljubljana, Ljubljana, Slovenia
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Lezaic
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Mairinger
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Thomas Filip
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sauberer
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - S Flunkert
- Neuropharmacology, QPS Austria GmbH, Grambach, Austria
| | - T Wanek
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Stanek
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - N Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - O Langer
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C Kuntner
- Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M C Fornito
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - R Balzano
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - V Di Martino
- Nuclear Medicine Department PET/TC center Arnas Garibaldi Catania, Catania, Italy
| | - S Cacciaguerra
- Pediatric Surgery Department Arnas Garibaldi Catania, Catania, Italy
| | - G Russo
- H. Pharmacy Department Arnas Garibaldi Catania, Catania, Italy
| | - D Seifert
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - M Kleinova
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - A Cepa
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - J Ralis
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - P Hanc
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - O Lebeda
- Nuclear Physics Institute of the CAS, Rez, Czech Republic
| | - M Mosa
- Charles university Faculty of Science Prague, Prague, Czech Republic
| | - S Vandenberghe
- MEDISIP research group, Ghent University, Ghent, Belgium
| | | | - D Borys
- Silesian University of Technology Gliwice, Gliwice, Poland
| | - V Viswanath
- PET instrumentation group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Stockhoff
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - N Efthimiou
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - P Caribe
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - R Van Holen
- MEDISIP research group, Ghent University, Ghent, Belgium
| | - J S Karp
- PET instrumentation group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - P M Haller
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - C Farhan
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - E Piackova
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - B Jäger
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - P Knoll
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - A Kiss
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - B K Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - J Wojta
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - K Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Chest Pain Unit, Wilhelminenhospital Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - S Mirzaei
- Department of Nuclear Medicine with PET-Center, Wilhelminenhospital, Vienna, Austria
| | - A Traxl
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - K Komposch
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Glitzner
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - T Wanek
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - S Mairinger
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sibilia
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - M C Fornito
- Nuclear Medicine Department PET/TC Center ARNAS Garibaldi, Catania, Italy
| | - M Russello
- Liver Unit ARNAS Garibaldi, Catania, Italy
| | - G Russo
- H.Pharmacy Department ARNAS Garibaldi, Catania, Italy
| | - R Balzano
- Nuclear Medicine Department PET/TC Center ARNAS Garibaldi, Catania, Italy
| | - S Sorko
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - H J Gallowitsch
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - S Kohlfuerst
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - S Matschnig
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Rieser
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Sorschag
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - P Lind
- Department of Nuclear Medicine and Endocrinology, PET/CT Center, Klinikum Klagenfurt, Klagenfurt, Austria
| | - L Ležaič
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Rep
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - J Žibert
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - N Frelih
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Šuštar
- Departments of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Adelaja
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Scharre
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R P Baum
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - T Langbein
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - A Singh
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - M Shahinfar
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - C Schuchardt
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - G F Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - H R Kulkarni
- Theranostics Center for Molecular Radiotherapy and Molecular ImagZentralklinik Bad Berka, Bad Berka, Germany
| | - M C Fornito
- Nuclear Medicine Department Arnas Garibaldi, Catania, Italy
| | | | - R Balzano
- Nuclear Medicine Department Arnas Garibaldi, Catania, Italy
| | - G V Di Martino
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - G Russo
- Pharmacy H. Department Arnas Garibaldi, Catania, Italy
| | - W H Thomson
- Physics and Nuclear Medicine, City Hospital, Birmingham, UK
| | - M Kudlacek
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - M Karik
- Department of Viceral and General Surgery, Wilhelminenspital, Vienna, Austria
| | - C Farhan
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - H Rieger
- Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - W Pokieser
- Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of Viceral and General Surgery, Wilhelminenspital, Vienna, Austria
| | - S Mirzaei
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
| | - V Petz
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - C Tugendsam
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - W Buchinger
- Schilddrueseninstitut Gleisdorf, Gleisdorf, Austria
| | - B Schmoll-Hauer
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Department of Nuclear Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - I P Schenk
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Department of Nuclear Medicine, Sozialmedizinisches Zentrum Hietzing, Vienna, Austria
| | - K Rudolph
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - M Krebs
- Schilddruesenpraxis Josefstadt, Vienna, Austria
- Clinical Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - G Zettinig
- Schilddruesenpraxis Josefstadt, Vienna, Austria
| | - V Zoufal
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Wanek
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Krohn
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - S Mairinger
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Stanek
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Sauberer
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Filip
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Pahnke
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - O Langer
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - F Weitzer
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - B Pernthaler
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - S Salamon
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - R Aigner
- Meduni Graz, Univ. Klinik für Radiologie, Abteilung für Nuklearmedizin, Graz, Austria
| | - P Koranda
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - L Henzlová
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - M Kamínek
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - Mo Váchalová
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - P Bachleda
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - D Summer
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - J Garousi
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - M Oroujeni
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - B Mitran
- Division of Molecular Imaging, Department of Medicinal Chemistry, Uppsala University, SE-751 83, Uppsala, Sweden
| | - K G Andersson
- Division of Protein Technology, KTH Royal Institute of Technology, SE-10691, Stockholm, Sweden
| | - A Vorobyeva
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - J N Löfblom
- Division of Protein Technology, KTH Royal Institute of Technology, SE-10691, Stockholm, Sweden
| | - A Orlova
- Division of Molecular Imaging, Department of Medicinal Chemistry, Uppsala University, SE-751 83, Uppsala, Sweden
| | - V Tolmachev
- Institute of Immunology, Genetic and Pathology, Uppsala University, SE-75185, Uppsala, Sweden
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - P Kaeopookum
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
- Research and Development Division, Thailand Institute of Nuclear Technology, Nakhonnayok, Thailand
| | - D Summer
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - T Orasch
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - B Lechner
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - M Petrik
- Faculty of Medicine and Dentistry, Institute of Molecular and Translation Medicine, Palacky University, Olomouc, Czech Republic
| | - Z Novy
- Faculty of Medicine and Dentistry, Institute of Molecular and Translation Medicine, Palacky University, Olomouc, Czech Republic
| | - C Rangger
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - H Haas
- Division of Molecular Biology, Biocenter, Medical University Innsbruck, Innsbruck, Austria
| | - C Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
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Dissemond J, Bültemann A, Gerber V, Jäger B, Kröger K, Münter C. Diagnosis and treatment of chronic wounds: current standards of Germany's Initiative for Chronic Wounds e. V. J Wound Care 2017; 26:727-732. [DOI: 10.12968/jowc.2017.26.12.727] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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)
- J. Dissemond
- Professor for Dermatology and Venerology, Department of Dermatology, Venerology and Allergology, University of Essen, Hufelnadstr. 55, 45147 Essen, Germany
| | - A. Bültemann
- Nurse, Askelpios Hospital Harburg, Wound care centrum in the Department of Vascular Sugery, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
| | - V. Gerber
- Nurse, Education in Wound Management, Anne-Frank-Str. 10, 48480 Spelle, Germany
| | - B. Jäger
- Nurse, Hospital in Justizvollzugsanstalt Lingen, Kaiserstraße 5, 49809 Lingen, Germany
| | - K. Kröger
- Professor for Angiology, Department for Angiology, Helios clinic, Lutherplatz 40, 47805 Krefeld, Germany
| | - C. Münter
- Doctor (GP), Gemeinschaftspraxis Bramfeld, Bramfelder Chaussee 200, 22177 Hamburg, Germany
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Dominguez C, Horch H, Jäger B, Nasrallah N, Schilcher K, Spiesberger H, Wittig H. Anomalous magnetic moment of the muon: A hybrid approach. Int J Clin Exp Med 2017. [DOI: 10.1103/physrevd.96.074016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Abstract P2-05-02: Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Introduction
The prognosis of patients with early breast cancer is commonly estimated by prognostic factors obtained at the time of the initial diagnosis. However, patients and physicians alike are seeking for factors evaluating the prognosis years thereafter during follow-up. The identification of a patient group with an unfavourable prognosis could lead to secondary treatment intervention, potentially improving outcome. Aim of the study was to assess the added prognostic value of circulating tumor cells (CTCs) and CA27.29 beyond established predictors.
Materials and Methods
Patients of the phase III SUCCESS-A study were included into this analysis (n=1005). SUCCESS-A is a chemotherapy study for high risk patients with a comprehensive translational research program, which included the determination of CTCs and CA27.29 two years after the initial diagnosis. A Cox regression model with disease-free survival (DFS) as outcome and well-established predictors (age, BMI, pT, pN, histology, grading, ER, PR, Her2neu) was compared with an extended Cox model with the well-established predictors and additionally CTC (>0 versus 0) two years after randomization, and CA27.29 (in U/mL) measured after chemotherapy and again two years after randomization using a likelihood ratio test. In case of significance, the extended model was applied to predict for each patient the risk of disease recurrence within the next 12 months (0 to 100%). Cross-validated AUC, sensitivity and specificity values were determined to assess clinical usefulness of risk prediction.
Results
The markers CA27.29 and CTC were both significantly associated with subsequent prognosis (p < 0.000001). The detection of CTCs increased the risk of subsequent DFS events (HR=2.14, 95%CI: 1.31-3.48), while CA27.29 after two years increased the risk for DFS events with a HR of 1.12 per U/mL increase (95%CI: 1.09-1.15). The combination of the two markers significantly empowered the prognostic relevance, with a HR of 6.64 for patients with CTCs and an elevated CA27.29 by 10 U/mL compared to patients without CTCs and without CA27.29 elevation. The mean risk of disease recurrence in the third year after randomization was 2.38%. Discrimination of patients with and without disease recurrence based on risk prediction from the extended Cox model (AUC: 0.80) was better than discrimination based on the clinical model without the markers CTC and CA27.29 (AUC: 0.64). Sensitivity with regard to decision thresholds 1%, 2%, 3%, and 4% predicted risk was 0.89, 0.77, 0.65, and 0.55, respectively. The corresponding specificity was 0.42, 0.69, 0.81, and 0.88.
Discussion
Both CTCs and CA29.27 values determined 2 years after primary diagnosis are clinically relevant predictors of subsequent prognosis for those patients. This study extends evidence for active surveillance of breast cancer survivors. Identifying a group of women with a high recurrence risk after two years could be the basis for the development of secondary adjuvant treatment.
Citation Format: Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-02.
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Affiliation(s)
- W Janni
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Rack
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - L Häberle
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - H Tesch
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - R Lorenz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - A Schneeweiß
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - W Lichtenegger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - J Blohmer
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - MW Beckmann
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - C Scholz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - K Pantel
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - E Trapp
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
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Below H, Assadian O, Baguhl R, Hildebrandt U, Jäger B, Meissner K, Leaper DJ, Kramer A. Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial. Br J Oral Maxillofac Surg 2016; 55:150-155. [PMID: 27789177 DOI: 10.1016/j.bjoms.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/14/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
Abstract
Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient's saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days. After the first, 8.7 (23.3) mg/L chlorhexidine (0.7%-2.5% of the total amount used) was measured in saliva. The concentration increased to 15.2 (6.2) mg/L after the second rinse (first postoperative day), and peaked at 29.4 (11.2) mg/L on the fourth postoperative day. It remained detectable for up to 12hours after the last one, but was not detectable in serum or urine at any time. The potentially carcinogenic metabolite p-chloroaniline was detectable in saliva at higher concentrations in the chlorhexidine group (0.55mg/L) than the octenidine group (0.21mg/L), and p-chloronitrobenzene was detected in both groups in only minimal concentrations (0.001-0.21mg/L). Chlorhexidine gluconate mouthwashes do increase the concentration of p-chloroaniline, but a single use seems to be safe. Whether prolonged exposure over many years may have carcinogenic potential is still not clear. Based on the hitherto unknown kinetics of p-chloroaniline in saliva, the recent recommendation of the Federal Drug Administration (FDA) in the USA to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months seems to be justified.
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Affiliation(s)
- H Below
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - O Assadian
- Institute of Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom.
| | - R Baguhl
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - U Hildebrandt
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - B Jäger
- Institute of Biometry and Medical Computer Science, University Medicine Greifswald, Germany
| | - K Meissner
- Department of Anaesthesiology and Intensive Medicine, University Medicine Greifswald, Germany
| | - D J Leaper
- Institute of Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
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Jäger B, Andergassen U, Neugebauer J, Alunni-Fabbroni M, Melcher C, Hagenbeck C, Albrecht S, Lorenz R, Decker T, Heinrich G, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Friese K, Fasching PA, Friedl TWP, Janni W, Rack BK. Persistenz zirkulierender Tumorzellen direkt nach und zwei Jahre nach adjuvanter Chemotherapie bei Patientinnen mit früher Brustkrebserkrankung – Ergebnisse der SUCCESS Studien. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593026] [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: 10/20/2022] Open
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Trapp E, Rack B, Friedl TW, Häberle L, Tesch H, Lorenz R, Jückstock J, Tzschaschel M, Alunni-Fabbroni M, Schramm A, Koch J, Jäger B, Müller V, Mahner S, Fehm T, Schneeweiss A, Beckmann MW, Lichtenegger W, Scholz C, Janni W. Detection of circulating tumor cells during long-term follow-up of high-risk breast cancer patients indicates poor prognosis – results of the adjuvant SUCCESS A trial. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593247] [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: 10/20/2022] Open
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Schröder L, Rack B, Sommer H, Koch JG, Weissenbacher T, Janni W, Schneeweiss A, Rezai M, Lorenz R, Jäger B, Schramm A, Häberle L, Fasching PA, Friedl TWP, Beckmann MW, Scholz C. Toxicity Assessment of a Phase III Study Evaluating FEC-Doc and FEC-Doc Combined with Gemcitabine as an Adjuvant Treatment for High-Risk Early Breast Cancer: the SUCCESS-A Trial. Geburtshilfe Frauenheilkd 2016; 76:542-550. [PMID: 27239063 PMCID: PMC4873296 DOI: 10.1055/s-0042-106209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/25/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 02/07/2023] Open
Abstract
Introduction: This paper aims to evaluate the toxicity profile of additive gemcitabine to adjuvant taxane-based chemotherapy in breast cancer patients. Methods: Patients enrolled in this open-label randomized controlled Phase III study were treated with 3 cycles of epirubicin-fluorouracil-cyclophosphamide (FEC) chemotherapy followed by 3 cycles of docetaxel with those receiving 3 cycles of FEC followed by 3 cycles of gemcitabine-docetaxel (FEC-DG). 3690 patients were evaluated according to National Cancer Institute (NCI) toxicity criteria (CTCAE). The study medications were assessed by the occurrence of grade 3-4 adverse events, dose reductions, postponements of treatment cycles and granulocyte colony-stimulating factor (G-CSF) support. Results: No differences in neutropenia or febrile neutropenia were demonstrated. However, thrombocytopenia was significantly increased with FEC-DG treatment (2.0 vs. 0.5 %, p < 0.001), as was leukopenia (64.1 vs. 58.5 %, p < 0.001). With FEC-DG significantly more G-CSF support in cycles 4 to 6 (FEC-DG: 57.8 %, FEC-D: 36.3 %, p < 0.001) was provided. Transaminase elevation was significantly more common with FEC-DG (SGPT: 6.3 %, SGOT: 2 %), whereas neuropathy (1.2 %), arthralgia (1.6 %) and bone pain (2.6 %) were more common using FEC-D. Dose reductions > 20 % (4 vs. 2.4 %) and postponement of treatment cycles (0.9 vs. 0.4 %) were significantly more frequent in the FEC-DG arm. Eight deaths occurred during treatment in the FEC-DG arm and four in the FEC-D arm. Conclusion: The addition of gemcitabine increased hematological toxicity and was associated with more dose reductions and postponements of treatment cycles.
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Affiliation(s)
- L Schröder
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - H Sommer
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - J G Koch
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - T Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - W Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - A Schneeweiss
- Head of Division Gynecologic Oncology National Center for Tumor Diseases, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - R Lorenz
- Gemeinschaftspraxis Dr. R. Lorenz/N. Hecker, Braunschweig
| | - B Jäger
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Düsseldorf
| | - A Schramm
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - L Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - C Scholz
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
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Biedermann B, Denner A, Dittmaier S, Hofer L, Jäger B. Electroweak Corrections to pp→μ^{+}μ^{-}e^{+}e^{-}+X at the LHC: A Higgs Boson Background Study. Phys Rev Lett 2016; 116:161803. [PMID: 27152792 DOI: 10.1103/physrevlett.116.161803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Indexed: 06/05/2023]
Abstract
The first complete calculation of the next-to-leading-order electroweak corrections to four-lepton production at the LHC is presented, where all off-shell effects of intermediate Z bosons and photons are taken into account. Focusing on the mixed final state μ^{+}μ^{-}e^{+}e^{-}, we study differential cross sections that are particularly interesting for Higgs boson analyses. The electroweak corrections are divided into photonic and purely weak corrections. The former exhibit patterns familiar from similar W- or Z-boson production processes with very large radiative tails near resonances and kinematical shoulders. The weak corrections are of the generic size of 5% and show interesting variations, in particular, a sign change between the regions of resonant Z-pair production and the Higgs signal.
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Affiliation(s)
- B Biedermann
- Julius-Maximilians-Universität Würzburg, Institut für Theoretische Physik und Astrophysik, D-97074 Würzburg, Germany
| | - A Denner
- Julius-Maximilians-Universität Würzburg, Institut für Theoretische Physik und Astrophysik, D-97074 Würzburg, Germany
| | - S Dittmaier
- Albert-Ludwigs-Universität Freiburg, Physikalisches Institut, D-79104 Freiburg, Germany
| | - L Hofer
- Department d'Estructura i Constituents de la Matèria (ECM), Institut de Ciències del Cosmos (ICCUB), Universitat de Barcelona (UB), Martí Franquès 1, E-08028 Barcelona, Spain
| | - B Jäger
- Eberhard-Karls-Universität Tübingen, Institut für Theoretische Physik, D-72076 Tübingen, Germany
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19
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Schramm A, Friedl TWP, Huober J, Jäger B, Rack B, Trapp E, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Kümmel S, Gebauer G, Müller L, Janni W, Fehm T. Abstract OT1-02-02: The DETECT study program – Personalized treatment in metastatic breast cancer based on circulating tumor cells. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot1-02-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Circulating tumor cells (CTCs) are found in patients with primary and metastatic breast cancer (MBC), respectively, and discordance in HER2 and hormone-receptor status between primary tumor, metastases and CTCs is well described. Treatment decisions are still based on the expression profile of solid tumor samples whereas CTCs are thought to cause tumor progression by blood-derived metastases. Nevertheless, targeted therapy based on expression profile of CTCs is not established in clinical routine. Individualized treatment decisions based on presence and phenotype of CTCs will be analyzed within the DETECT study program.
Metastatic breast cancer patients with HER2-negative MBC are screened in DETECT III and IV for presence of CTCs by using the CellSearch System (Janssen Diagnostics) which is FDA approved for enumeration of CTCs. Patients are enrolled into the different cohorts according to HER2-phenotype of CTCs. Since February 2012, women with HER2-negative MBC and HER2-positive CTCs are treated in the multicenter randomized Phase III study DETECT III with standard therapy with or without additional HER2-targeted therapy with Lapatinib. For standard therapy, physicians can choose between exemestane, letrozole and anastrozole for endocrine therapy, or docetaxel, paclitaxel, capecitabine, vinorelbine and non-pegylated liposomal doxorubicin for chemotherapy. Efficacy of CTC-based anti-HER2 treatment is evaluated by analyzing CTC-clearance rate after treatment.
Patients with only HER2-negative CTCs are recruited for the multicenter open-label phase II study DETECT IV. Since December 2013, women with hormone-receptor positive MBC receive endocrine therapy (tamoxifen, exemestane, letrozole or anastrozole) plus everolimus in DETECT IVa. In February 2015, DETECT IV was extended by the eribulin-cohort which offers a cytotoxic treatment with eribulin for women with triple-negative or hormone-receptor positive, chemotherapy demanding MBC (DETECT IVb). Progression free survival is used for assessment of clinical efficacy with overall survival and disease control rate as secondary objectives.
DETECT V, a multicenter open-label phase III study starting in summer 2015, randomizes patients with hormone-receptor positive, HER2-positive MBC to a dual HER2 targeted therapy (Trastuzumab and Pertuzumab) combined with either endocrine therapy or cytotoxic treatment. Quality of life determined by occurrence of adverse events is compared between both treatment arms. For prediction of endocrine treatment response, an "Endocrine Responsiveness Score" is calculated based on expression of estrogen-receptor and HER2 on detected CTCs.
More than 1200 patients are already screened in the DETECT study concept. Thus, it is the worldwide largest study concept with therapy decisions resulting from CTC-testing and CTC-phenotypization. The accompanying translational research programs evaluates further markers for molecular characterization of CTCs and prediction of therapy response.
Conclusion and Contact
The value of CTC phenotypes for making decisions on therapy interventions and predicting treatment responses in patients with MBC is tested in the DETECT study concept. The findings will help to move a step forward towards a more personalized anti-cancer therapy.
Citation Format: Schramm A, Friedl TWP, Huober J, Jäger B, Rack B, Trapp E, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Kümmel S, Gebauer G, Müller L, Janni W, Fehm T. The DETECT study program – Personalized treatment in metastatic breast cancer based on circulating tumor cells. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT1-02-02.
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Affiliation(s)
- A Schramm
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - TWP Friedl
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - J Huober
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Jäger
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Rack
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - E Trapp
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - PA Fasching
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - F-A Taran
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - A Hartkopf
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - A Schneeweiss
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - V Müller
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Aktas
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - K Pantel
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - F Meier-Stiegen
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - P Wimberger
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - S Kümmel
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - G Gebauer
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - L Müller
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - W Janni
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - T Fehm
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
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Abstract
BACKGROUND The Childbirth Self-Efficacy Inventory (CBSEI) is an instrument that measures women's perceived self-efficacy towards labour. It is used in 9 countries, a 32-item short form (CBSEI-C32) in 4 countries. German versions of the CBSEI and the CBSEI-C32 have not been developed thus far. METHODS A forward-backward translation was performed, followed by administration of both instruments to a sample of 155 participants of antenatal classes. Pregnant women answered questions regarding their medical history and user-friendliness of the instruments. 80 respondents completed the CBSEI, 75 the CBSEI-C32. Reliability via Cronbach alpha was calculated for the 4 subscales of the CBSEI and the 2 subscales of the short form. Validity was only assessed for the 2 scales of the CBSEI-C32 because all women (n=155) completed this instrument. RESULTS 2 Cronbach alpha values were greater than 0.74 (adequate), the others greater than 0.80 (good). Most of the factors of the CBSEI-C32 (75%) were above ≥0.5. Calculation of the item-to-total-correlations revealed that the exclusion of 3 items might be indicated for the German version. The short form showed a significant association between level of education and perceived self-efficacy (p=0.01). RESULTS in the area of user-friendliness were more encouraging for the CBSEI-C32 than for the CBSEI. CONCLUSION The German version of the CBSEI is a useful instrument which may improve advice and counselling during prenatal care in Germany.
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Affiliation(s)
- G Schmidt
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
| | - K Stoll
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
| | - B Jäger
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Hannover
| | - M M Gross
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
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Trapp EK, Rack B, Harbeck N, Würstlein R, Jückstock J, Majunke L, Koch J, Friedl TWP, Schramm A, Jäger B, Huober J, Janni W, Alunni-Fabbroni M. Detektion von heterogenen Populationen zirkulierender Tumorzellen bei metastasiertem Mammakarzinom unter verschiedenen Therapielinien. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555092] [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: 10/23/2022] Open
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Zenner HP, Delb W, Kröner-Herwig B, Jäger B, Peroz I, Hesse G, Mazurek B, Goebel G, Gerloff C, Trollmann R, Biesinger E, Seidler H, Langguth B. [On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus]. HNO 2015; 63:419-27. [PMID: 26054729 DOI: 10.1007/s00106-015-0011-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tinnitus is a frequent symptom, which, particularly in combination with comorbidities, can result in a severe disease-related burden. Chronic idiopathic tinnitus (CIT) is the most frequent type of tinnitus. A considerable number of treatment strategies are used to treat CIT-for many of which there is no evidence of efficacy. In order to enable scientific evidence-based treatment of CIT, German interdisciplinary S3 guidelines have recently been constructed for the first time. Here we present a short form of these S3 guidelines. MATERIALS AND METHODS The guidelines were constructed based on a meta-analysis of the treatment of chronic tinnitus performed by the authors. Additionally, a systematic literature search was performed in the PubMed and Cochrane Library databases. Furthermore, a systematic search for international guidelines was performed in Google, as well as in the Guidelines International Network and National Guideline Clearinghouse (USA) database. Evidence was classified according to the Oxford Centre for Evidence-Based Medicine system. RESULTS According to the guidelines, alongside counselling, manualized structured tinnitus-specific cognitive behavioral therapy (tCBT) with a validated treatment manual is available as evidence-based therapy. In addition, the guidelines recommend concurrent treatment of comorbidities, including drug-based treatment, where appropriate. Particularly important is treatment of anxiety and depression. Where a psychic or psychiatric comorbidity is suspected, further diagnosis and treatment should be performed by an appropriately qualified specialist (psychiatrist, neurologist, psychosomatic medicine consultant) or psychological psychotherapist. In cases accompanied by deafness or hearing loss bordering on deafness, cochlear implants may be indicated. CONCLUSION No recommendations can be made for drug-based treatment of CIT, audiotherapy, transcranial magnetic or electrical stimulation, specific forms of acoustic stimulation or music therapy; or such recommendations must remain open due to the lack of available evidence. Polypragmatic tinnitus treatment with therapeutic strategies for which there is no evidence of efficacy from controlled studies is to be refused.
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Affiliation(s)
- H-P Zenner
- Universitätsklinik für HNO-Heilkunde, Elfriede-Aulhorn-Str. 5, 72076, Tübingen, Deutschland,
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Breuer K, Göldner F, Jäger B, Werfel T, Schmid-Ott G. Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis. J Eur Acad Dermatol Venereol 2015; 29:1898-904. [DOI: 10.1111/jdv.12999] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K. Breuer
- Department of Allergology and Occupational Dermatology; Dermatologikum Hamburg; Hamburg Germany
| | - F.M. Göldner
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Tübingen Germany
| | - B. Jäger
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
| | - T. Werfel
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - G. Schmid-Ott
- Institute for Innovative Rehabilitation, Hospital Management and Distress Medicine (IREHA); Lielje Group; Löhne Germany
- Department of Psychosomatic Medicine; Berolina Clinic; Löhne Germany
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Schochter F, Albrecht S, Friedl TWP, Melchers C, Hagenbeck C, Jäger B, Rack B, Müller V, Fasching PA, Janni W, Fehm T. DETECT IV – Multizentrische Studie bei Patientinnen mit HER2-negativem metastasierten Brustkrebs und persistierenden ausschließlich HER2-negativen zirkulierenden Tumorzellen (CTCs). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388497] [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: 10/24/2022] Open
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Yi B, Rykova M, Feuerecker M, Jäger B, Ladinig C, Basner M, Hörl M, Matzel S, Kaufmann I, Strewe C, Nichiporuk I, Vassilieva G, Rinas K, Baatout S, Schelling G, Thiel M, Dinges DF, Morukov B, Choukèr A. 520-d Isolation and confinement simulating a flight to Mars reveals heightened immune responses and alterations of leukocyte phenotype. Brain Behav Immun 2014; 40:203-10. [PMID: 24704568 DOI: 10.1016/j.bbi.2014.03.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 03/24/2014] [Indexed: 01/20/2023] Open
Abstract
During interplanetary exploration, chronic stress caused by long term isolation and confinement in the spacecraft is one of the major concerns of physical and psychological health of space travelers. And for human on Earth, more and more people live in an isolated condition, which has become a common social problem in modern western society. Collective evidences have indicated prolonged chronic stress could bring big influence to human immune function, which may lead to a variety of health problems. However, to what extent long-term isolation can affect the immune system still remains largely unknow. A simulated 520-d Mars mission provided an extraordinary chance to study the effect of prolonged isolation. Six healthy males participated in this mission and their active neuroendocrine and immune conditions were studied with saliva and blood samples from all participants on chosen time points during the isolation period. As a typical neuroendocrine parameter, stress hormone cortisol was measured in the morning saliva samples. Immune phenotype changes were monitored through peripheral leukocyte phenotype analysis. Using an ex vivo viral infection simulation assay we assessed the immune response changes characterized by the ability to produce representative endogenous pro-inflammatory cytokines. The results of this study revealed elevated cortisol levels, increased lymphocyte amount and heightened immune responses, suggesting that prolonged isolation acting as chronic stressors are able to trigger leukocyte phenotype changes and poorly controlled immune responses.
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Affiliation(s)
- B Yi
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - M Rykova
- Institute for Biomedical Problems, Moscow, Russian Federation
| | - M Feuerecker
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - B Jäger
- Institute of Virology (Max von Pettenkofer-Institut), University of Munich, Munich, Germany
| | - C Ladinig
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - M Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Hörl
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - S Matzel
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - I Kaufmann
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - C Strewe
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - I Nichiporuk
- Institute for Biomedical Problems, Moscow, Russian Federation
| | - G Vassilieva
- Institute for Biomedical Problems, Moscow, Russian Federation
| | - K Rinas
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - S Baatout
- Laboratory of Radiobiology, Belgian Nuclear Research Centre, Mol, Belgium
| | - G Schelling
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany
| | - M Thiel
- Clinic of Anaesthesiology and Intensive Care, Klinikum Mannheim, University of Mannheim, Mannheim, Germany
| | - D F Dinges
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - B Morukov
- Institute for Biomedical Problems, Moscow, Russian Federation
| | - A Choukèr
- Hospital of the University of Munich (LMU), Department of Anesthesiology, Research Group Stress & Immunity, Marchioninistrasse 15, 81377 Munich, Germany.
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Schochter F, Melcher C, Hagenbeck C, Friedl TWP, Jäger B, Rack BK, Müller V, Fasching PA, Janni W, Fehm T. Abstract OT2-6-10: DETECT IV – A multicenter, single arm, phase II study evaluating the efficacy of everolimus in combination with endocrine therapy in patients with HER2-negative, hormone-receptor positive metastatic breast cancer and HER2-negative circulating tumor cells (CTCs). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot2-6-10] [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: The monitoring of therapy efficacy in metastatic breast cancer (MBC) is a very important component of treatment. Several studies have indicated that the determination of prevalence and number of circulating tumor cells (CTCs) at various times during treatment may be an effective tool for assessing treatment efficacy. Even if the prognostic value of CTCs in MBC is well understood, the role of CTC prevalence and - in particular - CTC phenotype in predicting treatment response requires further investigation. While the recently started DETECT III-trial is designed to evaluate the effect of HER2-targeted therapy in patients with HER2-negative MBC and HER2-postive CTCs, DETECT IV aims to assess the effect of an endocrine treatment in combination with the mTOR-inhibitor everolimus for patients with HER2-negative CTCs.
SPECIFIC AIMS/TRIAL DESIGN: DETECT IV is a prospective, multicenter, open-label, single arm phase II study aimed at postmenopausal patients with hormone-receptor positive, HER2-negative metastatic breast cancer. Patients with HER2-negative CTCs will be treated with Everolimus in combination with an endocrine therapy according to the physician's choice (letrozole, anastrozole, exemestan or tamoxifen). The primary objective of the trial is to estimate the clinical efficacy of everolimus in combination with endocrine therapy as assessed by progression-free survival (PFS) in the targeted patient population. Additional research will be done on CTC dynamics and characteristics (e.g. PI3K-mutation-analysis). This will provide a better understanding of prognostic and predictive value of the CTCs. This clinical trial is one more step into a more personalized therapy for metastatic breast cancer and will provide further information on CTCs and their informative value during the therapy.
ELIGIBILITY CRITERIA: In this trial postmenopausal female patients suffering from hormone-receptor positive, HER2-negative metastasizing breast cancer with HER2-negative circulating tumor cells (CTC) and indication for standard anticancer therapy will be included.
STATISTICAL METHODS/TARGET ACCRUAL: DETECT IV will start in September 2013. The estimated number of patients is 400. Therefore, 2000 patients need to be screened for HER2-negative CTCs. This screening is combined with the DETECT III - trail, which started February 2012. The primary endpoint progression-free survival will be estimated using the Kaplan-Meier method. Prevalence and number of CTCs at various time points will be determined using the FDA-approved CellSearch System (Veridex, USA). In addition, different measures of CTC dynamics and their value for evaluating therapy efficacy or as a prognostic tool will be examined in detail by explorative data analyses.
Contact information: fabienne.schochter@uniklinik-ulm.de.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-6-10.
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Affiliation(s)
- F Schochter
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Melcher
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Hagenbeck
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - BK Rack
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - W Janni
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
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de Gregorio N, Schochter F, Melcher C, Hagenbeck C, Friedl TWP, Jäger B, Rack BK, Müller V, Fasching PA, Janni W, Fehm T. Abstract OT1-1-11: DETECT III - A multicenter, randomized, phase III trial to compare standard therapy alone versus standard therapy plus lapatinib in patients with initially HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot1-1-11] [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: In metastatic breast cancer (MBC) patients, HER2 status may be subject to change and it has been shown that 20-30% of initially HER2-negative patients have HER2-positive metastases. The discordance of the HER2 status between primary tumor and circulating tumor cells (CTCs) may be an important factor affecting the response to HER2-targeted treatments; however, it is unclear if therapy based on the HER2 status of CTC offers a clinical benefit for patients.
Trial Design: DETECT III is a recruiting prospective, multicenter, open-label, two-arm, phase-III study for patients with HER2-negative MBC. Patients with HER2-positve CTCs are randomized to receive either a standard therapy of the physician's choice alone or a standard therapy plus additional HER2-targeted treatment with Lapatinib.
Main Eligibility criteria:
- Metastatic breast cancer;
- HER2-negative primary tumor tissue and/or biopsies from metastatic sites;
- Evidence of at least 1 HER2-positive CTC out of 7.5 ml blood;
- Indication for systemic treatment
- ≥1 lesion evaluable according to RECIST
Specific aims: The objective of the DETECT III trial is to estimate the clinical efficacy of standard therapy plus lapatinib as assessed by progression free survival (PFS) in patients with initially HER2-negative MBC and HER2-positive CTCs. Additional research will be performed on CTC dynamic and characteristics.
Present accrual and target accrual: The DETECT III – trial started February 2012 and has analyzed so far (2013-06-06) 506 patients. We found CTCs in 336 (66.4%) patients (median 7 CTCs, range 1-35078). 67 of these patients (19.9%) had at least one HER2 positive CTC. Estimated patient enrollment is 228.
Methods: The primary endpoint progression-free survival will be estimated using the Kaplan-Meier method. Prevalence and number of CTCs at various time points as well as the HER2 status of CTCs will be determined using the FDA-approved CellSearch System (Veridex, USA). In addition, different measures of CTC dynamics and their value for evaluating therapy efficacy or as a prognostic tool will be examined in detail by explorative data analyses.
Perspectives: The DETECT III-Trail is the first study where treatment is based on phenotypic characteristics of CTCs. If this trial succeeds in proving efficacy of lapatinib in patients with initially HER2-negative primary tumor but HER2-positive CTCs, it may lead to a new strategy for the treatment of metastatic breast cancer.
Contact information: nikolaus.de-gregorio@uniklinik-ulm.de.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-1-11.
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Affiliation(s)
- N de Gregorio
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - F Schochter
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Melcher
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Hagenbeck
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - BK Rack
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - W Janni
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
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Kittner JM, Brokamp F, Jäger B, Wulff W, Schwandt B, Jasinski J, Wedemeyer H, Schmidt RE, Schattenberg JM, Galle PR, Schuchmann M. Disclosure behaviour and experienced reactions in patients with HIV versus chronic viral hepatitis or diabetes mellitus in Germany. AIDS Care 2013; 25:1259-70. [PMID: 23383628 DOI: 10.1080/09540121.2013.764387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure is a prerequisite to receive disease-specific social support. However, in the case of a stigmatised disease, it can also lead to discrimination. We aimed to assess disclosure rates of HIV patients and the reactions they encountered in comparison to patients with chronic viral hepatitis or diabetes mellitus and patients' general perception of disease-specific discrimination. We constructed a self-report questionnaire, anonymously assessing the size of the social environment, the persons who had been informed, and the experienced reactions as perceived by the disclosing patients, to be rated on 1-4 point Likert scales. In addition, patients were asked whether they perceive general discrimination in Germany. One hundred and seventy-one patients were asked to participate. Five rejected, thus questionnaires from 83 patients with HIV, 42 patients with chronic viral hepatitis B (n = 9) or C (n = 33), and 41 patients with insulin-dependent diabetes mellitus (type I n = 14, type II n = 27) were analysed. Whereas the size of the social environment did not differ, HIV-infected patients were least likely to disclose their disease (60.7%, SD ± 31.9) to their social environment as compared to patients with chronic viral hepatitis (84.2 ± 23.3%, p<0.0001), or diabetes mellitus (94.4 ± 10.3%, p<0.0001), respectively. Within the HIV patient group, the mean disclosure rate was highest to partners (90.9%), followed by the public environment (65.2%), friends (59.4%) and family members (43.8%). HIV patients experienced supportive reactions after 79.3 ± 26.4% of disclosures, which was the case in 91.4 ± 19.6% and 75.7 ± 36.1% of patients with hepatitis or diabetes mellitus, respectively. 69.5% of HIV patients stated to perceive general discrimination in Germany. We conclude that HIV patients had experienced supportive reactions after the majority of disclosures, but the low rate points out that their information strategy had been very selective. Societal discrimination of HIV patients is still an issue and needs to be further addressed.
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Affiliation(s)
- J M Kittner
- a 1st Medical Department , University Hospital Mainz , Mainz , Germany
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Jäger B, Schupp J, Hornung V, Müller-Quernheim J, Prasse A. Increase in inflammasome activation in acute exacerbation of idiopathic pulmonary fibrosis. Pneumologie 2012. [DOI: 10.1055/s-0032-1329822] [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: 10/27/2022]
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32
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Stahmeyer JT, Zastrutzki S, Nyenhuis N, Kröner-Herwig B, Jäger B, Krauth C. Kosteneffektivität sekundärpräventiver Maßnahmen zur Vermeidung einer Anpassungsstörung bei akutem Tinnitus - medienbasierte Programme vs. Gruppenschulung. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322103] [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: 10/27/2022]
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33
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Andergassen U, Zebisch M, Kölbl AC, Neugebauer J, Jäger B, Heublein S, Rack B, Friese K, Jeschke U. Immunhistochemischer Nachweis disseminierter Tumorzellen aus dem Knochenmark von Brustkrebspatientinnen: Korrelation von Her2 und Thomsen-Friedenreich-Antigen. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318587] [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: 10/28/2022] Open
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34
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Zebisch M, Andergassen U, Kölbl AC, Heublein S, Jäger B, Neugebauer J, Rack B, Friese K, Jeschke U. Nachweis zirkulierender Tumorzellen aus dem Blut von Brustkrebspatientinnen anhand der Genexpression von Cytokeratin 8, 18 und 19. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318586] [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: 10/28/2022] Open
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35
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Jäger B, Schmid-Ott G, Ernst G, Dölle-Lange E, Sack M. [Development and validation of an inventory of ego functions and self regulation (Hannover Self-Regulation Inventory, HSRI)]. Fortschr Neurol Psychiatr 2012; 80:336-43. [PMID: 22431127 DOI: 10.1055/s-0031-1282071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to construct and validate a short self-rating questionnaire for the assessment of ego functions and ability of self regulation. MATERIAL AND METHODS An item pool of 120 items covering 6 postulated dimensions was reduced by two steps in independent samples (n = 136 + 470) via factor and item analyses to the final version consisting of 35 items. RESULTS The 5 resulting questionnaire scales "interpersonal disturbances", "frustration tolerance and impulse control", "identity disturbances", "affect differentiation and affect tolerance" and "self-esteem" were well interpretable and showed in confirmatory factor analysis the best fit to the data (CHI²/df = 3.48; RMSEA = 0.73). Total scores were found to differentiate well between diagnostic groups of patients with more or less ego pathology (FANOVA = 9.8; df = 11; p < 0.001), thus proving good concurrent validity. Reliability was shown by testing internal consistency and test-retest correlations. CONCLUSION The "Hannover self-regulation questionnaire" (HSRQ) evidently is an appropriate and reliable screening instrument in order to assess ego functions and capacities of self regulation in an economic and user-friendly means. The scale structure allows differentiated diagnostics of weak vs. stable ego functions and may be used for detailed therapy planning.
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Affiliation(s)
- B Jäger
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover.
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Andergassen U, Kölbl A, Zebisch M, Neugebauer J, Jäger B, Hutter S, Rack B, Schindlbeck C, Friese K, Jeschke U. 278 Two Methods for the Detection of Breast Cancer Cells in Blood Samples. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70345-3] [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: 11/28/2022]
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Melcher C, Scholz C, Jäger B, Hagenbeck C, Rack B, Janni W. Breast Cancer: State of the Art and New Findings. Geburtshilfe Frauenheilkd 2012; 72:215-224. [PMID: 26640286 PMCID: PMC4651153 DOI: 10.1055/s-0031-1298320] [Citation(s) in RCA: 12] [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: 12/22/2011] [Revised: 03/12/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022] Open
Abstract
Advances in research have a highly influential role to play in the strategy of early detection, treatment and aftercare of breast cancer and therefore everyday clinical practice. Newly-defined prognosis factors and a new form of molecular subtype classification, for example, are intended to help identify patients who will actually benefit from chemotherapy. In the field of neoadjuvant chemotherapy, the inclusion of the angiogenesis inhibitor Bevacizumab and dual antiHER2 therapy is being discussed. What's more, where defined criteria are met, even with positive sentinel lymph nodes, axillary dissection is not performed; besides bisphosphonates RANKL antibody Denosumab is now an option in the treatment of bone metastases.
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Affiliation(s)
- C. Melcher
- Womenʼs Clinic, Hospital of the Heinrich Heine University of Düsseldorf, Düsseldorf
| | - C. Scholz
- Womenʼs Clinic, Hospital of the Heinrich Heine University of Düsseldorf, Düsseldorf
| | - B. Jäger
- Department and Outpatient Clinic for Gynaecology and Obstetrics – Innenstadt, Hospital of the Ludwig Maximilian , University of Munich, Munich
| | - C. Hagenbeck
- Womenʼs Clinic, Hospital of the Heinrich Heine University of Düsseldorf, Düsseldorf
| | - B. Rack
- Department and Outpatient Clinic for Gynaecology and Obstetrics – Innenstadt, Hospital of the Ludwig Maximilian , University of Munich, Munich
| | - W. Janni
- Womenʼs Clinic, Hospital of the Heinrich Heine University of Düsseldorf, Düsseldorf
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Böhm D, Stock Gissendanner S, Bangemann K, Snitjer I, Werfel T, Weyergraf A, Schulz W, Jäger B, Schmid-Ott G. Perceived relationships between severity of psoriasis symptoms, gender, stigmatization and quality of life. J Eur Acad Dermatol Venereol 2012; 27:220-6. [DOI: 10.1111/j.1468-3083.2012.04451.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Jäger B, Hepp P, Rack B, Schindlbeck C, Andergassen U, Neugebauer J, Beck T, Schlag R, Hönig A, Bauerfeind I, Beckmann MW, Janni W, Friese K. Korrelation von CA27.29 und zirkulierenden Tumorzellen bevor, nach abgeschlossener Chemotherapie und nach zwei Jahre bei Patientinnen mit primärem Brustkrebs – Ergebnisse der SUCCESS Studie. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278568] [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] Open
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40
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Klein-Weigel P, Richter J, Arendt U, Gerdsen F, Härtwig A, Gutsche-Petrak B, Walter C, Santarelli A, Glöckner D, Hannemann A, Hermanns M, Leimbach T, Rakob J, Hullmeine D, Jordan A, Wiegand J, Lenke B, Lochmann UA, Grunwald H, Brackertz R, Jäger B, Bublak A, Brand T, Alsen H. Quality management in the prophylaxis of venous thrombembolism--results of a survey including 464 medical and surgical patients. VASA 2011; 40:123-30. [PMID: 21500177 DOI: 10.1024/0301-1526/a000082] [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: 11/19/2022]
Abstract
BACKGROUND We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. PATIENTS AND METHODS Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. RESULTS Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). CONCLUSIONS We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and "hot spots" quality management-audits proved to be valuable instruments.
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Jasper S, Stephan M, Jäger B, Rennekampff HO, Vogt PM, Mirastschijski U. Wie viel Anerkennung und Unterstützung braucht Spitzenmedizin? - Belastungen und Ressourcen von Mitarbeitern verschiedener Intensivstationen. Psychother Psychosom Med Psychol 2011. [DOI: 10.1055/s-0031-1272392] [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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42
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Isermann R, Grunwald S, Hatzung G, Könsgen-Mustea D, Behrndt PO, Geaid AA, Jäger B, Ohlinger R. Breast lesion sizing by B-mode imaging and sonoelastography in comparison to histopathological sizing--a prospective study. Ultraschall Med 2011; 32 Suppl 1:S21-S26. [PMID: 20408120 DOI: 10.1055/s-0029-1245297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE This prospective study evaluates whether sonoelastography can improve B-mode ultrasonographic sizing of breast tumors. Precise measuring is important for effective therapy planning for breast cancer patients. MATERIALS AND METHODS The size of 100 surgically excised breast lesions (92 patients: 77 malignant, 23 benign) was compared to preoperative measurements. Lesions were imaged with both ultrasonographic techniques in identical planes. The largest sizes measured with each modality were compared to the largest histopathological measurements. The interobserver variability was also computed from measurements made by two examiners assessing identical planes. RESULTS Both ultrasonographic measuring techniques underestimate lesion size. The sonoelastography measurements were within ± 5 mm of the histological size in 70.1 % of malignant lesions, and the B-mode measurements in 57.1 % of cases. Sonoelastography leads to more accurate measurements of 13.0 % of cases (statistically not significant). A total of 22 lesions were also imaged by a second examiner. Sonoelastography had 27.3 % less interobserver variability (examiners agreed in 36.4 % of sonoelastography and in 9.1 % of B-mode results). CONCLUSION In this study there is no significant advantage of sonoelastography, although a tendency is apparent. The low interobserver variability also favors sonoelastography for preoperative diagnostics, since it may be less dependent on the observer than conventional B-mode imaging. The results of this prospective study require validation in a prospective multicenter study with larger case numbers.
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Affiliation(s)
- R Isermann
- Department of Gynecology & Obstetrics, E-M-A-University, Greifswald, Germany
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Timofeeva M, Kropp S, Sauter W, Beckmann L, Rosenberger A, Illig T, Jäger B, Mittelstrass K, Dienemann H, Bartsch H, Bickeböller H, Chang-Claude J, Risch A, Wichmann HE. Genetic polymorphisms of MPO, GSTT1, GSTM1, GSTP1, EPHX1 and NQO1 as risk factors of early-onset lung cancer. Int J Cancer 2010; 127:1547-61. [DOI: 10.1002/ijc.25175] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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44
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Scherf DB, Dally H, Müller P, Werle-Schneider G, Jäger B, Edler L, Tuengerthal S, Fischer JR, Drings P, Bartsch H, Risch A. Single nucleotide polymorphisms in matrix metalloproteinase genes and lung cancer chemotherapy response and prognosis. Eur Respir J 2009; 35:381-90. [PMID: 19643940 DOI: 10.1183/09031936.00125608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prognosis for lung cancer patients treated with chemotherapy is poor. Single nucleotide polymorphisms (SNPs) in matrix metalloproteinase (MMP) genes could influence treatment outcome by altering apoptotic pathways. Eight SNPs with known or suspected phenotypic effect in six genes (MMP1, MMP2, MMP3, MMP7, MMP9 and MMP12) were investigated. For 349 Caucasian patients with primary lung cancer, receiving first-line chemotherapy, three different endpoints were analysed: response after the second cycle, progression free survival (PFS) and overall survival (OS). The prognostic value of the SNPs was analysed using multiple logistic regression for all patients and histology-, stage- and treatment-specific subgroups. Hazard ratio estimates for PFS and OS were calculated using Cox regression methods. None of the investigated polymorphisms modified response significantly in the whole patient population. However, tumour stage IIIB variant allele carriers of MMP2 C-735T showed a significantly worse response. PFS was significantly prolonged in MMP1 G-1607GG variant allele carriers and OS in small cell lung cancer patients carrying the MMP12 A-82G variant allele. In conclusion, this study identified SNPs in MMP1, MMP2, MMP7 and MMP12 for further investigation as possible predictors of chemotherapy outcome in lung cancer patients.
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Affiliation(s)
- D B Scherf
- Dept of Epigenomics and Cancer Risk Factors, German Cancer Research Center Heidelberg, Germany
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Timofeeva MN, Kropp S, Sauter W, Beckmann L, Rosenberger A, Illig T, Jäger B, Mittelstrass K, Dienemann H, Bartsch H, Bickeböller H, Chang-Claude JC, Risch A, Wichmann HE. CYP450 polymorphisms as risk factors for early-onset lung cancer: gender-specific differences. Carcinogenesis 2009; 30:1161-9. [DOI: 10.1093/carcin/bgp102] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
| | - Silke Kropp
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Wiebke Sauter
- Institute of Epidemiology, Helmholtz Centre, 85764 Munich, Germany
| | - Lars Beckmann
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Albert Rosenberger
- Department of Genetic Epidemiology, Georg-August University of Göttingen, Medical School, 37073 Göttingen, Germany
| | - Thomas Illig
- Institute of Epidemiology, Helmholtz Centre, 85764 Munich, Germany
| | | | | | | | | | - Heike Bickeböller
- Department of Genetic Epidemiology, Georg-August University of Göttingen, Medical School, 37073 Göttingen, Germany
| | - Jenny C. Chang-Claude
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Centre, 85764 Munich, Germany
- Chair of Epidemiology, Ludwig-Maximilians-University, 80539 Munich, Germany
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46
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Timofeeva M, Jäger B, Rosenberger A, Sauter W, Wichmann HE, Bickeböller H, Risch A. A multiplex real-time PCR method for detection of GSTM1 and GSTT1 copy numbers. Clin Biochem 2009; 42:500-9. [DOI: 10.1016/j.clinbiochem.2008.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/20/2008] [Accepted: 12/09/2008] [Indexed: 02/06/2023]
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Rakob JC, Jäger B, Schmauser I, Willenborg A, Moers AV, Riebe K. Dünndarmduplikaturen – 3 Fallberichte. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223095] [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: 10/20/2022]
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48
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Köhler J, Krause B, Grunwald S, Thomas A, Köhler G, Schwesinger G, Schimming A, Jäger B, Paepke S, Ohlinger R. Ultrasound and mammography guided wire marking of non-palpable breast lesions: analysis of 741 cases. Ultraschall Med 2007; 28:283-90. [PMID: 17315109 DOI: 10.1055/s-2006-927238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Aim of the study were to evaluate the success of ultrasound and mammography guided wire marking of non-palpable breast lesions and the results of specimen mammography/ultrasonography, completeness of resection, and number of secondary resections (during the initial surgical session and as a separate intervention) were analysed. MATERIALS AND METHODS Between May 1994 and December 2004, 668 women with 741 non-palpable breast lesions underwent surgery at the Greifswald University Department of Gynaecology and Obstetrics. Ultrasound directed wire marking was used in 418, mammography directed marking in 284 cases. In 39 lesions, both techniques were combined. RESULTS Out of all lesions approached with ultrasound directed wire marking, 88 (21.1 %) were malignant. Among lesions marked during mammography, 52 (19.3 %) were malignant. Specimen ultrasonography indicated that 90.9 % of lesions were resected completely. Specimen mammography demonstrated complete resection in 89.1 %. On histological examination, 19.5 % of the malignant lesions marked with sonographic guiding and 36.5 % of the malignant lesions marked with mammographic guiding did not have clear margins. Secondary resections (during the first procedure) for incomplete specimens were needed in 10 patients in whom sonographic localisation had been used, and in 25 patients in whom mammographic localisation had been employed. A second surgical session for secondary resection was required in 5.5 % of lesions marked with ultrasound and in 12.3 % of lesions marked with mammography guidance. CONCLUSION Sonography directed wire localisation appears to be superior to the respective mammographic method. Ultrasound guided wire marking should be considered the preferred method for all mammographic lesions with an ultrasonographic equivalent and no micro-calcifications.
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Affiliation(s)
- J Köhler
- Ernst-Moritz-Arndt-University of Greifswald, Department of Gynecology and Obstetrics, Germany
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Jäger B, Sack M, Schmid-Ott G. Faktorenstruktur und Validität des Hannover-Fragebogens zur Selbstregulation und zu Ich-Funktionen (HSRI): Die 35-Item-Version. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970658] [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: 10/21/2022]
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50
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Jäger B. Notfälle in der Strabologie. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-984588] [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: 10/21/2022]
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