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Gampenrieder SP, Pircher M, Fesl C, Rinnerthaler G, Mlineritsch B, Greil-Ressler S, Steger GG, Sagaster V, Fitzal F, Exner R, Devyatko Y, Balic M, Stöger H, Suppan C, Bauernhofer T, Singer CF, Pfeiler G, Seifert M, Helfgott R, Heck D, Rumpold H, Kwasny W, Wieder U, Gnant M, Greil R. Influence of Height on Risk and Outcome of Patients with Early Breast Cancer: A Pooled Analysis of 4,925 Patients from 5 Randomized Trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG). Breast Care (Basel) 2021; 17:137-145. [PMID: 35707180 PMCID: PMC9149458 DOI: 10.1159/000516157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Associations between height, cancer risk and worse outcome have been reported for several cancers including breast cancer. We hypothesized that in breast cancer clinical trials, tall women should be overrepresented and might have worse prognosis. <b><i>Methods:</i></b> Data of 4,935 women, included from 1990 to 2010 in 5 trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG), were analyzed retrospectively. The primary objective was to determine differences in height distribution between the ABCSG cohort and the Austrian female population according to a cross-sectional health survey conducted by the Austrian Statistic Center in 2006 and 2007. Secondary endpoints were disease-free survival (DFS) and overall survival (OS) in different height classes and differences of body mass index (BMI) distribution. <b><i>Results:</i></b> Breast cancer patients in the ABCSG cohort were only slightly but statistically significantly smaller compared to unselected Austrian adult females (mean 164.3 vs. 164.8 cm; <i>p</i> < 0.0001) and significantly more patients were seen in the lower body height class (50 vs. 46%; <i>p</i> < 0.0001) when using the median as a cutoff. However, after adjustment for age, the difference in body height between the two cohorts was no longer significant (<i>p</i> = 0.089). DFS and OS in the two upper height groups (≥170 cm) compared to the two lowest height groups (<160 cm) was not significantly different (5-year DFS: 84.7 vs. 83.0%; HR 0.91, 95% CI 0.73–1.13, <i>p</i> = 0.379; 5-year OS: 94.8 vs. 91.7%; HR 0.74, 95% CI 0.55–1.00, <i>p</i> = 0.051). The BMI of ABCSG patients was significantly higher than in the reference population (mean BMI 24.64 vs. 23.96; <i>p</i> < 0.0001). <b><i>Conclusions:</i></b> Our results do not confirm previous findings that greater body height is associated with a higher breast cancer risk and worse outcome.
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Affiliation(s)
- Simon P Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Magdalena Pircher
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sigrun Greil-Ressler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther G Steger
- Department of Internal Medicine 1, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Verena Sagaster
- Department of Internal Medicine 1, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Bauernhofer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Helfgott
- Department of Surgery and Breast Health Center, Ordensklinikum Linz, Sisters of Charity Linz, Linz, Austria
| | - Dietmar Heck
- Department of Surgery and Breast Health Center, Ordensklinikum Linz, Sisters of Charity Linz, Linz, Austria
| | - Holger Rumpold
- Department of Internal Medicine 2 with Medical Oncology, Hematology, Gastroenterology and Rheumatology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Werner Kwasny
- Department of Surgery, Wiener Neustadt Hospital, Vienna, Austria
| | - Ursula Wieder
- Department of Surgery, Hanusch Hospital Vienna, Vienna, Austria
| | - Michael Gnant
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
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2
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Prager GW, Oehler L, Gerger A, Mlineritsch B, Andel J, Petzer A, Wilthoner K, Sliwa T, Pichler P, Winder T, Heibl S, Gruenberger B, Laengle F, Hubmann E, Korger M, Pecherstorfer M, Djanani A, Neumann HJ, Philipp-Abbrederis K, Wöll E, Trondl R, Arnold-Schrauf C, Eisterer W. Comparison of nab-paclitaxel plus gemcitabine in elderly versus younger patients with metastatic pancreatic cancer: Analysis of a multicentre, prospective, non-interventional study. Eur J Cancer 2020; 143:101-112. [PMID: 33296830 DOI: 10.1016/j.ejca.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatic cancer (PC) ranks among the deadliest malignancies worldwide. In the MPACT study, first-line nab-paclitaxel plus gemcitabine (nab-P/G) demonstrated activity (median overall survival [OS], 8.7 months) and tolerability in patients with metastatic PC (mPC). However, the clinical evidence of nab-P/G in the elderly (>70 years), who account for the majority of patients with mPC, is limited. This is the first prospective, multicentre, non-interventional study evaluating the tolerability and effectiveness of nab-P/G in younger (≤70 years) versus elderly (>70 years) patients with mPC in the daily clinical routine. METHODS Eligible patients with mPC were treated with nab-P/G and observed until disease progression or unacceptable toxicity. The primary objectives were safety and tolerability of nab-P/G, and the secondary objectives were efficacy and real-life dosing. RESULTS A total of 317 patients with mPC (median age, 70 years) were recruited, of which 299, aged ≤70 (n = 162) and >70 (n = 137) years, were eligible for analysis. Baseline characteristics and the safety profile were comparable between the groups. However, fatigue (22.8% versus 13.0%) and decreased appetite (8.8% versus 1.2%) were more frequent in elderly patients. Younger versus elderly patients equally benefited in terms of objective response rate (36% versus 48%), median progression-free survival (5.6 versus 5.5 months; hazard ratio [HR] = 1.03; p = 0.81) and OS (10.6 versus 10.2 months; HR = 0.89; p = 0.4). In addition, the median treatment duration (5 versus 4 cycles), relative dose intensity (70% versus 74%) or reasons for treatment discontinuation were similar. Most patients (56.2% versus 47.4%) benefited from a second-line therapy. CONCLUSION This prospective real-world analysis confirms the feasibility and tolerability of nab-P/G treatment and reveals OS data similar for younger patients and elderly patients aged >70 years. CLINICALTRIALS. GOV REGISTRATION NCT02555813. AUSTRIAN NIS REGISTRY NIS005071.
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Affiliation(s)
- Gerald W Prager
- Medical University of Vienna, Department of Oncology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Leopold Oehler
- Sankt Josef Krankenhaus, Internal Medicine 2, Auhofstraße 189, 1130, Vienna, Wien, Austria.
| | - Armin Gerger
- Medical University of Graz, Clinical Institute of Oncology, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Brigitte Mlineritsch
- Universitätsklinik Salzburg, University Clinic for Internal Medicine III, Müllner Haupstraße 48, 5020, Salzburg, Austria.
| | - Johannes Andel
- Pyhrn-Eisenwurzen Klinikum, Internal Medicine II, Sierningerstraße 170, 4400, Steyr, Austria.
| | - Andreas Petzer
- Ordensklinikum Linz BHS - EKH, Internal Medicine I, Medical Oncology and Hematology, Seilerstätte 4, 4010, Linz Austria.
| | - Klaus Wilthoner
- Landeskrankenhaus Vöcklabruck, Vöcklabruck, Internal Medicine, Hemato-Oncology, Dr. Wilhelm-Bock-Straße 1, 4840 Vöcklabruck, Austria.
| | - Thamer Sliwa
- Hanuschkrankenhaus, Medicine III for Hematology and Oncology, Heinrich-Collin-Straße 30, 1140, Wien, Vienna, Austria.
| | - Petra Pichler
- Universitätsklinikum St. Pölten, Internal Medicine I, Dunant-Platz 1, 3100, Sankt Pölten, Austria.
| | - Thomas Winder
- Landeskrankenhaus Feldkirch, Internal Medicine II, Carinagasse 47, 6807, Feldkirch, Austria.
| | - Sonja Heibl
- Klinikum Wels-Grieskirchen, Internal Medicine IV, Grieskirchner Straße 42, 4600, Wels, Austria.
| | - Birgit Gruenberger
- Landesklinikum Wiener Neustadt, Internal Medicine for Hematology and Internal Oncology, Corvinusring 2-5, 2700, Wiener Neustadt, Austria.
| | - Friedrich Laengle
- Landesklinikum Wiener Neustadt, Department of Surgery, Corvinusring 2-5, 2700, Wiener Neustadt, Austria.
| | - Eva Hubmann
- Krankenhaus der Barmherzigen Brüder, Internal Medicine, Marschallgasse 12, 8020, Graz, Austria.
| | - Markus Korger
- Krankenhaus der Barmherzigen Brüder, Internal Medicine II, Johannes von Gott-Platz 1, 7000, Eisenstadt, Austria.
| | - Martin Pecherstorfer
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine, University Hospital, 3500, Krems an der Donau, Austria.
| | - Angela Djanani
- Medical University of Innsbruck, Institute of Gastroenterology, Internal Medicine I, Institute of Gastroenterology, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Hans-Joerg Neumann
- Krankenhaus der Elisabethinen, Internal Medicine, Völkermarkter Straße 15-19, 9020, Klagenfurt, Austria.
| | - Kathrin Philipp-Abbrederis
- Medical University of Innsbruck, Institute of Hematology and Oncology, Internal Medicine V, Institute of Hematology and Oncology, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Ewald Wöll
- Krankenhaus Zams, Internal Medicine, Sanatoriumstraße 43, 6511, Zams, Austria.
| | - Robert Trondl
- Celgene Austria GmbH, EuroPlaza Building E, Technologiestraße 10, 1120, Vienna, Austria.
| | | | - Wolfgang Eisterer
- Klinikum Klagenfurt Am Wörthersee, Internal Medicine and Oncology, Feschnigstraße 11, 9020, Klagenfurt, Austria.
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3
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Gnant M, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Jakesz R, Marth C, Sevelda P, Mlineritsch B, Exner R, Fesl C, Frantal S, Singer CF. Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2019; 20:339-351. [PMID: 30795951 DOI: 10.1016/s1470-2045(18)30862-3] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND In postmenopausal women with hormone receptor-positive, early-stage breast cancer, treatment with adjuvant aromatase inhibitors is the standard of care, but it increases risk for osteoporosis and fractures. Results from the ABCSG-18 trial showed that use of denosumab as an adjuvant to aromatase inhibitor therapy significantly reduced clinical fractures. Disease-free survival outcomes from ABCSG-18 have not yet been reported. METHODS Postmenopausal patients with early, hormone receptor-positive, non-metastatic adenocarcinoma of the breast, who had completed their initial adjuvant treatment pathway (surgery, radiotherapy, or chemotherapy, or a combination) and were receiving adjuvant aromatase inhibitors, were enrolled at 58 trial centres in Austria and Sweden into this prospective, double-blind, placebo-controlled, phase 3 trial. With permuted block randomisation (block sizes 2 and 4, stratified by previous aromatase inhibitor use, total lumbar spine bone mineral density score at baseline, and type of centre), patients were assigned (1:1) to receive subcutaneous denosumab (60 mg) or matching placebo every 6 months during aromatase inhibitor therapy. The primary endpoint (previously reported) was the time to first clinical fracture after randomisation. The secondary endpoint reported here is disease-free survival (defined as time from randomisation to first evidence of local or distant metastasis, contralateral breast cancer, secondary carcinoma, or death from any cause) in the intention-to-treat population. This study is registered with EudraCT (number 2005-005275-15) and ClinicalTrials.gov (number NCT00556374), and is ongoing for long-term follow-up. FINDINGS Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled and randomly assigned; 1711 to the denosumab group and 1709 to the placebo group (with five others withdrawing consent). After a median follow-up of 73 months (IQR 58-95), 240 (14·0%) patients in the denosumab and 287 (16·8%) in the placebo group had disease-free survival events. Disease-free survival was significantly improved in the denosumab group versus the placebo group (hazard ratio 0·82, 95% CI 0·69-0·98, Cox p=0·0260; descriptive analysis, without controlling for multiplicity). In the denosumab group, disease-free survival was 89·2% (95% CI 87·6-90·8) at 5 years and 80·6% (78·1-83·1) at 8 years of follow-up, compared with 87·3% (85·7-89·0) at 5 years and 77·5% (74·8-80·2) and 8 years in the placebo group. No independently adjudicated cases of osteonecrosis of the jaw or confirmed atypical femoral fractures were recorded. The total number of adverse events was similar in the denosumab group (1367 [including 521 serious] adverse events) and the placebo group (1339 [515 serious]). The most common serious adverse events were osteoarthritis (62 [3·6%] of 1709 in the denosumab group vs 58 [3·4%] of 1690 in the placebo group), meniscus injury (23 [1·3%] vs 24 [1·4%]), and cataract (16 [0·9%] vs 28 [1·7%]). One (<0·1%) treatment-related death (due to pneumonia, septic kidney failure, and cardiac decompensation) occurred in the denosumab group. INTERPRETATION Denosumab constitutes an effective and safe adjuvant treatment for patients with postmenopausal hormone receptor-positive early breast cancer receiving aromatase inhibitor therapy. FUNDING Amgen.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Department of Gynaecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Günther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-Centre for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute, Salzburg, Austria
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Breast Health Centre, Hospital of Sisters of Mercy Linz, Linz, Austria
| | | | - Marija Balic
- Department of Oncology, Medical University Graz, Graz, Austria
| | - Ferdinand Haslbauer
- Department of Internal Medicine, Hospital Voecklabruck, Voecklabruck, Austria
| | | | | | - Raimund Jakesz
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Christian Marth
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Sevelda
- Department of Gynaecology, Hospital Hietzing, Vienna, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-Centre for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Salzburg, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Sophie Frantal
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F Singer
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Department of Gynaecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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4
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract OT3-07-01: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Recently, the PARP inhibitor olaparib was approved as first targeted treatment beyond antiVEGF therapy for the BRCA1/2 mutated subgroup of TNBC. However, cytotoxic agents still remain the mainstay of treatment for this breast cancer subtype. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated as treatment of multiple myeloma. In a preclinical cell line model for TNBC the first-generation proteasome inhibitor bortezomib showed synergistic efficacy with cisplatin. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity (47% and 38% response rate, respectively) and good tolerability. In solid tumors cytotoxic effect of proteasome inhibitors is thought to be mediated through different mechanisms: (1) Inhibition of the Fanconi Anemia and BRCA1 DNA repair mechanism (2) Inhibition of p53 degradation (3) Inhibition of NF-kappa B signaling cascade. Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the oral second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study.Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - S Burgstaller
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Voskova
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Rossmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Egle
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Rumpold
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - CF Singer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
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5
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Gampenrieder SP, Peer A, Weismann C, Meissnitzer M, Rinnerthaler G, Webhofer J, Westphal T, Riedmann M, Meissnitzer T, Egger H, Klaassen Federspiel F, Reitsamer R, Hauser-Kronberger C, Stering K, Hergan K, Mlineritsch B, Greil R. Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR). Breast Cancer Res 2019; 21:19. [PMID: 30704493 PMCID: PMC6357474 DOI: 10.1186/s13058-018-1091-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background Patients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT. Methods Patients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen’s kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS). Results Overall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38–57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79–92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63–84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59–74%) and 69% (170/246; 95% CI 63–75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen’s kappa − 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043). Conclusion Preoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS. Electronic supplementary material The online version of this article (10.1186/s13058-018-1091-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon Peter Gampenrieder
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Andreas Peer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria
| | - Christian Weismann
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Matthias Meissnitzer
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Johanna Webhofer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria
| | - Theresa Westphal
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria
| | - Marina Riedmann
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Meissnitzer
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Heike Egger
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Roland Reitsamer
- Department of Special Gynecology and Breast Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Katharina Stering
- Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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6
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Westphal T, Rinnerthaler G, Gampenrieder SP, Niebauer J, Thaler J, Pfob M, Fuchs D, Riedmann M, Mayr B, Reich B, Melchardt T, Mlineritsch B, Pleyer L, Greil R. Supervised versus autonomous exercise training in breast cancer patients: A multicenter randomized clinical trial. Cancer Med 2018; 7:5962-5972. [PMID: 30415507 PMCID: PMC6308077 DOI: 10.1002/cam4.1851] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background There is a well‐known correlation between obesity, sedentary lifestyle, and breast cancer incidence and outcome. The Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT) exercise study was a multicenter, randomized clinical trial and assessed the feasibility and efficacy of physical training in 50 breast cancer patients undergoing aromatase inhibitor treatment. Methods Postmenopausal, estrogen receptor‐positive breast cancer patients under aromatase inhibitor treatment were randomized 1:1 to counseling and unsupervised training for 48 weeks (unsupervised arm) or counseling and a sequential training (supervised arm) with a supervised phase (24 weeks) followed by unsupervised physical training (further 24 weeks). Primary endpoint was the individual maximum power output on a cycle ergometer after 24 weeks of exercise. A key secondary endpoint was the feasibility of achieving 12 METh/week (metabolic equivalent of task hours per week). Results Twenty‐three patients (92%) in the unsupervised arm and 19 patients (76%) in the supervised arm with early‐stage breast cancer completed the study. After 24 weeks, the supervised arm achieved a significantly higher maximum output in watt (mean 132 ± standard deviation [SD] 34; 95% confidence interval [CI] 117‐147) compared to baseline (107 ± 25; 95%CI 97‐117; P = 0.012) with a numerically higher output than the unsupervised arm (week 24 115 ± 25; 95%CI 105‐125; P = 0.059). Significantly higher METh/week was reported in the supervised arm compared to the unsupervised arm during the whole study period (week 1‐24 unsupervised: 18.3 (7.6‐58.3); supervised: 28.5 (6.7‐40.1); P = 0.043; week 25‐48; P = 0.041)). Conclusion This trial indicates that patients in an exercise program achieve higher fitness levels during supervised than unsupervised training.
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Affiliation(s)
- Theresa Westphal
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Simon Peter Gampenrieder
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Josef Thaler
- IVth department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Michael Pfob
- mediFIT Wels, Medical Fitness and Training Center, Wels, Austria
| | - David Fuchs
- Department of Internal Medicine 3, Hematology and Oncology, Kepler University Hospital Med Campus III, Linz, Austria
| | - Marina Riedmann
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Mayr
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Reich
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
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7
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Fuchs D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Bartsch R, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple-negative breast cancer, a phase I/II trial of the AGMT (AGMT MBC-10 trial). BMC Cancer 2018; 18:1074. [PMID: 30400780 PMCID: PMC6220453 DOI: 10.1186/s12885-018-4979-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Up to now, no targeted treatment beyond anti-VEGF therapy has been approved for TNBC and cytotoxic agents remain the mainstay of treatment. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated in the treatment of multiple myeloma. In a preclinical study TNBC cells were treated with the first-generation proteasome inhibitor bortezomib in combination with cisplatin and synergistic efficacy was demonstrated. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity and good tolerability (Mol Cancer 11:26 2012, J Thorac Oncol 4:87–92 2009, J Thorac Oncol 7:1032–1040, 2012). Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Methods Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease according to RECIST criteria 1.1 are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study utilizes an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), the efficacy and safety of the combination will be further evaluated (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include progression-free survival, safety, and quality of life. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within 2 years. Discussion Based on preclinical and clinical findings an ixazomib and carboplatin combination is thought to be effective in metastatic TNBC patients. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. Trial registration EudraCT Number: 2016–001421-13 received on March 31, 2016, ClinicalTrials.gov Identifier: NCT02993094 first posted on December 15, 2016. This trial was registered prospectively.
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Affiliation(s)
- Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Internal Department I for Medical Oncology and Hematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Sonja Burgstaller
- IVth Department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Wels, Austria
| | - David Fuchs
- Department of Internal Medicine 3 - Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Dieter Rossmann
- 2nd Medical Department, County Hospital Steyr, Steyr, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology, Clinical Department of Gynecology, Medical University Graz, Graz, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Mlineritsch
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. .,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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8
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Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract CT160: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Recently, the PARP inhibitor olaparib was approved as first targeted treatment beyond antiVEGF therapy for the BRCA1/2 mutated subgroup of TNBC. However, cytotoxic agents still remain the mainstay of treatment for this breast cancer subtype. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated as treatment of multiple myeloma. In a preclinical cell line model for TNBC the first-generation proteasome inhibitor bortezomib showed synergistic efficacy with cisplatin. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity (47% and 38% response rate, respectively) and good tolerability. In solid tumors cytotoxic effect of proteasome inhibitors is thought to be mediated through different mechanisms: (1) Inhibition of the Fanconi Anemia and BRCA1 DNA repair mechanism (2) Inhibition of p53 degradation (3) Inhibition of NF-kappa B signaling cascade. Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the oral second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC.
Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Gabriel Rinnerthaler, Simon P. Gampenrieder, Andreas Petzer, Renate Pusch, Daniela Voskova, Dieter Rossmann, Marija Balic, Daniel Egle, Holger Rumpold, Christian F. Singer, Thomas Melchardt, Hanno Ulmer, Brigitte Mlineritsch, Richard Greil. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT160.
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Affiliation(s)
- Gabriel Rinnerthaler
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon P. Gampenrieder
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- 2Internal Department I for Medical Oncology and Hematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Renate Pusch
- 3IVth department of Internal Medicine with Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Daniela Voskova
- 43rd Medical Department, Johannes Kepler University Linz, Linz, Austria
| | - Dieter Rossmann
- 52nd Medical Department, County Hospital Steyr, Steyr, Austria
| | - Marija Balic
- 6Division of Oncology, Medical University Graz, Graz, Austria
| | - Daniel Egle
- 7Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Holger Rumpold
- 8Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian F. Singer
- 9Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Thomas Melchardt
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- 10Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Mlineritsch
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
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Eisterer W, Gerger A, Öhler L, Mlineritsch B, Sliwa T, Wilthoner K, Petzer A, Pichler P, Hubmann E, Winder T, Burgstaller S, Korger M, Andel J, Wöll E, Neumann H, Pecherstorfer M, Philipp-Abbrederis K, Djanani A, Gruenberger B, Längle F, Prager G. Austrian real world data in elderly and younger metastatic pancreatic cancer patients: Interim results of a multicenter non-interventional study with nab-paclitaxel/gemcitabine. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gnant M, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Bergh JCS, Jakesz R, Marth C, Sevelda P, Mlineritsch B, Exner R, Fesl C, Frantal S, Singer CF. Adjuvant denosumab in early breast cancer: Disease-free survival analysis of 3,425 postmenopausal patients in the ABCSG-18 trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna and Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Georg Pfeiler
- Medical University of Vienna, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Vienna, Austria
| | - Guenther G. Steger
- Department of Internal Medicine and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Viktor Wette
- Breast Center, Doctor's Office Wette, St.Veit an Der Glan, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | | | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | | | - Christian Marth
- AGO-A and Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Ruth Exner
- Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Christian F. Singer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Steger G, Petru E, Haslbauer F, Marth C, Egle D, Galid A, Sliwa T, Lang A, Kuehr T, Petzer A, Ruckser R, Greil R, Mlineritsch B, Singer C, Seifert M, Andel J, Kwasny W, Pichler P, Tinchon C, Bartsch R. Real-World multicenter Austrian analysis of the safety and effectiveness of nab-paclitaxel in young and elderly patients with metastatic breast cancer. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30519-7] [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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Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Fridrik M, Rossmann D, Balic M, Egle D, Rumpold H, Singer C, Bartsch R, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract OT2-07-11: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, a phase I/II trial (AGMT MBC-10 trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-07-11] [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: Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with a poor prognosis. Up to now, no targeted treatment beyond anti-VEGF therapy is approved for TNBC so far and cytotoxic agents are the mainstay for the treatment of advanced tumor stages. Ixazomib is a selective, and reversible inhibitor of the proteasome, which has been mainly investigated in the treatment of multiple myeloma. In a preclinical study triple-negative breast cancer cells were treated with bortezomib, a first generation proteaseome inhibitor, alone and in combination with cisplatin, which had a synergistic effect. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity and good tolerability. Based on this rational, the MBC-10 trial will evaluate the toxicity profile and efficacy of ixazomib in combination with carboplatin in patients with advanced TNBC.
Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Fridrik M, Rossmann D, Balic M, Egle D, Rumpold H, Singer C, Bartsch R, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, a phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-11.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Pusch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Fridrik
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Rossmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Egle
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Rumpold
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - C Singer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Bartsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
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Gampenrieder SP, Peer A, Weismann C, Meissnitzer M, Rinnerthaler G, Webhofer J, Westphal T, Popovscaia M, Meissnitzer T, Reitsamer R, Hauser-Kronberger C, Egger H, Hergan K, Mlineritsch B, Greil R. Abstract P4-02-02: Contrast-enhanced MRI does not accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy in early or locally advanced breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-02] [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: Patients with early or locally advanced breast cancer achieving a pathologic complete response (pCR) after neoadjuvant chemotherapy have a lower risk for recurrence or death compared to patients with residual invasive cancer. In the future, breast surgery might be avoided in patients in whom the presence of residual tumor after neoadjuvant therapy can be ruled out with very high confidence. Magnetic resonance imaging (MRI) has been shown to be the most accurate radiologic tool in breast cancer diagnostics and follow-up care. Therefore, we investigated the diagnostic accuracy of contrast-enhanced MRI to predict a pathological complete remission after neoadjuvant chemotherapy.
Methods: This retrospective study included all non-metastatic breast cancer patients treated with neoadjuvant chemotherapy followed by a contrast-enhanced MRI and breast cancer surgery at our institution between 09/2006 and 05/2016. Three specialized breast radiologists, blinded to the clinical and pathological data, reevaluated all preoperative MRI scans and recorded the presence or absence of contrast enhancement as indicator for residual cancer. pCR was defined as no invasive tumor in breast and axilla (ypT0/is N0), however 3 alternative definitions were investigated as well (ypT0 N0, ypT0/is and ypT). Cross tables were used to calculate sensitivity, specificity, pCR-predictive value (PPV), non-pCR-predictive value (NPV) and accuracy. P-values reflecting PPV and NPV differences between various patient subgroups were calculated with Fisher's exact test. The Kaplan-Meier method was used for estimates of distant-recurrence-free survival (DRFS) and overall survival (OS).
Results: In total, 246 patients fulfilled the inclusion criteria and were evaluated. Overall pCR and radiologic complete remission (rCR) rate were 29% and 45%, respectively. Only 48% of rCR corresponded to a pCR (PPV). Conversely, in 87% of cases, residual tumor in the MRI was pathologically confirmed (NPV). The sensitivity to detect a pCR was 75%, while specificity and accuracy were 67% and 69%, respectively. The diagnostic performance of MRI to predict treatment response varied between different histologic and molecular tumor subtypes, however there were little differences between the 4 pCR definitions. The PPV was significantly lower in the hormone-receptor(HR)-positive subgroup compared with the HR-negative subgroup (33% vs. 61%; P = 0.004), especially in luminal-A-like (7%) and lobular carcinomas (0%), respectively. Despite the low concordance (Kohens kappa -0.1), the prognostic value for distant recurrence-free survival was similar between rCR (HR 0.29) and pCR (HR 0.27), respectively. The median pathologic tumor size of residual disease in false-positive cases (rCR but no pCR) was 0.7 cm (SD 0.98 cm).
Conclusion: Contrast-enhanced MRI does not accurately predict pCR after neoadjuvant chemotherapy in early or locally advanced breast cancer, especially in HR-positive tumors. However, in case of false rCR the dimension of residual disease is generally small. Since residual tumor tissue can be detected with high precision, preoperative breast MRI is still of value for operation planning.
Citation Format: Gampenrieder SP, Peer A, Weismann C, Meissnitzer M, Rinnerthaler G, Webhofer J, Westphal T, Popovscaia M, Meissnitzer T, Reitsamer R, Hauser-Kronberger C, Egger H, Hergan K, Mlineritsch B, Greil R. Contrast-enhanced MRI does not accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy in early or locally advanced breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-02.
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Affiliation(s)
- SP Gampenrieder
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - A Peer
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - C Weismann
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - M Meissnitzer
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - G Rinnerthaler
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - J Webhofer
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - T Westphal
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - M Popovscaia
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - T Meissnitzer
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - R Reitsamer
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - C Hauser-Kronberger
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - H Egger
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - K Hergan
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - R Greil
- Paracelsus Medical University Salzburg, Salzburg, Austria; Medical University of Innsbruck, Innsbruck, Austria
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Salat A, Gnant M, Kwasny W, Mlineritsch B, Menzel RC, Schmid M, Smola M, Stierer M, Tausch C, Galid A, Steger G, Jakesz R, Taucher S. Impact of pretreatment thrombocytosis on survival in primary breast cancer. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613413] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPlatelet count has been reported to have predictive value in various cancer entities. In the case of breast cancer, evidence about involvement of platelets is still incomplete. Our objective was to assess the influence of pretreatment thrombocytosis on survival and establish its prognostic relevance for breast cancer patients.We performed a retrospective, multivariate analysis of 4,300 patients with early-stage breast cancer. All subjects participated in one of five prospective, randomized, multicenter trials conducted by the Austrian Breast and Colorectal Cancer Study Group. Thrombocytosis was defined as a platelet count exceeding 400 G/L. Median follow-up was 52 months. Univariate and multiple Cox regression models were calculated for overall survival (OS), breast cancer-related survival and disease-free survival (DFS). Pretreatment thrombocytosis was observed in 161 patients (3.7%). Estimated median OS, breast cancer-related survival and DFS for patients with versus those without thrombocytosis was 71.0 versus 99.5, 72.0 versus 100.9, and 80.4 versus 88.4 months, respectively (p = 0.0054, p = 0.0095, p = 0.0199). A multiple Cox regression model including tumor and nodal status, grading, age, hormone receptor status and pretreatment thrombocytosis identified pretreatment thrombocytosis as an independent predictive factor for OS (p = 0.0064) and breast cancer-related survival (p = 0.0162). Multivariate analysis failed to identify pretreatment thrombocytosis as an independent risk factor for DFS (p = 0.1355).In our retrospective study, elevated platelet counts at time of diagnosis were associated with poor prognosis in breast cancer. We hypothesize that platelets may contribute to the patho-physiology of hematogenous metastasis.
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Brandberg Y, Loibl S, Foukakis T, Johansson H, Gnant M, Singer C, von Minckwitz G, Bengtsson NO, Karlsson E, Mlineritsch B, Hellström M, Steger G, Carlsson L, Egle D, Greil R, Bergh J. CTCA toxicity scoring and EORTC quality of life questionnaire: A comparison of physicians’ and patients’ scoring of toxicity in the “Panther trial”. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Singer CF, Jahn SW, Rudas M, Bago-Horvath Z, Fitzal F, Greil R, Mlineritsch B, Schmitt M, Filipits M, Gnant M. Independent validation of stromal uPA in archived tumor samples from the prospectively randomized ABCSG8 trial to provide level 1b evidence for a prognostic value of uPA immunohistochemistry in endocrine-treated postmenopausal breast cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.536] [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: 11/20/2022] Open
Abstract
536 Background: We have recently demonstrated that urokinase Plasminogen Activator (uPA), together with its inhibitor PAI-1, have prognostic value in hormone-receptor positive early breast cancer, and can be measured in FFPE archived tumor samples. We have now aimed to validate the prognostic role of uPA protein expression in FFPE archived tumor samples in an independent cohort of endocrine-treated breast cancer patients. Methods: 303 postmenopausal women with hormone receptor–positive, early breast cancer who had received 5 years of endocrine therapy in the prospectively designed ABCSG-08 trial, and in whom FFPE tumor tissue was available, were included in this analysis. Stromal uPA and PAI-1 protein expression was evaluated by immunohistochemistry and correlated with distant recurrence-free survival (DRFS) and overall survival (OS). Results: Stromal uPA was detected in 132 of 297 tumors (44.4%), and 74 out of 269 samples (27.5%) exhibited stromal PAI-1, while co-expression of both proteins was found in 48 of 294 (16.3%) samples. Neither uPA nor PAI-1 expression were associated with tumor size, age, nodal status, grading, or receptor status. Patients whose tumor stroma expressed uPA protein were more likely to have a shorter DRFS (adjusted HR for relapse: 2.78; 95% CI 1.31-5.93; p=0.008 Cox regression analysis) and OS (adjusted HR for death: 1.29; 95% CI 0.86-12.50; p=0.161) than women without uPA expression. No such association was observed for PAI-1 and for the uPA/PAI1 ratio. After a median follow-up of 5.6 years women with uPA-positive tumors experienced a significantly shorter DRFS (93.3% vs 84.8%; p<0.013 log rank test) and tended to have a worse OS (83.0.4% vs 77.3%; p=0.106) compared to women with uPA negative tumors. Conclusions: By confirming the clinical utility of stromal uPA IHC in archived breast cancer samples from an independent prospective randomized trial, we now provide level 1b evidence for a prognostic role of stromal uPA in women with endocrine-responsive early breast cancer.
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Affiliation(s)
- Christian F. Singer
- Medical University of Vienna, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Vienna, Austria
| | | | - Margaretha Rudas
- Department of Pathology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | | | - Manfred Schmitt
- Department of Obstetrics and Gynecology, Klinikum r.d. Isar Frauenklinik, Technische Universitaet Muenchen, Munich, Germany
| | - Martin Filipits
- Institute of Cancer Research, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center and Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
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Gampenrieder SP, Rinnerthaler G, Pulverer W, Weinhäusel A, Hufnagl C, Hackl H, Hauser-Kronberger C, Mlineritsch B, Greil R. Abstract P6-07-10: DNA methylation signature predicting bevacizumab efficacy in metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-07-10] [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: Biomarkers predicting response to bevacizumab containing therapy in breast cancer are still missing. Since epigenetic modifications can contribute to an aberrant regulation of angiogenesis and to treatment resistance, we investigated the influence of DNA methylation on bevacizumab efficacy.
Patients and methods: A genome-wide methylation profiling using the Illumina Infinium HumanMethylation450 BeadChip was performed in archival FFPE specimen of 36 patients with HER2-negative metastatic breast cancer treated with chemotherapy in combination with bevacizumab as first-line therapy (learning set). Based on objective response and progression-free survival (PFS) and considering ER expression, patients were divided in responders (R) and non-responders (NR). Differentially methylated gene loci (methylation variable position = MVP) and differentially methylated regions (DMR) between R and NR were identified. Only significant sites with a strong change in methylation levels (Δβ>0.15 or Δβ<-0.15), an area under the curve of at least 0.85 by logistic regression analysis, and/or sites in proximity to genes functionally involved in angiogenesis and carcinogenesis were selected and further validated. Validation was performed in 81 bevacizumab treated breast cancer patients (validation set) and in 15 patients treated with chemotherapy only (control set) using targeted bisulfite sequencing. Methylated gene loci were considered predictive if there was a significant association with outcome (PFS) in the validation set but not in the control set using Spearman rank correlation, Cox regression, and logrank test.
Results: In the learning set 435 MVPs (p<0.001) and 144 DMRs (adjusted combined p<0.0001 with at least 3 significant MVPs p<0.05 in the same region) showed significantly different methylation between R and NR. In R 152 sites were hypermethylated with a median change of methylation (Δβ) of 0.13; 283 sites were hypomethylated with a median Δβ of -0.09. A methylation signature of 48 genes was specified allowing a good separation between responders and non-responders (odds ratio=101, p<0.0001; data presented at the 38th SABCS 2015, P3-07-43). At least one methylated cytosine in close proximity to 24 of these genes showed a significant association with PFS in the validation set but was not (or in the other direction) in the control set. Based on these data the methylation signature predicting long lasting response to bevacizumab could be reduced to 24 genes including several genes involved in angiogenesis and carcinogenesis, respectively (FLT1 also known as VEGFR-1, MLH1, GNAS, APC, DKK3, WNT2B and COL4A1).
Conclusion: A 24-gene methylation signature can reproducible discriminate between responders and non-responders to a bevacizumab-based therapy in breast cancer and could help to identify patients deriving greater benefit from anti-VEGF agents.
Citation Format: Gampenrieder SP, Rinnerthaler G, Pulverer W, Weinhäusel A, Hufnagl C, Hackl H, Hauser-Kronberger C, Mlineritsch B, Greil R. DNA methylation signature predicting bevacizumab efficacy in metastatic breast cancer [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 P6-07-10.
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Affiliation(s)
- SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - W Pulverer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - A Weinhäusel
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Hufnagl
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - H Hackl
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Hauser-Kronberger
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Voskova D, Petzer A, Hubalek M, Petru E, Hartmann B, Andel J, Balic M, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract P5-15-13: Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Final PFS results of a phase II trial (AGMT MBC-6). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-15-13] [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: Capecitabine is a well-established treatment option in HER2-negative advanced breast cancer (ABC) patients. Bendamustine is a generally well tolerated cytotoxic drug. Since bendamustine has already shown anticancer activity in ABC we evaluated the efficacy and tolerability of bendamustine in combination with capecitabine in pretreated patients with ABC. Here we present the final PFS results of this phase II trial.
Patients and methods: MBC-6 is a non-randomized, multicenter, open-label, single-arm phase II study in patients with HER2-negative ABC (ClinicalTrials.gov: NCT01891227). All patients were pretreated with anthracyclines and/or taxans and had measurable disease according to RECIST 1.1. Patients received 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine on day 1 and 8 of a 3-week cycle for a maximum of 6 cycles. Afterwards capecitabine was continued as monotherapy. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), clinical benefit rate (CBR), safety and quality of life.
Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centers. Median age was 60 years (range 29-77). Twenty-five percent of patients had triple-negative disease (TNBC) and 93% showed visceral involvement. Sixty-five percent had received prior chemotherapy in the (neo)adjuvant setting and 63% for ABC (43% one line, 15% two lines, 5% three lines). All patients with ER-positive disease had received prior endocrine therapy.At data cut-off on 06/08/16 overall 39 of 40 patients had discontinued treatment with a median PFS of 7.0 months (95% CI 4.6-9.5), 7.4 months in ER-positive and 4.0 months in triple negative disease (TNBC), respectively. Twelve patients (30%) experienced at least one drug related non-hematological AE ≥ grade 3 during combination treatment and further 6 patients (15%) during capecitabine maintenance. Three grade 4 hematological AEs (neutropenia) were observed. One patient died as a result of restrictive cardiomyopathy, where a relationship to capecitabine cannot be excluded, but seems unlikely.
Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and a moderate toxicity profile. Further evaluation of this drug combination is warranted.Background: Capecitabine is a well-established treatment option in HER2-negative advanced breast cancer (ABC) patients. Bendamustine is a generally well tolerated cytotoxic drug. Since bendamustine has already shown anticancer activity in ABC we evaluated the efficacy and tolerability of bendamustine in combination with capecitabine in pretreated patients with ABC. Here we present the final PFS results of this phase II trial.
Patients and methods: MBC-6 is a non-randomized, multicenter, open-label, single-arm phase II study in patients with HER2-negative ABC (ClinicalTrials.gov: NCT01891227). All patients were pretreated with anthracyclines and/or taxans and had measurable disease according to RECIST 1.1. Patients received 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine on day 1 and 8 of a 3-week cycle for a maximum of 6 cycles. Afterwards capecitabine was continued as monotherapy. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), clinical benefit rate (CBR), safety and quality of life.
Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centers. Median age was 60 years (range 29-77). Twenty-five percent of patients had triple-negative disease (TNBC) and 93% showed visceral involvement. Sixty-five percent had received prior chemotherapy in the (neo)adjuvant setting and 63% for ABC (43% one line, 15% two lines, 5% three lines). All patients with ER-positive disease had received prior endocrine therapy.At data cut-off on 06/08/16 overall 39 of 40 patients had discontinued treatment with a median PFS of 7.0 months (95% CI 4.6-9.5), 7.4 months in ER-positive and 4.0 months in triple negative disease (TNBC), respectively. Twelve patients (30%) experienced at least one drug related non-hematological AE ≥ grade 3 during combination treatment and further 6 patients (15%) during capecitabine maintenance. Three grade 4 hematological AEs (neutropenia) were observed. One patient died as a result of restrictive cardiomyopathy, where a relationship to capecitabine cannot be excluded, but seems unlikely.
Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and a moderate toxicity profile. Further evaluation of this drug combination is warranted.
Citation Format: Rinnerthaler G, Gampenrieder SP, Voskova D, Petzer A, Hubalek M, Petru E, Hartmann B, Andel J, Balic M, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Final PFS results of a phase II trial (AGMT MBC-6) [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 P5-15-13.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Voskova
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Hubalek
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Hartmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - J Andel
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
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Foukakis T, von Minckwitz G, Bengtsson NO, Brandberg Y, Wallberg B, Fornander T, Mlineritsch B, Schmatloch S, Singer CF, Steger G, Egle D, Karlsson E, Carlsson L, Loibl S, Untch M, Hellström M, Johansson H, Anderson H, Malmström P, Gnant M, Greil R, Möbus V, Bergh J. Effect of Tailored Dose-Dense Chemotherapy vs Standard 3-Weekly Adjuvant Chemotherapy on Recurrence-Free Survival Among Women With High-Risk Early Breast Cancer: A Randomized Clinical Trial. JAMA 2016; 316:1888-1896. [PMID: 27825007 DOI: 10.1001/jama.2016.15865] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Standard dosing of chemotherapy based on body surface area results in marked interpatient variation in pharmacokinetics, toxic effects, and efficacy. Whether tailored dosing can improve outcomes is unknown, as is the role of dose-dense adjuvant chemotherapy. OBJECTIVE To determine whether tailored dose-dense adjuvant chemotherapy improves the outcomes of early breast cancer compared with a standard 3-weekly chemotherapy schedule. DESIGN, SETTING, AND PARTICIPANTS A randomized, open-label, phase 3 trial of women aged 65 years and younger who had surgery for nonmetastatic node-positive or high-risk node-negative breast cancer at 86 sites in Sweden, Germany, and Austria between February 20, 2007, and September 14, 2011. INTERVENTIONS Patients were randomized 1:1 either to 4 cycles of leukocyte nadir-based tailored and dose-dense adjuvant epirubicin and cyclophosphamide every 2 weeks followed by 4 cycles of tailored dose-dense docetaxel every 2 weeks, or to standard-interval chemotherapy with 3 cycles of fluorouracil and epirubicin-cyclophosphamide every 3 weeks followed by 3 cycles of docetaxel every 3 weeks. MAIN OUTCOMES AND MEASURES The primary end point was breast cancer recurrence-free survival (BCRFS). Secondary end points included 5-year event-free survival (EFS), distant disease-free survival (DDFS), overall survival (OS), and rates of grade 3 or 4 toxic effects. RESULTS Among 2017 randomized patients (1006 in the tailored dose-dense group and 1011 in the control group; median [IQR] age, 51 [45-58] years; 80% with hormone receptor-positive tumors; 97% with node-positive disease), 2000 received study treatment (≥1 cycle of chemotherapy; 1001 in the tailored dose-dense group and 999 in the control group). After a median follow-up of 5.3 years (IQR, 4.5-6.1 years), 269 BCRFS events were reported, 118 in the tailored dose-dense group and 151 in the control group (HR, 0.79; 95% CI, 0.61-1.01; log-rank P = .06; 5-year BCRFS, 88.7% vs 85.0%). The tailored dose-dense group had significantly better EFS than the control group (HR, 0.79; 95% CI, 0.63-0.99; P = .04; 5-year EFS, 86.7% vs 82.1%). The groups did not differ in OS (HR, 0.77; 95% CI, 0.57-1.05; P = .09; 5-year OS, 92.1% vs 90.2%) or DDFS (HR, 0.83; 95% CI, 0.64-1.08; P = .17; 5-year DDFS, 89.4% vs 86.7%). Grade 3 or 4 nonhematologic toxic effects occurred in 527 (52.6%) in the tailored dose-dense group and 366 (36.6%) in the control group. CONCLUSIONS AND RELEVANCE Among women with high-risk early breast cancer, the use of tailored dose-dense chemotherapy compared with standard adjuvant chemotherapy did not result in a statistically significant improvement in breast cancer recurrence-free survival. Nonhematologic toxic effects were more frequent in the tailored dose-dense group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00798070; isrctn.org Identifier: ISRCTN39017665.
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | | | - Yvonne Brandberg
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Birgitta Wallberg
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Tommy Fornander
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | | | - Christian F Singer
- Department of Gynecology, Comprehensive Cancer Center, Medical University, Vienna, Austria
| | - Günther Steger
- Department of Internal Medicine, Comprehensive Cancer Center, Medical University, Vienna, Austria
| | - Daniel Egle
- Department of Gynecology, Medical University, Innsbruck, Austria
| | | | | | | | | | - Mats Hellström
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Harald Anderson
- Department of Clinical Sciences, Cancer Epidemiology, Lund University, Lund, Sweden
| | | | - Michael Gnant
- Department of Surgery, Comprehensive Cancer Center, Medical University, Vienna, Austria
| | - Richard Greil
- Landeskrankenhaus and Paracelsus Medical University, Salzburg, Austria
| | | | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Steger G, Petru E, Haslbauer F, Egle D, Galid A, Sliwa T, Lang A, Kühr T, Petzer A, Ruckser R, Mlineritsch B, Greil R, Seifert M, Singer C, Andel J, Kwasny W, Marth C, Pichler P, Tinchon C, Bartsch R. Safety and effectiveness of nab-paclitaxel in young and elderly patients with metastatic breast cancer: a prospective, multicenter non-interventional study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scheithauer W, Prager G, Greil R, Mlineritsch B, Schaberl-Moser R, Gerger A, Längle F, Viragos-Toth I, Andel J, Pichler A, Pecherstorfer M, Kretschmer A, Seebacher A, Jagdt B, Eisterer W, Krippl P. Secondary resectability rates observed in a multicenter randomized phase II study of modified capecitabine/irinotecan (mXELIRI) plus bevacizumab (bev) followed by capecitabine/oxaliplatin (XELOX) plus bev or the reverse sequence in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.41] [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: 11/14/2022] Open
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Abstract
Increased numbers of tumour infiltrating T‑cells have long been associated with a better prognosis in ovarian cancer, which has led to the general assumption of a relevant impact of T‑cellular anti-tumour immunity in this disease. As a consequence of this knowledge, a multitude of immunologic therapies has emerged over the past years. Although some reports could evidence a successful induction of anti-tumour T‑cells, in general, these attempts did not translate into clinically significant activity. As has already been shown in other tumour entities, immune checkpoint blockade – mainly antibodies directed against PD-1 and PD-L1 – could possibly become a real “game changer” in ovarian cancer in the future.
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Affiliation(s)
- Lukas Weiss
- 3rd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute (SCRI), Muellner Hauptstraße 48, 5020 Salzburg, Austria
| | - Florian Huemer
- 3rd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute (SCRI), Muellner Hauptstraße 48, 5020 Salzburg, Austria
| | - Brigitte Mlineritsch
- 3rd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute (SCRI), Muellner Hauptstraße 48, 5020 Salzburg, Austria
| | - Richard Greil
- 3rd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute (SCRI), Muellner Hauptstraße 48, 5020 Salzburg, Austria
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Bergh JCS, Foukakis T, von Minckwitz G, Bengtsson NO, Wallberg B, Fornander T, Mlineritsch B, Schmatloch S, Singer CF, Steger GG, Karlsson E, Carlsson L, Loibl S, Untch M, Hellstrom M, Johansson H, Malmstrom P, Gnant M, Greil R, Moebus V. PANTHER: Prospective randomized phase III trial of tailored and dose-dense versus standard tri-weekly adjuvant chemotherapy for high-risk breast cancer in the modern era of endocrine and anti-HER2 therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jonas C. S. Bergh
- Karolinska Institutet, Karolinska University Hospital and SweBCG, Stockholm, Sweden
| | | | | | | | | | | | | | | | - Christian F. Singer
- Medical University of Vienna, Department of Obstetrics and Gynecology, Vienna, Austria
| | | | | | | | | | | | - Mats Hellstrom
- Karolinska University hospital, Clinical trial Unit Oncology, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Michael Gnant
- Medical University of Vienna and ABCSG, Vienna, Austria
| | - Richard Greil
- Landeskrankenhaus and Paracelsus Medical University, Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Voskova D, Petzer AL, Hubalek M, Petru E, Hartmann B, Andel J, Balic M, Ulmer H, Melchardt T, Mlineritsch B, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Efficacy results of a phase II trial (AGMT MBC-6). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hanno Ulmer
- Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg, Austria
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Gouy C, Fazelnia C, Wolfrum-Ristau P, Koch H, Mlineritsch B, Schönlieb C, Kronberger C, Bogner G, Fischer T. Primäres diffus großzelliges B-Zell-Lymphom der Zervix in der Schwangerschaft – ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1579591] [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: 10/22/2022] Open
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Rinnerthaler G, Gampenrieder SP, Fridrik M, Petzer A, Hubalek M, Petru E, Jäger T, Andel J, Balic M, Ulmer H, Mlineritsch B, Greil R. Abstract P1-13-10: Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Stage 1 results of a phase II trial (AGMT MBC-6). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-10] [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: Although there is no single accepted standard of care after failure of anthracycline and taxane therapy in HER2-negative metastatic breast cancer, capecitabine is a well-established treatment option. Bendamustine is a hybrid cytotoxic drug because of its structural similarity to alkylating agents and purine and it is generally well tolerated. Since bendamustine has already shown anticancer activity in breast cancer we evaluated the efficacy and tolerability of bendamustine in combination with capecitabine in 40 patients with advanced breast cancer after anthracycline and/or taxane pretreatment.
Patients and methods: MBC-6 is a non-randomized, multicenter, open-label, single-arm phase II study in patients with HER2-negative advanced breast cancer (ClinicalTrials.gov identifier: NCT01891227). All patients were pretreated with anthracyclines and/or taxans in the (neo-)adjuvant and/or metastatic setting and measurable disease according to RECIST 1.1. had to be present at baseline. Following a two-stage Green-Dahlberg design, 20 subjects were accrued and treated within stage 1 of the study. The trial was planned to enroll further 20 patients if there were at least four subjects (20%) with a complete (CR) or partial response (PR). Eligible patients received 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine on day 1 and 8 of a 3-week cycle. After a maximum of eight cycles capecitabine was continued as single drug therapy until disease progression or unacceptable toxicity. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression free survival (PFS), clinical benefit rate (CBR), safety profile and quality of life. Here we report the efficacy and safety analysis of stage 1 patients.
Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centers. Median age of the stage 1 cohort was 59 years (range 29-77), 80% and 20% of patients had an ECOG performance score of 0 and 1, respectively. Thirty-three percent had triple-negative disease, 85% had had (neo-)adjuvant treatment and 65% patients were pretreated with at least one chemotherapy line for metastatic disease (15% one line, 50% two lines, 40% three lines). In stage 1, ORR was 50% with 9 confirmed PR and 1 confirmed CR, and ORR was comparable between hormone receptor-positive and triple-negative disease (54% vs. 43%). CBR was 55%. At data cut-off on 05/28/15 overall 15 of 20 patients had discontinued treatment: 10 patients (50%) due to progressive disease, 3 (15%) because of adverse events (AEs) and 2 patients on their own decision (10%). Five patients (25%) experienced at least one drug related non-hematological AE ≥ grade 3: 2 diarrhea, 2 fatigue, 3 respiratory or viral infections, 1 dyspnea, 1 thromboembolic event (each grade 3). One grade 4 hematological AE (neutropenia) was observed. One patient died as a result of restrictive cardiomyopathy, where a relationship to capecitabine cannot be excluded, but seems unlikely.
Conclusion: The combination of capecitabine and bendamustine has a moderate toxicity profile and the response data of the stage 1 are promising. Final study results are awaited in the first half of 2016.
Citation Format: Rinnerthaler G, Gampenrieder SP, Fridrik M, Petzer A, Hubalek M, Petru E, Jäger T, Andel J, Balic M, Ulmer H, Mlineritsch B, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Stage 1 results of a phase II trial (AGMT MBC-6). [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 P1-13-10.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Fridrik
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Hubalek
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - T Jäger
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - J Andel
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute With Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; General Hospital Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Division of Oncology, Medical University Graz, Graz, Austria; Medical University Innsbruck, Innsbruck, Austria
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Gampenrieder SP, Rinnerthaler G, Weinhäusel A, Pulverer W, Hugnagl C, Hackl H, Romeder F, Monzo Fuentes C, Hauser-Kronberger C, Mlineritsch B, Greil R. Abstract P3-07-43: DNA methylation patterns correlating with outcome in patients treated with first-line bevacizumab for metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-43] [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: Biomarkers predicting response to bevacizumab containing therapy in breast cancer are of urgent need for a personalized treatment approach. DNA methylation is involved in regulation of angiogenesis and development of treatment resistance and could therefore provide predictive information for bevacizumab efficacy.
Patients and methods: A genome-wide methylation profiling using the Illumina Infinium HumanMethylation450 BeadChip was performed in FFPE specimen of 36 patients with HER2-negative metastatic breast cancer treated with chemotherapy in combination with bevacizumab as first-line therapy (discovery set). Twenty-eight (78%) samples came from primary tumor and 8 (22%) from metastasis (2 lung mets., 1 pleural met., 1 liver met., 2 soft tissue mets., 1 ovarial met, 1 bone marrow infiltration). Based on progression-free survival (PFS) and breast cancer subtype (ER+ vs. triple-negative) patients were divided in responder (R) and non-responder (NR). By biostatistical methods differences in the methylation pattern between R and NR were detected. The 48 most interesting genes (e.g. because of there involvement in angiogenesis or carcinogenesis) showing a differential methylation status between R and NR are currently validated in two further metastatic breast cancer cohorts treated with (main set) and without bevacizumab (validation set), respectively. These validated results will be presented at the meeting.
Citation Format: Gampenrieder SP, Rinnerthaler G, Weinhäusel A, Pulverer W, Hugnagl C, Hackl H, Romeder F, Monzo Fuentes C, Hauser-Kronberger C, Mlineritsch B, Greil R. DNA methylation patterns correlating with outcome in patients treated with first-line bevacizumab for metastatic breast cancer. [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 P3-07-43.
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Affiliation(s)
- SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - A Weinhäusel
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - W Pulverer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Hugnagl
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - H Hackl
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Romeder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Monzo Fuentes
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Hauser-Kronberger
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Business Unit for Molecular Diagnostics, AIT – Austrian Institute of Technology GmbH, Vienna, Austria; Division of Bioinformatics, Biocenter, Innsbruck Medical University, Innsbruck, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
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Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, Wette V, Balic M, Haslbauer F, Melbinger E, Bjelic-Radisic V, Artner-Matuschek S, Fitzal F, Marth C, Sevelda P, Mlineritsch B, Steger GG, Manfreda D, Exner R, Egle D, Bergh J, Kainberger F, Talbot S, Warner D, Fesl C, Singer CF. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386:433-43. [PMID: 26040499 DOI: 10.1016/s0140-6736(15)60995-3] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adjuvant endocrine therapy compromises bone health in patients with breast cancer, causing osteopenia, osteoporosis, and fractures. Antiresorptive treatments such as bisphosphonates prevent and counteract these side-effects. In this trial, we aimed to investigate the effects of the anti-RANK ligand antibody denosumab in postmenopausal, aromatase inhibitor-treated patients with early-stage hormone receptor-positive breast cancer. METHODS In this prospective, double-blind, placebo-controlled, phase 3 trial, postmenopausal patients with early hormone receptor-positive breast cancer receiving treatment with aromatase inhibitors were randomly assigned in a 1:1 ratio to receive either denosumab 60 mg or placebo administered subcutaneously every 6 months in 58 trial centres in Austria and Sweden. Patients were assigned by an interactive voice response system. The randomisation schedule used a randomly permuted block design with block sizes 2 and 4, stratified by type of hospital regarding Hologic device for DXA scans, previous aromatase inhibitor use, and baseline bone mineral density. Patients, treating physicians, investigators, data managers, and all study personnel were masked to treatment allocation. The primary endpoint was time from randomisation to first clinical fracture, analysed by intention to treat. As an additional sensitivity analysis, we also analysed the primary endpoint on the per-protocol population. Patients were treated until the prespecified number of 247 first clinical fractures was reached. This trial is ongoing (patients are in follow-up) and is registered with the European Clinical Trials Database, number 2005-005275-15, and with ClinicalTrials.gov, number NCT00556374. FINDINGS Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled into the trial, of whom 3420 were randomly assigned to receive denosumab 60 mg (n=1711) or placebo (n=1709) subcutaneously every 6 months. Compared with the placebo group, patients in the denosumab group had a significantly delayed time to first clinical fracture (hazard ratio [HR] 0·50 [95% CI 0·39-0·65], p<0·0001). The overall lower number of fractures in the denosumab group (92) than in the placebo group (176) was similar in all patient subgroups, including in patients with a bone mineral density T-score of -1 or higher at baseline (n=1872, HR 0·44 [95% CI 0·31-0·64], p<0·0001) and in those with a bone mineral density T-score of less than -1 already at baseline (n=1548, HR 0·57 [95% CI 0·40-0·82], p=0·002). The patient incidence of adverse events in the safety analysis set (all patients who received at least one dose of study drug) did not differ between the denosumab group (1366 events, 80%) and the placebo group (1334 events, 79%), nor did the numbers of serious adverse events (521 vs 511 [30% in each group]). The main adverse events were arthralgia and other aromatase-inhibitor related symptoms; no additional toxicity from the study drug was reported. Despite proactive adjudication of every potential osteonecrosis of the jaw by an international expert panel, no cases of osteonecrosis of the jaw were reported. 93 patients (3% of the full analysis set) died during the study, of which one death (in the denosumab group) was thought to be related to the study drug. INTERPRETATION Adjuvant denosumab 60 mg twice per year reduces the risk of clinical fractures in postmenopausal women with breast cancer receiving aromatase inhibitors, and can be administered without added toxicity. Since a main side-effect of adjuvant breast cancer treatment can be substantially reduced by the addition of denosumab, this treatment should be considered for clinical practice. FUNDING Amgen.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Peter C Dubsky
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Hubalek
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute, Salzburg, Austria
| | - Raimund Jakesz
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Viktor Wette
- Doctor's Office Wette, Breast Center, St Veit an der Glan, Austria
| | - Marija Balic
- Department of Oncology, Medical University of Graz, Graz, Austria
| | | | | | | | | | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Health Center, Hospital of Sisters of Mercy Linz, Linz, Austria
| | - Christian Marth
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Sevelda
- Department of Gynecology, Hospital Hietzing, Vienna, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jonas Bergh
- Department of Oncology/Radiumhemmet, Karolinska Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | - Christian Fesl
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F Singer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic Radisic V, Bergh JCS, Fitzal F, Egle D, Mlineritsch B, Steger GG, Talbot S, Warner DJ, Fesl C, Singer CF. Adjuvant denosumab in breast cancer: Results from 3,425 postmenopausal patients of the ABCSG-18 trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Michael Hubalek
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Viktor Wette
- Breast Center/ Doctor´s Office Wette, St.Veit an Der Glan, Austria
| | | | | | | | | | | | - Florian Fitzal
- Hospital of Sisters of Mercy Linz/ Breast Health Center, Linz, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
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Rinnerthaler G, Knopp AM, Hauser-Kronberger C, Gampenrieder SP, Morre P, Mlineritsch B, Fesl C, Gnant M, Greil R. Abstract P6-08-47: Androgen receptor expression in pre-menopausal early breast cancer patients treated with endocrine therapy within the ABCSG-12 trial - a single center pilot analysis. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-08-47] [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: Estrogen-receptor (ER) positive breast cancer co-expresses androgen receptor (AR) in 75% to 95% of cases. The Austrian Breast & Colorectal Cancer Study Group (ABCSG) trial 12 compared anastrozole plus goserelin with tamoxifen plus goserelin in premenopausal patients with hormone receptor positive early breast cancer. In addition, patients were randomized to receive zoledronic acid or not. The aim of this analysis was to investigate the effect of AR expression on outcome in dependency of the treatment arm.
Patients and methods: AR expression was analyzed by immunohistochemistry using a mouse monoclonal antibody (Novocastra) in formalin-fixed paraffin-embedded specimens from 194 early breast cancer patients treated within the ABCSG 12 trial at our institution. As there is no generally accepted cut-off level defining AR positivity, we used two definitions for this analysis: A) positive staining of ≥ 10% of tumor cells B) an immune reactive score (IRS; intensity of staining X percentage of stained cells) ≥ 3 according to the Remmele score used for ER/PR evaluation.
Results: A total of 194 patients were included in this analysis. In tissue samples collected before 2001 AR staining was very weak, interpreted as a loss of antigenicity due to archival time and conditions. Therefore, 40 patients with tissue samples achieved earlier than 2001 were excluded from further analysis. Seventy-nine percent (122 of 154) and 63% (97 of 154) of tumors were AR positive by definition A and B, respectively. All except one of the AR positive tumors according to definition B, were also positive according to definition A.
Disease free survival (DFS) and overall survival (OS) data N (%)DFSOSDefinition A (≥ 10%) AR positive122 (79)HR 0.61 (0.21-1.72) P=0.3428HR 0.17 (0.03-0.99) P=0.025AR negative32 (21) Definition B (IRS ≥ 3) AR positive97 (63)HR 0.88 (0.33-2.35) P=0.7994HR 0.39 (0.07-2.34) P=0.2846AR negative57 (37)
DFS and OS did not differ between both endocrine treatment arms in a Cox regression model tested for interaction between AR expression and endocrine treatment.
Conclusion: In this pilot study patients with AR positive disease had a numerically better DFS and OS compared to AR negative patients, but only prolongation of OS in patients with ≥ 10% AR positive tumor cells was statistically significant. AR expression did not influence outcome between tamoxifen and anastrozole treated patients, but based on the small number of events, this results have to be interpreted with caution. This data will be confirmed in a larger proportion of patients treated within the ABCSG-12 trial.
Citation Format: Gabriel Rinnerthaler, Anna M Knopp, Cornelia Hauser-Kronberger, Simon P Gampenrieder, Patrick Morre, Brigitte Mlineritsch, Christian Fesl, Michael Gnant, Richard Greil. Androgen receptor expression in pre-menopausal early breast cancer patients treated with endocrine therapy within the ABCSG-12 trial - a single center pilot analysis [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-47.
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Affiliation(s)
- Gabriel Rinnerthaler
- 1Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University
| | | | | | - Simon P Gampenrieder
- 1Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University
| | - Patrick Morre
- 1Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University
| | - Brigitte Mlineritsch
- 1Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University
| | | | - Michael Gnant
- 4Breast Health Center, Comprehensive Cancer Center, Medical University of Vienna
| | - Richard Greil
- 1Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University
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Rinnerthaler G, Hackl H, Hamacher F, Gampenrieder S, Hufnagl C, Romeder F, Monzo Fuentes C, Hauser-Kronberger C, Mlineritsch B, Greil R. MiR-16 is the most stable-expressed housekeeping microRNA in breast cancer tissues from primary and metastatic sites. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv116.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pircher M, Mlineritsch B, Fridrik MA, Dittrich C, Lang A, Petru E, Weltermann A, Thaler J, Hufnagl C, Gampenrieder SP, Rinnerthaler G, Ressler S, Ulmer H, Greil R. Lapatinib-plus-pegylated liposomal doxorubicin in advanced HER2-positive breast cancer following trastuzumab: a phase II trial. Anticancer Res 2015; 35:517-521. [PMID: 25550597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Trastuzumab, one important treatment option for HER2-positive metastatic breast cancer (MBC) is limited by its cardiotoxic potential. Lapatinib and pegylated liposomal doxorubicin (PLD) represent a cardiosparing alternative that can cross the blood brain barrier. This is important, because one third of breast cancer patients develop brain metastases. PATIENTS AND METHODS We included 24 patients with HER2-positive MBC progressing under trastuzumab. They received 1,250 mg lapatinib daily until progression plus PLD (40 mg/m(2)) every 4 weeks for maximal 6 cycles. The primary end-point was the overall response rate (ORR). Secondary end-points were progression-free survival (PFS), overall survival (OS), 1-year PFS and 1-year OS rates. RESULTS ORR was 54%. Median PFS was 5.8 and median OS 23.3 months. The one-year PFS rate was 27% and 1-year OS rate 76%. CONCLUSION Lapatinib-plus-PLD is active and safe in HER2-positive MBC, especially suitable for patients with cardiological risk or brain metastases.
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Affiliation(s)
- Magdalena Pircher
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Brigitte Mlineritsch
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael A Fridrik
- 3rd Medical Department with Haematology and Medical Oncology, General Hospital Linz, Linz, Austria
| | - Christian Dittrich
- Ludwig Boltzmann Institute for Applied Cancer Research (LBI-ACR VIEnna)-LB-CTO and ACR-ITR VIEnna, Vienna, Austria
| | - Alois Lang
- Medical Department E with Oncology, General Hospital Rankweil, Rankweil, Austria
| | - Edgar Petru
- Department of Gynaecology, Medical University Graz, Graz, Austria
| | - Ansgar Weltermann
- Ist Medical Department, General Hospital Elisabethinen Linz, Linz, Austria
| | - Josef Thaler
- 4th Medical Department, Hospital Wels-Grieskirchen, Grieskirchen, Austria
| | - Clemens Hufnagl
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sigrun Ressler
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- 3rd Medical Department with Haematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Centre, Salzburg Cancer Research Institute (SCRI) with the Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and the Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
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Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Knauer M, Moik M, Jakesz R, Seifert M, Taucher S, Bjelic-Radisic V, Balic M, Eidtmann H, Eiermann W, Steger G, Kwasny W, Dubsky P, Selim U, Fitzal F, Hochreiner G, Wette V, Sevelda P, Ploner F, Bartsch R, Fesl C, Greil R. Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozol plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian Breast and Colorectal Cancer Study Group Trial 12. Ann Oncol 2014; 26:313-20. [PMID: 25403582 DOI: 10.1093/annonc/mdu544] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Zoledronic acid (ZOL) plus adjuvant endocrine therapy significantly improved disease-free survival (DFS) at 48- and 62-month follow-up in the ABCSG-12 trial. We present efficacy results of a final additional analysis after 94.4 months. PATIENTS AND METHODS Patients were premenopausal women who had undergone primary surgery for stage I/II estrogen-receptor-positive and/or progesterone-receptor-positive breast cancer with <10 positive lymph nodes, and were scheduled for standard goserelin therapy. All 1803 patients received goserelin (3.6 mg every 28 days) and were randomized to tamoxifen (20 mg/days) or anastrozole (1 mg/days), both with or without ZOL (4 mg every 6 months) for 3 years. The primary end point was DFS; recurrence-free survival and overall survival (OS) were secondary end points. RESULTS After 94.4-month median follow-up (range, 0-114 months), relative risks of disease progression [hazard ratio (HR) = 0.77; 95% confidence interval (CI) 0.60-0.99; P = 0.042] and of death (HR = 0.66; 95% CI 0.43-1.02; P = 0.064) are still reduced by ZOL although no longer significant at the predefined significance level. Overall, 251 DFS events and 86 deaths were reported. Absolute risk reductions with ZOL were 3.4% for DFS and 2.2% for OS. There was no DFS difference between tamoxifen alone versus anastrozole alone, but there was a pronounced higher risk of death for anastrozole-treated patients (HR = 1.63; 95% CI 1.05-1.45; P = 0.030). Treatments were generally well tolerated, with no reports of renal failure or osteonecrosis of the jaw. CONCLUSION These final results from ABCSG 12 suggest that twice-yearly ZOL enhances the efficacy of adjuvant endocrine treatment, and this benefit is maintained long-term. CLINICALTRIALSGOV NCT00295646 (http://www.clinicaltrials.gov/ct2/results?term=00295646).
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Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - B Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | - H Stoeger
- Clinical Department of Oncology, Medical University of Graz, Graz
| | | | - M Knauer
- Department of General and Visceral Surgery, Hospital of the Sisters of Charity, Linz
| | - M Moik
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | - R Jakesz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - M Seifert
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - S Taucher
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - V Bjelic-Radisic
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - M Balic
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - H Eidtmann
- Gynecology and Obstetrics Clinic, University of Schleswig-Holstein, Kiel
| | - W Eiermann
- Gynecology and Gynecological Oncology, IOZ-München, Munich, Germany
| | - G Steger
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - W Kwasny
- Department of Surgery, Wiener Neustadt Hospital, Wiener Neustadt
| | - P Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - U Selim
- Department of Surgery, Hanusch Hospital, Vienna
| | - F Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - G Hochreiner
- Center of Hematology and Medical Oncology, General Hospital Linz, Linz
| | - V Wette
- Department of Surgery, Practice of Dr Wette, Sankt Veit an der Glan
| | | | - F Ploner
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - R Bartsch
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - C Fesl
- Department of Statistics, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
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Pfeiler G, Königsberg R, Filipcic L, Greil R, Stoger H, Singer CF, Knauer M, Steger GG, Seifert M, Dubsky PC, Fitzal F, Balic M, Bjelic-Radisic V, Mlineritsch B, Marth C, Gnant M. Follicle stimulating hormone (FSH) as a surrogate parameter for the effectiveness of endocrine therapy with or without zoledronic acid in premenopausal patients with breast cancer: An analysis of the prospective ABCSG-12 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | - Robert Königsberg
- Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Vienna, Austria, Vienna, Austria
| | - Lidija Filipcic
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | | | | | | | - Michael Knauer
- Department of Surgery, Sisters of Mercy Hospital, Linz, Austria
| | - Guenther G. Steger
- Department of Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Suppan C, Steger G, Balic M, Dandachi N, Lang A, Mlineritsch B, Fesl C, Samonigg H, Gnant M, Bauernhofer T. Evaluation of Soluble E-Cadherin as a Predictive Marker for Response to Preoperative Systemic Chemotherapy in Early Breast Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu066.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Filipits M, Nielsen TO, Rudas M, Greil R, Stöger H, Jakesz R, Bago-Horvath Z, Dietze O, Regitnig P, Gruber-Rossipal C, Müller-Holzner E, Singer CF, Mlineritsch B, Dubsky P, Bauernhofer T, Hubalek M, Knauer M, Trapl H, Fesl C, Schaper C, Ferree S, Liu S, Cowens JW, Gnant M. The PAM50 risk-of-recurrence score predicts risk for late distant recurrence after endocrine therapy in postmenopausal women with endocrine-responsive early breast cancer. Clin Cancer Res 2014; 20:1298-305. [PMID: 24520097 DOI: 10.1158/1078-0432.ccr-13-1845] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [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: 11/16/2022]
Abstract
PURPOSE To assess the prognostic value of the PAM50 risk-of-recurrence (ROR) score on late distant recurrence (beyond 5 years after diagnosis and treatment) in a large cohort of postmenopausal, endocrine-responsive breast cancer patients. EXPERIMENTAL DESIGN The PAM50 assay was performed on formalin-fixed paraffin-embedded whole-tumor sections of patients who had been enrolled in the Austrian Breast and Colorectal Cancer Study Group Trial 8 (ABCSG-8). RNA expression levels of the PAM50 genes were determined centrally using the nCounter Dx Analysis System. Late distant recurrence-free survival (DRFS) was analyzed using Cox models adjusted for clinical and pathologic parameters. RESULTS PAM50 analysis was successfully performed in 1,246 ABCSG-8 patients. PAM50 ROR score and ROR-based risk groups provided significant additional prognostic information with respect to late DRFS compared with a combined score of clinical factors alone (ROR score: ΔLRχ(2) 15.32, P < 0.001; ROR-based risk groups: ΔLRχ(2) 14.83, P < 0.001). Between years 5 and 15, we observed an absolute risk of distant recurrence of 2.4% in the low ROR-based risk group, as compared with 17.5% in the high ROR-based risk group. The DRFS differences according to the PAM50 ROR score were observed for both node-positive and node-negative disease. CONCLUSION PAM50 ROR score and ROR-based risk groups can differentiate patients with breast cancer with respect to their risk for late distant recurrence beyond what can be achieved with established clinicopathologic risk factors.
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Affiliation(s)
- Martin Filipits
- Authors' Affiliations: Departments of Medicine I, Pathology, and Surgery; Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Medical University of Vienna; Austrian Breast and Colorectal Cancer Study Group, Vienna; Departments of Internal Medicine III and Pathology, Paracelsus Private Medical University, Salzburg; Departments of Internal Medicine and Pathology, Medical University of Graz, Graz; Departments of Pathology and Surgery, Sisters of Charity Hospital and Cancer Center, Linz; Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck; Department of Surgery, General Hospital Baden, Baden, Austria; Myraqa, Redwood Shores, California; NanoString Technologies, Seattle, Washington; and British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Gampenrieder SP, Romeder F, Muß C, Pircher M, Ressler S, Rinnerthaler G, Bartsch R, Sattlberger C, Mlineritsch B, Greil R. Hypertension as a predictive marker for bevacizumab in metastatic breast cancer: results from a retrospective matched-pair analysis. Anticancer Res 2014; 34:227-233. [PMID: 24403467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Several phase-III studies have shown improvements in terms of progression-free survival (PFS) with bevacizumab when added to chemotherapy in advanced breast cancer. However, the extent of improvement varied and none of the trials showed benefit in terms of overall survival (OS). PATIENTS AND METHODS All patients with metastatic breast cancer treated with bevacizumab at our Institution between 2005 and 2011 were retrospectively analyzed. A control group was matched according to the following variables: receptor status, treatment line, type of chemotherapy, presence of visceral disease and age. RESULTS All 212 patients were evaluable for toxicity, and 198 for response; 430 controls allowed a complete matching for 85 bevacizumab-treated patients. The addition of bevacizumab to chemotherapy significantly prolonged PFS (9.3 vs. 7.6 months, hazard ratio [HR]=0.70, 95% confidence interval [CI]=0.51-0.97, p=0.031) and OS (28.9 vs. 22.6 months, HR=0.67, 95% CI=0.45-0.99, p=0.043). Clinical benefit rate (overall response rate + stable disease for at least six months) was significantly better in the bevacizumab group (75% vs. 59%, p=0.002), while ORR did not differ significantly (48% vs. 35%, p=0.21). Patients developing hypertension during treatment had a more favourable outcome (PFS 13.7 vs. 6.6 months, HR=0.34, 95% CI=0.23-0.49 p<0.001; 2-year OS 78% vs. 30%, HR=0.20, 95% CI=0.12-0.35, p<0.001). CONCLUSION Bevacizumab in addition to chemotherapy prolonged PFS and OS in a non-selected, partly intensively pre-treated breast cancer population. Hypertension induced by bevacizumab predicted therapy efficacy.
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Affiliation(s)
- Simon Peter Gampenrieder
- Third Medical Department, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
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Steger GG, Greil R, Lang A, Rudas M, Fitzal F, Mlineritsch B, Hartmann BL, Bartsch R, Melbinger E, Hubalek M, Stoeger H, Dubsky P, Ressler S, Petzer AL, Singer CF, Muss C, Jakesz R, Gampenrieder SP, Zielinski CC, Fesl C, Gnant M. Epirubicin and docetaxel with or without capecitabine as neoadjuvant treatment for early breast cancer: final results of a randomized phase III study (ABCSG-24). Ann Oncol 2013; 25:366-71. [PMID: 24347519 DOI: 10.1093/annonc/mdt508] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This randomized phase III trial compared pathologic complete response (pCR) rates of early breast cancer (EBC) following neoadjuvant epirubicin-docetaxel (ED)±capecitabine (C), and evaluated the addition of trastuzumab in HER2-positive tumors. PATIENTS AND METHODS Patients with invasive breast cancer (except T4d) were randomly assigned to receive six 3-weekly cycles of ED (both 75 mg/m2)±C (1000 mg/m2, twice daily, days 1-14). Patients with HER2-positive disease were further randomized to receive trastuzumab (8 mg/kg, then 6 mg/kg every 3 weeks) or not. Primary end point: pCR rate at the time of surgery. RESULTS Five hundred thirty-six patients were randomized to ED (n=266) or EDC (n=270); 93 patients were further randomized to trastuzumab (n=44) or not (n=49). pCR rate was significantly increased with EDC (23.0% versus 15.4% ED, P=0.027), and nonsignificantly further increased with trastuzumab (38.6% EDC versus 26.5% ED, P=0.212). Rates of axillary node involvement at surgery and breast conservation were improved with EDC versus ED, but not significantly; the addition of trastuzumab had no further impact. Hormone receptor status, tumor size, grade, and C (all P≤0.035) were independent prognostic factors for pCR. Trastuzumab added to ED±C significantly increased the number of serious adverse events (35 versus 18; P=0.020), mainly due to infusion-related reactions. CONCLUSION These findings show that the integration of C into a neoadjuvant taxane-/anthracycline-based regimen is a feasible, safe, and effective treatment option, with incorporation of trastuzumab in HER2-positive disease. CLINICAL TRIAL NUMBER NCT00309556, www.clinicaltrials.gov.
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Affiliation(s)
- G G Steger
- Department of Internal Medicine I, Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna
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Gnant M, Filipits M, Greil R, Stoeger H, Rudas M, Bago-Horvath Z, Mlineritsch B, Kwasny W, Knauer M, Singer C, Jakesz R, Dubsky P, Fitzal F, Bartsch R, Steger G, Balic M, Ressler S, Cowens JW, Storhoff J, Ferree S, Schaper C, Liu S, Fesl C, Nielsen TO. Predicting distant recurrence in receptor-positive breast cancer patients with limited clinicopathological risk: using the PAM50 Risk of Recurrence score in 1478 postmenopausal patients of the ABCSG-8 trial treated with adjuvant endocrine therapy alone. Ann Oncol 2013; 25:339-45. [PMID: 24347518 DOI: 10.1093/annonc/mdt494] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND PAM50 is a 50-gene test that is designed to identify intrinsic breast cancer subtypes and generate a Risk of Recurrence (ROR) score. It has been developed to be carried out in qualified routine hospital pathology laboratories. PATIENTS AND METHODS One thousand four hundred seventy-eight postmenopausal women with estrogen receptor (ER)+ early breast cancer (EBC) treated with tamoxifen or tamoxifen followed by anastrozole from the prospective randomized ABCSG-8 trial were entered into this study. Patients did not receive adjuvant chemotherapy. RNA was extracted from paraffin blocks and analyzed using the PAM50 test. Both intrinsic subtype (luminal A/B, HER2-enriched, basal-like) and ROR score were calculated. The primary analysis was designed to test whether the continuous ROR score adds prognostic value in predicting distant recurrence (DR) over and above standard clinical variables. RESULTS In all tested subgroups, ROR score significantly adds prognostic information to the clinical predictor (P<0.0001). PAM50 assigns an intrinsic subtype to all cases, and the luminal A cohort had a significantly lower ROR at 10 years compared with Luminal B (P<0.0001). Significant and clinically relevant discrimination between low- and high-risk groups occurred also within all tested subgroups. CONCLUSION(S) The results of the primary analysis, in combination with recently published results from the ATAC trial, constitute Level 1 evidence for clinical validity of the PAM50 test for predicting the risk of DR in postmenopausal women with ER+ EBC. A 10-year metastasis risk of <3.5% in the ROR low category makes it unlikely that additional chemotherapy would improve this outcome-this finding could help to avoid unwarranted overtreatment. CLINICAL TRIAL NUMBER ABCSG 8: NCT00291759.
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Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Gnant M, Pfeiler G, Stöger H, Mlineritsch B, Fitzal F, Balic M, Kwasny W, Seifert M, Stierer M, Dubsky P, Greil R, Steger G, Samonigg H, Fesl C, Jakesz R. The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial. Br J Cancer 2013; 109:589-96. [PMID: 23868011 PMCID: PMC3738117 DOI: 10.1038/bjc.2013.367] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/10/2013] [Accepted: 06/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We investigated whether body mass index (BMI) can be used as a predictive parameter indicating patients who benefit from extended aromatase inhibitor (AI) treatment. METHODS The ABCSG-6a trial re-randomised event-free postmenopausal hormone receptor-positive patients from the ABCSG-6 trial to receive either 3 additional years of endocrine therapy using anastrozole vs nil. In this retrospective analysis, we investigated the prognostic and predictive impact of BMI on disease outcome and safety. RESULTS In all, 634 patients (177 normal weight, 307 overweight, and 150 obese) patients were included in this analysis. Normal weight patients with additional 3 years of anastrozole halved their risk of disease recurrence (disease-free survival (DFS) HR 0.48; P=0.02) and death (HR 0.45; P=0.06) and had only a fifth of the risk of distant metastases (HR 0.22; P=0.05) compared with normal weight patients without any further treatment. In contrast, overweight+obese patients derived no benefit from additional 3 years of anastrozole (DFS HR 0.93; P=0.68; distant recurrence-free survival HR 0.91; P=0.78; and OS HR 0.9; P=0.68). The possible predictive impact of BMI on extended endocrine treatment could be strengthened by a Cox regression interaction model between BMI and treatment (P=0.07). CONCLUSION Body mass index may be used to predict outcome benefit of extended AI treatment in patients with receptor-positive breast cancer.
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Affiliation(s)
- M Gnant
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Gampenrieder SP, Romeder F, Muß C, Pircher M, Ressler S, Rinnerthaler G, Bartsch R, Sattlberger C, Mlineritsch B, Greil R. Abstract P5-20-11: Bevacizumab in metastatic breast cancer: a retrospective matched-pair analysis. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-20-11] [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 November 2011 the FDA withdrew accelerated approval of the breast cancer indication for bevacizumab, because “the drug has not been shown to be safe and effective for this use” (FDA Commissioner M. A. Hamburg, MD). The objective of this analysis was to evaluate efficacy and safety of bevacizumab in non-selected patients with stage IV breast cancer.
Patients and methods: All patients with metastatic breast cancer treated with bevacizumab in combination with chemotherapy in our institution between 2005 and 2011 were retrospectively analysed. At least 1 cycle of bevacizumab was required for safety analysis, 3 applications for efficacy evaluation. A control group was matched according to the following criteria: receptor status, line of treatment, chemotherapy backbone, visceral or non-visceral disease and age.
Results: A total of 213 patients fulfilled the inclusion criteria. All of them were evaluable for toxicity, 199 for response. 503 potential controls allowed a complete matching for 103 patients. Fifty-eight percent of patients received first-line, 15% second-line and 27% of patients beyond second-line treatment. Visceral metastases were present in 69% of patients in both groups. The most common chemotherapy backbones were paclitaxel, capecitabine and docetaxel with 44%, 32% and 19%, respectively.
Most common grade 3/4 toxicities related to bevacizumab were hypertension (27%), proteinuria (1%), thromboembolism (9%) and bleeding events (1%). Interestingly, patients developing hypertension during bevacizumab treatment had a more favourable outcome (PSF 11.7 vs. 5.7 months, p < .001; OS 27.4 vs. 14.5 months, p < .001). Since the median time until apparent blood pressure elevation was only 1.4 months, this provides a simple biologic biomarker for bevacizumab efficacy.
Conclusion: Bevacizumab in combination with chemotherapy appears to be an effective, well-tolerated regimen in the treatment of advanced breast cancer even in a non-selected, partly intensively pre-treated population. Bevacizumab induced hypertension predicted a better PFS and OS.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-11.
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Affiliation(s)
- SP Gampenrieder
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - F Romeder
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - C Muß
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - M Pircher
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - S Ressler
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - G Rinnerthaler
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - R Bartsch
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - C Sattlberger
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - B Mlineritsch
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
| | - R Greil
- Paracelsus Medical University, Salzburg, Austria; Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria; Hospital of Vöcklabruck, Vöcklabruck, Austria
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Pfeiler G, Konigsberg R, Fesl C, Mlineritsch B, Stoger H, Singer CF, Poestlberger S, Steger GG, Seifert M, Dubsky PC, Jakesz R, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Gnant M. Impact of body mass index (BMI) on the efficacy of zoledronic acid in premenopausal patients with hormone receptor positive breast cancer: An analysis of the ABCSG-12 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.514] [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: 11/20/2022] Open
Abstract
514 Background: Zoledronic acid (ZOL) improves disease outcome in premenopausal patients with breast cancer (BC), especially in those with low estrogen environment. Obesity is associated with increased estrogen serum levels, which might influence the efficacy of ZOL. We investigated the impact of BMI on the efficacy of ZOL in premenopausal patients with BC. Methods: ABCSG-12 examined the efficacy of ovarian suppression using goserelin (3.6 mg q28d SC) in combination with anastrozole (ANA) or tamoxifen (TAM) ± ZOL 4 mg IV q6mo) in premenopausal women with endocrine-responsive BC. BMI was calculated using the prospectively collected data on patients’ height and weight at study entry. BMI definitions of the WHO were used: normal 18.5-24.9 kg/m2, overweight: BMI 25-29.9 kg/m2, obese BMI ≥ 30 kg/m2). Disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier method and results were compared by using the log-rank test and Cox proportional hazard modeling. Results: Two thirds of the patients were normal weight (1,111) and one third was overweight (391) or obese (182). Normal weight patients treated with ZOL experienced the same benefit as overweight/obese patients treated with ZOL compared to patients without ZOL regarding disease free survival (HR 0.75, 95%CI 0.53 1.05 p = 0.09 and HR 0.71, 95%CI 0.46 1.1, p=0.12, respectively) as well as overall survival (HR 0.67, 95% CI 0.37 1.22, p=0.19 and HR 0.64, 95%CI 0.32 1.28, p=0.19, respectively). No difference regarding DFS and OS could be detected between normal weight and overweight/ obese patients treated with ZOL (HR 1.05, 95%CI 0.69 1.59, p=0.83 and HR 1.27, 95%CI 0.62 2.61, p= 0.51). Comparing normal weight patients with ZOL to obese patients with ZOL, again no difference could be observed. Conclusions: The significant outcome benefit of adjuvant zoledronic acid in ABCSG-12 can be demonstrated both in normal weight and overweight/obese premenopausal patients with early breast cancer, indicating that the bone marrow microenvironment changing impact of adjuvant bisphopshonate treatment does not correlate with patients’ BMI.
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Affiliation(s)
- Georg Pfeiler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Robert Konigsberg
- Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Vienna, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | | | | | | | | | | | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | | | - Hellmut Samonigg
- Department of Medical Oncology, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology, Medical Oncology, Paracelsus Medical University Hospital Salzburg and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie), Salzburg, Austria
| | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Department of Surgery, Vienna, Austria
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Dubsky PC, Jakesz R, Mlineritsch B, Pöstlberger S, Samonigg H, Kwasny W, Tausch C, Stöger H, Haider K, Fitzal F, Singer CF, Stierer M, Sevelda P, Luschin-Ebengreuth G, Taucher S, Rudas M, Bartsch R, Steger GG, Greil R, Filipcic L, Gnant M. Tamoxifen and anastrozole as a sequencing strategy: a randomized controlled trial in postmenopausal patients with endocrine-responsive early breast cancer from the Austrian Breast and Colorectal Cancer Study Group. J Clin Oncol 2012; 30:722-8. [PMID: 22271481 DOI: 10.1200/jco.2011.36.8993] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Anastrozole (ANA) alone delivers significant disease-free survival benefits over tamoxifen (TAM) monotherapy in postmenopausal women with early estrogen receptor-positive breast cancer. The ABCSG-8 (Austrian Breast and Colorectal Cancer Study Group 8) study is a large phase III clinical trial addressing the sequence strategy containing ANA in comparison with 5 years of TAM in a low- to intermediate-risk group of postmenopausal patients. PATIENTS AND METHODS Endocrine receptor-positive patients with G1 or G2 tumors were eligible. After surgery, patients were randomly assigned to 5 years of TAM or 2 years of TAM followed by 3 years of ANA. Adjuvant chemotherapy and G3 and T4 tumors were exclusion criteria. Intention-to-treat and censored analyses of on-treatment recurrence-free survival (RFS) were performed, and exploratory survival end points and toxicity were investigated. RESULTS Information from 3,714 patients, including 17,563 woman-years, with a median of 60 months of follow-up was available for this analysis. Median age was 63.8 years, 75% were node negative, and 75% had T1 tumors. Sequencing of ANA after identical 2-year treatment with TAM in both arms did not result in a statistically significant improvement of RFS (hazard ratio [HR], 0.80; 95% CI, 0.63 to 1.01; P = .06). Exploratory analyses of distant relapse-free survival indicated a 22% improvement (HR, 0.78; 95% CI, 0.60 to 1.00). On-treatment adverse events and serious adverse events were consistent with known toxicity profiles of ANA and TAM treatment. CONCLUSION Despite a low overall rate of recurrence in a population with breast cancer at limited risk of relapse, the a priori sequence strategy of 2 years of TAM followed by 3 years of ANA led to small outcome and toxicity benefits.
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Fiegl M, Mlineritsch B, Hubalek M, Bartsch R, Pluschnig U, Steger GG. Single-agent pegylated liposomal doxorubicin (PLD) in the treatment of metastatic breast cancer: results of an Austrian observational trial. BMC Cancer 2011; 11:373. [PMID: 21864402 PMCID: PMC3178544 DOI: 10.1186/1471-2407-11-373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 08/24/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In advanced breast cancer, multiple sequential lines of treatments are frequently applied. Pegylated liposomal doxorubicin (PLD) has a favourable toxicity profile and can be used in first or higher lines of therapy. PLD has demonstrated response activity even after prior anthracycline exposure. METHODS 129 consecutive patients with advanced breast cancer, of whom the majority had been massively pretreated, received PLD as monotherapy within licensed approval, for which efficacy and toxicities were documented. RESULTS In a routine therapy setting, PLD was administered in a slightly reduced dose (median, 40 mg/m2 per cycle). Response rate (complete and partial remission) was 26%, and stable disease was observed in 19% of patients. Progression-free (PFS) and overall survival (OS) were 5.8 months and 14.2 months, respectively. There was no difference in terms of response and PFS, no matter if patients had already received anthracycline treatment. Interestingly, PFS proved similar regardless whether PLD was administered as palliative therapy in first, second or third line. Furthermore, PFS and OS were similar in patients with response or stable disease, underscoring the view that disease stabilization is associated with a profound clinical benefit. The most common side effects reported were palmar-plantar erythrodysesthesia (17%), exanthema (14%) and mucositis (12%). CONCLUSIONS Efficacy and toxicity data in these "real life" patients permit the conclusion that PLD is a valuable option in the treatment of advanced breast cancer even in heavily pretreated patients.
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Affiliation(s)
- Michael Fiegl
- Department of Internal Medicine V/Hematology-Oncoloy, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Private Medical University of Salzburg, Müllner Hauptstrasse 48, Salzburg, Austria
| | - Michael Hubalek
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Rupert Bartsch
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Günther G Steger
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
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Abstract
Zoledronic acid, a nitrogen-containing bisphosphonate, is firmly established in the management of metastatic bone disease. It inhibits farnesyl diphosphonate synthase within the mevalonate pathway and, through this mechanism, is a potent inhibitor of osteoclast-mediated bone resorption. In addition, there are preclinical data suggesting that farnesyl diphosphonate synthase inhibition by zoledronic acid has anti-tumor effects in breast cancer. Adjuvant therapies for early breast cancer are associated with substantial decreases in bone mineral density. Results from three clinical trials, ABCSG-12, Z-FAST and ZO-FAST, indicate that the addition of twice-yearly zoledronic acid to standard adjuvant endocrine therapy in premenopausal and postmenopausal patients with hormone receptor-positive breast cancer prevents cancer treatment-induced bone loss. Moreover, it is becoming evident that it may also exert anticancer effects in an estrogen-deprived state in the adjuvant and neoadjuvant setting. However, long-term side effects need to be taken into consideration for treatment decisions.
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Affiliation(s)
- Sigrun Ressler
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory of Immunological and Molecular Cancer Research, Private Medical University Hospital, Salzburg, Austria
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Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Heck D, Menzel C, Jakesz R, Seifert M, Hubalek M, Pristauz G, Bauernhofer T, Eidtmann H, Eiermann W, Steger G, Kwasny W, Dubsky P, Hochreiner G, Forsthuber EP, Fesl C, Greil R. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 62-month follow-up from the ABCSG-12 randomised trial. Lancet Oncol 2011; 12:631-41. [PMID: 21641868 DOI: 10.1016/s1470-2045(11)70122-x] [Citation(s) in RCA: 351] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Analysis of the Austrian Breast and Colorectal Cancer Study Group trial-12 (ABCSG-12) at 48 months' follow-up showed that addition of zoledronic acid to adjuvant endocrine therapy significantly improved disease-free survival. We have now assessed long-term clinical efficacy including disease-free survival and disease outcomes in patients receiving anastrozole or tamoxifen with or without zoledronic acid. METHODS ABSCG-12 is a randomised, controlled, open-label, two-by-two factorial, multicentre trial in 1803 premenopausal women with endocrine-receptor-positive early-stage (stage I-II) breast cancer receiving goserelin (3.6 mg every 28 days), comparing the efficacy and safety of anastrozole (1 mg per day) or tamoxifen (20 mg per day) with or without zoledronic acid (4 mg every 6 months) for 3 years. Randomisation (1:1:1:1 ratio) was computerised and based on the Pocock and Simon minimisation method to balance the four treatment arms across eight prognostic variables (age, neoadjuvant chemotherapy, pathological tumour stage; lymph-node involvement, type of surgery or locoregional therapy, complete axillary dissection, intraoperative radiation therapy, and geographical region). Treatment allocation was not masked. The primary endpoint was disease-free survival (defined as disease recurrence or death) and analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00295646; follow-up is ongoing. FINDINGS At a median follow-up of 62 months (range 0-114.4 months), more than 2 years after treatment completion, 186 disease-free survival events had been reported (53 events in 450 patients on tamoxifen alone, 57 in 453 patients on anastrozole alone, 36 in 450 patients on tamoxifen plus zoledronic acid, and 40 in 450 patients on anastrozole plus zoledronic acid). Zoledronic acid reduced risk of disease-free survival events overall (HR 0.68, 95% CI 0.51-0.91; p=0.009), although the difference was not significant in the tamoxifen (HR 0.67, 95% CI 0.44-1.03; p=0.067) and anastrozole arms (HR 0.68, 95% CI 0.45-1.02; p=0.061) assessed separately. Zoledronic acid did not significantly affect risk of death (30 deaths with zoledronic acid vs 43 deaths without; HR 0.67, 95% CI 0.41-1.07; p=0.09). There was no difference in disease-free survival between patients on tamoxifen alone versus anastrozole alone (HR 1.08, 95% CI 0.81-1.44; p=0.591), but overall survival was worse with anastrozole than with tamoxifen (46 vs 27 deaths; HR 1.75, 95% CI 1.08-2.83; p=0.02). Treatments were generally well tolerated, with no reports of renal failure or osteonecrosis of the jaw. Bone pain was reported in 601 patients (33%; 349 patients on zoledronic acid vs 252 not on the drug), fatigue in 361 (20%; 192 vs 169), headache in 280 (16%; 147 vs 133), and arthralgia in 266 (15%; 145 vs 121). INTERPRETATION Addition of zoledronic acid improved disease-free survival in the patients taking anastrozole or tamoxifen. There was no difference in disease-free survival between patients receiving anastrozole and tamoxifen overall, but those on anastrozole alone had inferior overall survival. These data show persistent benefits with zoledronic acid and support its addition to adjuvant endocrine therapy in premenopausal patients with early-stage breast cancer. FUNDING AstraZeneca; Novartis.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Comprehensive Cancer Centre Vienna, Medical University of Vienna, A-1090 Vienna, Austria.
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Pfeiler G, Königsberg R, Mlineritsch B, Stoger H, Singer CF, Poestlberger S, Steger GG, Seifert M, Dubsky PC, Jakesz R, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Fesl C, Gnant M. Effect of change of body mass index (BMI) during therapy on the efficacy of endocrine therapy in premenopausal patients with breast cancer: An analysis of the ABCSG-12 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.514] [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: 11/20/2022] Open
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Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Poestlberger S, Dubsky PC, Jakesz R, Singer CF, Eidtmann H, Greil R. Overall survival with adjuvant zoledronic acid in patients with premenopausal breast cancer with complete endocrine blockade: Long-term results from ABCSG-12. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pfeiler G, Königsberg R, Fesl C, Mlineritsch B, Stoeger H, Singer CF, Pöstlberger S, Steger GG, Seifert M, Dubsky P, Taucher S, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Gnant M. Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 2011; 29:2653-9. [PMID: 21555684 DOI: 10.1200/jco.2010.33.2585] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Aromatase inhibitors are effective as endocrine treatment for patients with hormone receptor-positive breast cancer. According to the hypothesis that overweight patients have higher levels of aromatase enzyme availability, we investigated the influence of body mass index (BMI) on the efficacy of adjuvant endocrine therapy in premenopausal patients in a retrospective analysis of the Austrian Breast and Colorectal Cancer Study Group (ABCSG) 12 trial. PATIENTS AND METHODS ABCSG-12 examined the efficacy of ovarian suppression using goserelin (3.6 mg subcutaneously every 28 days) in combination with anastrozole or tamoxifen with or without zoledronic acid (4 mg intravenously every 6 months) in premenopausal women with endocrine-responsive breast cancer. BMI was calculated using the prospectively collected data on patients' height and weight at study entry. BMI categories have been differentiated according to the WHO definition. RESULTS Overweight patients treated with anastrozole had a 60% increase in the risk of disease recurrence (hazard ratio [HR], 1.60; 95% CI, 1.06 to 2.41; P = .02) and more than a doubling in the risk of death (HR, 2.14; 95% CI, 1.17 to 3.92; P = .01) compared with normal weight patients treated with anastrozole. In the overweight group, patients treated with anastrozole had a nearly 50% increase in the risk of disease recurrence (HR, 1.49; 95% CI, 0.93 to 2.38; P = .08) and a three-fold increase in the risk of death (HR, 3.03; 95% CI, 1.35 to 6.82; P = .004) compared with patients treated with tamoxifen. CONCLUSION BMI significantly impacts on the efficacy of anastrozole plus goserelin in premenopausal patients with breast cancer, probably through influencing aromatase availability and/or ovarian suppression by goserelin.
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Affiliation(s)
- Georg Pfeiler
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Heck D, Steger G, Jakesz R, Singer C, Dubsky P, Greil R. P286 Preplanned subgroup analysis of ABCSG-12 suggests that benefits of adjuvant zoledronic acid (ZOL) are most pronounced in lowest estrogen environment. Breast 2011. [DOI: 10.1016/s0960-9776(11)70228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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