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Kirn V, Bors S, Fridrich C, Schumacher C, Thangarajah F. Staging for Breast Cancer: A Comparison Between Old and New Approaches. Cancer Diagn Progn 2023; 3:673-677. [PMID: 37927808 PMCID: PMC10619575 DOI: 10.21873/cdp.10271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
Background/Aim Staging for breast cancer in advanced stages or prior to neoadjuvant chemotherapy is recommended to be performed with CT scan of the chest and abdomen and a bone scan. This recommendation is valid since 2012, when conventional staging with chest x-ray and ultrasound of the abdomen was replaced by the more sensitive CT scan. However, it remains unclear if this approach improves patient outcome and prognosis. Patients and Methods We identified patients who were treated for breast cancer at the breast center of the St. Elisabeth Hospital, Cologne, in 2012 and 2014. Clinical information such as age at diagnosis, stage, tumor biology, grading, and the applied method for staging was abstracted from the patient chart. We also looked for local or distant recurrence and data of survival. Results A total of 1,122 patients were identified. Of those, 104 patients developed local or distant recurrence and 54 died. Conventional staging with chest x-ray, abdominal ultrasound and a bone scan was more often in 2012 (482 cases) than in 2014 (135), but CT-staging was more often in 2014 (180 vs. 29 cases). In general, less patients were staged in 2014 than in 2012. There were no significant survival differences between the two groups. Conclusion Staging habits changed in 2012 compared to 2014 according to the changes in guidelines. This change did not affect disease-free survival.
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Affiliation(s)
- Verena Kirn
- Medical Faculty of the University of Cologne, Cologne, Germany
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Sarah Bors
- Medical Faculty of the University of Cologne, Cologne, Germany
| | - Claudius Fridrich
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Claudia Schumacher
- Breast Center St. Elisabeth Hospital/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
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2
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Gluz O, Kuemmel S, Nitz U, Braun M, Lüdtke-Heckenkamp K, von Schumann R, Darsow M, Forstbauer H, Potenberg J, Uleer C, Grischke EM, Aktas B, Schumacher C, Zu Eulenburg C, Kates R, Jóźwiak K, Graeser M, Wuerstlein R, Baehner R, Christgen M, Kreipe HH, Harbeck N. Nab-paclitaxel weekly versus dose-dense solvent-based paclitaxel followed by dose-dense epirubicin plus cyclophosphamide in high-risk HR+/HER2- early breast cancer: results from the neoadjuvant part of the WSG-ADAPT-HR+/HER2- trial. Ann Oncol 2023; 34:531-542. [PMID: 37062416 DOI: 10.1016/j.annonc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND In high-risk hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer (EBC), nanoparticle albumin-bound (nab)-paclitaxel showed promising efficacy versus solvent-based (sb)-paclitaxel in neoadjuvant trials; however, optimal patient and therapy selection remains a topic of ongoing research. Here, we investigate the potential of Oncotype DX® recurrence score (RS) and endocrine therapy (ET) response (low post-endocrine Ki67) for therapy selection. PATIENTS AND METHODS Within the WSG-ADAPT trial (NCT01779206), high-risk HR+/HER2- EBC patients were randomized to (neo)adjuvant 4× sb-paclitaxel 175 mg/m2 q2w or 8× nab-paclitaxel 125 mg/m2 q1w, followed by 4× epirubicin + cyclophosphamide (90 mg + 600 mg) q2w; inclusion criteria: (i) cN0-1, RS 12-25, and post-ET Ki67 >10%; (ii) cN0-1 with RS >25. Patients with cN2-3 or (G3, baseline Ki67 ≥40%, and tumor size >1 cm) were allowed to be included without RS and/or ET response testing. Associations of key factors with pathological complete response (pCR) (primary) and survival (secondary) endpoints were analyzed using statistical mediation and moderation models. RESULTS Eight hundred and sixty-four patients received neoadjuvant nab-paclitaxel (n= 437) or sb-paclitaxel (n = 427); nab-paclitaxel was superior for pCR (20.8% versus 12.9%, P = 0.002). pCR was higher for RS >25 versus RS ≤25 (16.0% versus 8.4%, P = 0.021) and for ET non-response versus ET response (15.1% versus 6.0%, P = 0.027); no factors were predictive for the relative efficacy of nab-paclitaxel versus sb-paclitaxel. Patients with pCR had longer distant disease-free survival [dDFS; hazard ratio 0.42, 95% confidence interval (CI) 0.20-0.91, P = 0.024]. Despite favorable prognostic association of RS >25 versus RS ≤25 with pCR (odds ratio 3.11, 95% CI 1.71-5.63, P ≤ 0.001), higher RS was unfavorably associated with dDFS (hazard ratio 1.03, 95% CI 1.01-1.05, P = 0.010). CONCLUSIONS In high-risk HR+/HER2- EBC, neoadjuvant nab-paclitaxel q1w appears superior to sb-paclitaxel q2w regarding pCR. Combining RS and ET response assessment appears to select patients with highest pCR rates. The disadvantage of higher RS for dDFS is reduced in patients with pCR. These are the first results from a large neoadjuvant randomized trial supporting the use of RS to help select patients for neoadjuvant chemotherapy in high-risk HR+/HER2- EBC.
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Affiliation(s)
- O Gluz
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach; University Clinics Cologne, Cologne.
| | - S Kuemmel
- West German Study Group, Moenchengladbach; Breast Unit, Kliniken Essen-Mitte, Essen; Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin
| | - U Nitz
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach
| | - M Braun
- Breast Center, Rotkreuz Clinics Munich, Munich
| | - K Lüdtke-Heckenkamp
- Department of Oncology and Hematology, Niels Stensen-Kliniken, Georgsmarienhütte
| | - R von Schumann
- Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach
| | - M Darsow
- Breast Center, Luisenhospital, Duesseldorf; Practice for Senologic Oncology, Duesseldorf
| | | | | | - C Uleer
- Frauenaerzte am Bahnhofsplatz, Practice of Gynecology and Oncology, Hildesheim
| | - E M Grischke
- Women's Clinic, University Clinics Tuebingen, Tuebingen
| | - B Aktas
- Women's Clinic, University Clinics Essen, Essen; University Clinics Leipzig, Women's Clinic, Leipzig
| | - C Schumacher
- Breast Center, St. Elisabeth Hospital Cologne, Cologne
| | - C Zu Eulenburg
- West German Study Group, Moenchengladbach; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg
| | - R Kates
- West German Study Group, Moenchengladbach
| | - K Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin
| | - M Graeser
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach; Department of Gynecology, University Medical Center Hamburg, Hamburg
| | - R Wuerstlein
- West German Study Group, Moenchengladbach; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
| | | | - M Christgen
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - H H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - N Harbeck
- West German Study Group, Moenchengladbach; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
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3
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Harbeck N, Nitz UA, Christgen M, Kümmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Forstbauer H, Grischke EM, Scheffen I, Malter W, von Schumann R, Just M, Zu Eulenburg C, Biehl C, Kolberg-Liedtke C, Deurloo R, de Haas S, Jóźwiak K, Hauptmann M, Kates R, Graeser M, Wuerstlein R, Kreipe HH, Gluz O. De-Escalated Neoadjuvant Trastuzumab-Emtansine With or Without Endocrine Therapy Versus Trastuzumab With Endocrine Therapy in HR+/HER2+ Early Breast Cancer: 5-Year Survival in the WSG-ADAPT-TP Trial. J Clin Oncol 2023:JCO2201816. [PMID: 36809046 DOI: 10.1200/jco.22.01816] [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: 02/23/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy is standard of care in human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC), irrespective of the hormone receptor status. Trastuzumab-emtansine (T-DM1), antibody-drug conjugate, is highly effective in HER2+ EBC; however, no survival data are available for de-escalated antibody-drug conjugate-based neoadjuvant therapy without conventional chemotherapy. PATIENTS AND METHODS In the WSG-ADAPT-TP (ClinicalTrials.gov identifier: NCT01779206) phase II trial, 375 centrally reviewed patients with hormone receptor-positive (HR+)/HER2+ EBC (clinical stage I-III) were randomly assigned to 12 weeks of T-DM1 with or without endocrine therapy (ET) or trastuzumab + ET once every 3 weeks (ratio 1:1:1). Adjuvant chemotherapy (ACT) omission was allowed in patients with pathologic complete response (pCR). In this study, we report the secondary survival end points and biomarker analysis. Patients who received at least one dose of study treatment were analyzed. Survival was analyzed using the Kaplan-Meier method, two-sided log-rank statistics, and Cox regression models stratified for nodal and menopausal status. P values < .05 were considered statistically significant. RESULTS T-DM1, T-DM1 + ET, and trastuzumab + ET induced similar 5-year invasive disease-free survival (iDFS; 88.9%, 85.3%, 84.6%; Plog-rank = .608) and overall survival rates (97.2%, 96.4%, 96.3%; Plog-rank = .534). Patients with pCR versus non-pCR had improved 5-year iDFS rates (92.7% v 82.7%; hazard ratio, 0.40; 95% CI, 0.18 to 0.85). Among the 117 patients with pCR, 41 did not receive ACT; 5-year iDFS rates were similar in those with (93.0%; 95% CI, 84.0 to 97.0) and without ACT (92.1%; 95% CI, 77.5 to 97.4; Plog-rank = .848). Translational research revealed that tumors with PIK3CA wild type, high immune marker expression, and luminal-A tumors (by PAM50) had an excellent prognosis with de-escalated anti-HER2 therapy. CONCLUSION The WSG-ADAPT-TP trial demonstrated that pCR after 12 weeks of chemotherapy-free de-escalated neoadjuvant therapy was associated with excellent survival in HR+/HER2+ EBC without further ACT. Despite higher pCR rates for T-DM1 ± ET versus trastuzumab + ET, all trial arms had similar outcomes because of mandatory standard chemotherapy after non-pCR. WSG-ADAPT-TP demonstrated that such de-escalation trials in HER2+ EBC are feasible and safe for patients. Patient selection on the basis of biomarkers or molecular subtypes may increase the efficacy of systemic chemotherapy-free HER2-targeted approaches.
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Affiliation(s)
- Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Ulrike A Nitz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | | | - Sherko Kümmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | | | | | - Joke Tio
- Department of Gynecology, University Hospital Münster, Münster, Germany
| | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Iris Scheffen
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Breast Center, University Hospital, Cologne, Germany
| | | | | | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Claudia Biehl
- Westphalian Brest Center Dortmund, Dortmund, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Women's Clinic, University Clinics Essen, Essen, Germany
| | | | | | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
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4
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Graeser M, Gluz O, Biehl C, Ulbrich-Gebauer D, Christgen M, Palatty J, Kuemmel S, Grischke EM, Augustin D, Braun M, Potenberg J, Wuerstlein R, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Ni H, Kolberg-Liedtke C, Feuerhake F, Kreipe HH, Nitz U, Harbeck N. Impact of RNA Signatures on pCR and Survival after 12-Week Neoadjuvant Pertuzumab plus Trastuzumab with or without Paclitaxel in the WSG-ADAPT HER2+/HR- Trial. Clin Cancer Res 2023; 29:805-814. [PMID: 36441798 PMCID: PMC9932580 DOI: 10.1158/1078-0432.ccr-22-1587] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/26/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify associations of biological signatures and stromal tumor-infiltrating lymphocytes (sTIL) with pathological complete response (pCR; ypT0 ypN0) and survival in the Phase II WSG-ADAPT HER2+/HR- trial (NCT01817452). EXPERIMENTAL DESIGN Patients with cT1-cT4c, cN0-3 HER2+/HR- early breast cancer (EBC) were randomized to pertuzumab+trastuzumab (P+T, n = 92) or P+T+paclitaxel (n = 42). Gene expression signatures were analyzed in baseline biopsies using NanoString Breast Cancer 360 panel (n = 117); baseline and on-treatment (week 3) sTIL levels were available in 119 and 76 patients, respectively. Impacts of standardized gene expression signatures on pCR and invasive disease-free survival (iDFS) were estimated by logistic and Cox regression. RESULTS In all patients, ERBB2 [OR, 1.70; 95% confidence interval (CI), 1.08-2.67] and estrogen receptor (ER) signaling (OR, 1.72; 95% CI, 1.13-2.61) were favorable, whereas PTEN (OR, 0.57; 95% CI, 0.38-0.87) was unfavorable for pCR. After 60 months median follow-up, 13 invasive events occurred (P+T: n = 11, P+T+paclitaxel: n = 2), none following pCR. Gene signatures related to immune response (IR) and ER signaling were favorable for iDFS, all with similar HR about 0.43-0.55. These patterns were even more prominent in the neoadjuvant chemotherapy-free group, where additionally BRCAness signature was unfavorable (HR, 2.00; 95% CI, 1.04-3.84). IR signatures were strongly intercorrelated. sTILs (baseline/week 3/change) were not associated with pCR or iDFS, though baseline sTILs correlated positively with IR signatures. CONCLUSIONS Distinct gene signatures were associated with pCR versus iDFS in HER2+/HR- EBC. The potential role of IR in preventing recurrence suggests that patients with upregulated IR signatures could be candidates for de-escalation concepts in HER2+ EBC.
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Affiliation(s)
- Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany.,Corresponding Author: Monika Graeser, Bethesda Hospital, West German Study Group, University Medical Center Hamburg—Eppendorf, Moenchengladbach and Hamburg 41061, Germany. Phone: 49-216-1981-2330; Fax: 49-216-1566-2319; E-mail:
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Claudia Biehl
- Westphalian Brest Center Dortmund, Dortmund, Germany
| | | | | | | | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, University Hospital Charité, Humboldt University, Berlin, Germany
| | | | | | - Michael Braun
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Munich, Germany
| | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCLMU, Breast Center, LMU University Hospital, Munich, Germany
| | - Katja Krauss
- University Hospital Aachen, Breast Center, Aachen, Germany
| | | | | | - Toralf Reimer
- University Hospital Gynecology and Policlinic Rostock, Rostock, Germany
| | - Andrea Stefek
- Johanniter Women's Clinic Stendal, Breast Center, Stendal, Germany
| | | | | | - Christine zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Hua Ni
- Department of Gynecology and Obstetrics and CCCLMU, Breast Center, LMU University Hospital, Munich, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, University Hospital Charité, Humboldt University, Berlin, Germany.,University Clinics Essen, Women's Clinic, Essen, Germany
| | - Friedrich Feuerhake
- Medical School Hannover, Institute of Pathology, Hannover, Germany.,Institute of Neuropathology, University Clinic Freiburg, Freiburg, Germany
| | | | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCLMU, Breast Center, LMU University Hospital, Munich, Germany
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5
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Kartikeswar G, Parikh T, Randive B, Kinikar A, Rajput U, Valvi C, Vaidya U, Malwade S, Agarkhedkar S, Kadam A, Smith R, Westercamp M, Schumacher C, Mave V, Robinson M, Gupta A, Milstone A, Manabe Y, Johnson J. Bloodstream infections in neonates with central venous catheters in three tertiary neonatal intensive care units in Pune, India. J Neonatal Perinatal Med 2023; 16:507-516. [PMID: 37718859 PMCID: PMC10875914 DOI: 10.3233/npm-221110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. RESULTS During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). CONCLUSIONS We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.
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Affiliation(s)
- G.A.P. Kartikeswar
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - T.B. Parikh
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - B. Randive
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A. Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U.C. Rajput
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - C. Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U. Vaidya
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - S. Malwade
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - S. Agarkhedkar
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - A. Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R.M. Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Westercamp
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C. Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V. Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M.L. Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A.M. Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y.C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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6
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Bopp L, Martinez ML, Schumacher C, Lukas D, Oh J, Brodesser S, Brachvogel B, Geltink RK, Fabri M. 018 Imiquimod perturbs amino acid metabolism in human CD8+ T cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.027] [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: 11/19/2022]
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7
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Gluz O, Nitz U, Kolberg-Liedtke C, Prat A, Christgen M, Kuemmel S, Mohammadian MP, Gebauer D, Kates R, Paré L, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Wuerstlein R, Graeser M, Pelz E, Jóźwiak K, Zu Eulenburg C, Kreipe HH, Harbeck N. De-escalated Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer (TNBC): Impact of Molecular Markers and Final Survival Analysis of the WSG-ADAPT-TN Trial. Clin Cancer Res 2022; 28:4995-5003. [PMID: 35797219 DOI: 10.1158/1078-0432.ccr-22-0482] [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: 02/13/2022] [Revised: 04/13/2022] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Although optimal treatment in early triple-negative breast cancer (TNBC) remains unclear, de-escalated chemotherapy appears to be an option in selected patients within this aggressive subtype. Previous studies have identified several pro-immune factors as prognostic markers in TNBC, but their predictive impact regarding different chemotherapy strategies is still controversial. EXPERIMENTAL DESIGN ADAPT-TN is a randomized neoadjuvant multicenter phase II trial in early patients with TNBC (n = 336) who were randomized to 12 weeks of nab-paclitaxel 125 mg/m2 + gemcitabine or carboplatin d 1,8 q3w. Omission of further (neo-) adjuvant chemotherapy was allowed only in patients with pathological complete response [pCR, primary endpoint (ypT0/is, ypN0)]. Secondary invasive/distant disease-free and overall survival (i/dDFS, OS) and translational research objectives included quantification of a predictive impact of markers regarding selection for chemotherapy de-escalation, measured by gene expression of 119 genes (including PAM50 subtype) by nCounter platform and stromal tumor-infiltrating lymphocytes (sTIL). RESULTS After 60 months of median follow-up, 12-week-pCR was favorably associated (HR, 0.24; P = 0.001) with 5y-iDFS of 90.6% versus 62.8%. No survival advantage of carboplatin use was observed, despite a higher pCR rate [HR, 1.04; 95% confidence interval (CI), 0.68-1.59]. Additional anthracycline-containing chemotherapy was not associated with a significant iDFS advantage in pCR patients (HR, 1.29; 95% CI, 0.41-4.02). Beyond pCR rate, nodal status and high sTILs were independently associated with better iDFS, dDFS, and OS by multivariable analysis. CONCLUSIONS Short de-escalated neoadjuvant taxane/platinum-based combination therapy appears to be a promising strategy in early TNBC for using pCR rate as an early decision point for further therapy (de-) escalation together with node-negative status and high sTILs. See related commentary by Sharma, p. 4840.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Mohammad Parsa Mohammadian
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | | | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Michael Braun
- Rotkreuz Clinics Munich, Breast Center, Munich, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
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8
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Kolberg-Liedtke C, Feuerhake F, Garke M, Christgen M, Kates R, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Wuerstlein R, Graeser M, Nitz U, Kreipe H, Gluz O, Harbeck N. Impact of stromal tumor-infiltrating lymphocytes (sTILs) on response to neoadjuvant chemotherapy in triple-negative early breast cancer in the WSG-ADAPT TN trial. Breast Cancer Res 2022; 24:58. [PMID: 36056374 PMCID: PMC9438265 DOI: 10.1186/s13058-022-01552-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Higher density of stromal tumor-infiltrating lymphocytes (sTILs) at baseline has been associated with increased rates of pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in triple-negative breast cancer (TNBC). While evidence supports favorable association of pCR with survival in TNBC, an independent impact of sTILs (after adjustment for pCR) on survival is not yet established. Moreover, the impact of sTIL dynamics during NACT on pCR and survival in TNBC is unknown. METHODS The randomized WSG-ADAPT TN phase II trial compared efficacy of 12-week nab-paclitaxel with gemcitabine versus carboplatin. This preplanned translational analysis assessed impacts of sTIL measurements at baseline (sTIL-0) and after 3 weeks of chemotherapy (sTIL-3) on pCR and invasive disease-free survival (iDFS). Predictive performance of sTIL-0 and sTIL-3 for pCR was quantified by ROC analysis and logistic regression; Kaplan-Meier estimation and Cox regression (with mediation analysis) were used to determine their impact on iDFS. RESULTS For prediction of pCR, the AUC statistics for sTIL-0 and sTIL-3 were 0.60 and 0.63, respectively, in all patients; AUC for sTIL-3 was higher in NP/G. The positive predictive value (PPV) of "lymphocyte-predominant" status (sTIL-0 ≥ 60%) at baseline was 59.3%, though only 13.0% of patients had this status. To predict non-pCR, the cut point sTIL-0 ≤ 10% yielded PPV = 69.5% while addressing 33.8% of patients. Higher sTIL levels (particularly at 3 weeks) were independently and favorably associated with better iDFS, even after adjusting for pCR. For example, the adjusted hazard ratio for 3-week sTILs ≥ 60% (vs. < 60%) was 0.48 [0.23-0.99]. Low cellularity in 3-week biopsies was the strongest individual predictor for pCR (in both therapy arms), but not for iDFS. CONCLUSION The independent impact of sTILs on iDFS suggests that favorable immune response can influence key tumor biological processes for long-term survival. The results suggest that the reliability of pCR following neoadjuvant therapy as a surrogate for survival could vary among subgroups in TNBC defined by immune response or other factors. Dynamic measurements of sTILs under NACT could support immune response-guided patient selection for individualized therapy approaches for both very low levels (more effective therapies) and very high levels (de-escalation concepts). TRIAL REGISTRATION Clinical trials No: NCT01815242, retrospectively registered January 25, 2013.
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Affiliation(s)
- Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | | | | | | | - Ronald Kates
- West German Study Group, Mönchengladbach, Germany
| | | | | | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | - Mathias Warm
- Breast Center, City Hospital Holweide, Cologne, Germany
| | | | | | - Bahriye Aktas
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Mönchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany.,Breast Center, LMU University Hospital, Munich, Germany
| | - Monika Graeser
- West German Study Group, Mönchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Hans Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany.,Breast Center, LMU University Hospital, Munich, Germany
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9
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, Schochter F, de Gregorio A, Tzschaschel M, Rack B, Janni W, Friedl TWP. Does the Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer Patients Predict the Site of First Metastasis—Results from the Adjuvant SUCCESS A Trial. Cancers (Basel) 2022; 14:cancers14163949. [PMID: 36010945 PMCID: PMC9406108 DOI: 10.3390/cancers14163949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Due to recent advances in breast cancer detection and treatment strategies, the number of breast cancer survivors has increased over the past decades. However, breast cancer follow-up guidelines have not changed for years. The presence of CTCs detected during follow-up has been shown to indicate poor prognosis in high-risk breast cancer patients. Here, we evaluated if the presence of CTCs also indicates the site of metastatic disease by analyzing CTC status and metastatic location in 206 patients with distant recurrence from the large adjuvant breast cancer trial SUCCESS A. Patients who were CTC-positive both before and after chemotherapy were more likely to show bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs. These data indicate that CTCs might serve as a liquid biopsy surveillance-marker enabling risk-stratification for deciding on further adjuvant add-on-treatment. Abstract The prognostic relevance of circulating tumor cells (CTCs) in breast cancer is well established. However, little is known about the association of CTCs and site of first metastasis. In the SUCCESS A trial, 373 out of 3754 randomized high-risk breast cancer patients developed metastatic disease. CTC status was assessed by the FDA-approved CellSearch®-System (Menarini Silicon Biosystems, Bologna, Italy) in 206 of these patients before chemotherapy and additionally in 159 patients after chemotherapy. CTCs were detected in 70 (34.0%) of 206 patients before (median 2 CTCs, 1–827) and in 44 (27.7%) of 159 patients after chemotherapy (median 1 CTC, 1–124); 16 (10.1%) of 159 patients were CTC-positive at both timepoints. The site of first distant disease was bone-only, visceral-only, and other-site-only in 44 (21.4%), 60 (29.1%), and 74 (35.9%) patients, respectively, while 28 (13.6%) patients had multiple sites of first metastatic disease. Patients with CTCs at both timepoints more often showed bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs before and/or after chemotherapy (p = 0.027). In conclusion, the presence of CTCs before and after chemotherapy is associated with multiple-site or bone-only first-distant disease and may trigger intensified follow-up and perhaps further treatment.
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Affiliation(s)
- Elisabeth K. Trapp
- Department of Gynecology and Obstetrics, Medical University of Graz, 8036 Graz, Austria
- Correspondence:
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, 40225 Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, 81337 München, Germany
| | - Ralf Lorenz
- Gynecologic Practice Dr. Lorenz, N. Hecker, Dr. Kreiss-Sender, 38100 Braunschweig, Germany
| | - Claudia Schumacher
- Department of Gynecology and Obstetrics, St. Elisabeth’s Hospital, 50935 Cologne, Germany
| | | | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Amelie de Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Marie Tzschaschel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas W. P. Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
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10
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Gluz O, Christgen M, Kuemmel S, zu Eulenburg C, Braun M, Aktas B, Luedtke-Heckenkamp K, Forstbauer H, Grischke EM, Schumacher C, Krauss K, Thill M, Warm M, Graeser MK, Wuerstlein R, Kates RE, Baehner FL, Nitz U, Kreipe HH, Harbeck N. Concordance and clinical impact of ER, PR, HER2 expression by local and central immunohistochemistry versus RT-PCR in HR+/HER2- early breast cancer (EBC): Results from the ADAPT trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_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 evaluated concordance of ER, PR and HER2 status between local, central, and RT-PCR/mRNA assessments and its clinical impact in the ADAPT trial collective in HR+ HER2- EBC (NCT01779206). Particularly, validity of borderline ER-positivity (expression level 1-10%) has great clinical relevance as treatment concepts between luminal-like and triple negative (TNBC) EBC differ substantially. Methods: Patients (pts) with clinically high-risk HR+/HER2- EBC (ER and/or PR >1%) were initially treated by 3 (+/-1) weeks of endocrine therapy (ET) before surgery or sequential core biopsy (CB) and then allocated to an ET-alone or chemotherapy (ET) trial, depending on risk and endocrine response. OncotypeDX (incl. RT-PCR for ER, PR, HER2) and central IHC for ER, PR, HER2 were performed on the initial 1.CB. ER-low cohort was defined as 1-10% expression by local OR central lab (ASCO-CAP). Cox models were used to estimate hazard ratios. Results: In ADAPT, 5149 pts from 81 centers in Germany with locally ER and/or PR positive (known quantitative levels) EBC were screened 2012-2018. Median follow-up was 59 months. For ER (positive vs. negative), overall concordance measured as agreement (κ) was high between all three assessments: Local vs. central IHC: 99.3% (κ = 0.45), RT-PCR vs. central IHC: 99% (κ = 0.48). Concordance was lower for PR: RT-PCR vs. central IHC: 90.5% (κ = 0.58), local vs. central IHC: 93.1% (κ = 0.56). 3% were centrally found as HER2+ in 1.CB (73% of them were negative by RT-PCR) and/or 2. Sample. Regarding HER2-low status (1+ or 2+ but ISH negative), concordance between local and central IHC was only 53.8% (κ = 0.09). Of all pts, only 2% (n=109; n=85 with both measurements available) had low ER expression (1-10%) by either local or central pathology. Only 9 of them were concordantly identified as ER-low (11%); 8/58 (14%) ER-low by local lab had TNBC by central lab. 17/47 ER-low cases (36.2%) with known post-endocrine Ki67post had Ki67post <10% vs. 59.7% in ER>10%. 41.8% of ER-low cases had RS<25 vs. 76.7% in ER>10%. All cases with ER <10% by both assessments and those with Ki-67≥40% had RS >25. We observed worse iDFS (HR 1.91, p=0.034) in the ER-low group vs. ER>10%. Conclusions: Although we have confirmed high agreement between local and central IHC and RT-PCR for ER, PR, HER2 assessment in locally HR+/HER2- EBC, there are still a few clinically relevant discordances. Regarding HER2-low status, standardization and quality assurance are needed if this becomes clinically relevant. Treatment of the heterogeneous ER-low group as TNBC appears reasonable only if “ER-low” is confirmed by a second assessment and in cases with Ki-67>40%. Preoperative ET response assessment may be helpful if an endocrine-based therapy concept is intended. Clinical trial information: NCT01779206.
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Affiliation(s)
- Oleg Gluz
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany and University Hospital Cologne, Cologne, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany and Clinics Essen-Mitte, Breast Center, Essen, Germany and Women’s Clinic, Charité Berlin, Berlin, Germany, Essen, Germany
| | | | - Michael Braun
- Interdisciplinary Breast Center, Rotkreuz-Clinics Munich, Munich, Germany
| | - Bahriye Aktas
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | | | | | - Eva-Maria Grischke
- University Women´s Clinic Tuebingen, Eberhard Karls University, Tubingen, Germany
| | | | - Katja Krauss
- Breast Center, Dept. Obstetrics & Gynecology, RWTH Aachen, Aachen, Germany
| | - Marc Thill
- Breast Center, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Mathias Warm
- Breast Center Cologne-Holweide, Municipal Hospital Holweide, Cologne, Germany
| | - Monika Karla Graeser
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany and Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, West German Study Group, Munich, Germany
| | | | | | - Ulrike Nitz
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany, Moenchengladbach, Germany
| | | | - Nadia Harbeck
- Breast Center, LMU University Hospital, Munich, Germany
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11
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Nitz UA, Gluz O, Kümmel S, Christgen M, Braun M, Aktas B, Lüdtke-Heckenkamp K, Forstbauer H, Grischke EM, Schumacher C, Darsow M, Krauss K, Nuding B, Thill M, Potenberg J, Uleer C, Warm M, Fischer HH, Malter W, Hauptmann M, Kates RE, Gräser M, Würstlein R, Shak S, Baehner F, Kreipe HH, Harbeck N. Endocrine Therapy Response and 21-Gene Expression Assay for Therapy Guidance in HR+/HER2- Early Breast Cancer. J Clin Oncol 2022; 40:2557-2567. [PMID: 35404683 DOI: 10.1200/jco.21.02759] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To our knowledge, WSG-ADAPT-HR+/HER2- (NCT01779206; n = 5,625 registered) is the first trial combining the 21-gene expression assay (recurrence score [RS]) and response to 3-week preoperative endocrine therapy (ET) to guide systemic therapy in early breast cancer. MATERIALS AND METHODS Baseline and postendocrine Ki67 (Ki67post) were evaluated centrally. In the endocrine trial, all patients received exclusively ET: patients with pathologic regional lymph node status (pN) 0-1 (ie, 0-3 involved lymph nodes) entered control arm if RS ≤ 11 and experimental arm if RS12-25 with ET response (Ki67post ≤ 10%). All other patients (including N0-1 RS12-25 without ET response) received dose-dense chemotherapy (CT) followed by ET in the CT trial. Primary end point of the endocrine trial was noninferiority of 5-year invasive disease-free survival (5y-iDFS) in experimental (v control) arm; secondary end points included distant DFS, overall survival, and translational research. RESULTS Intention-to-treat population comprised 2,290 patients (n = 1,422 experimental v n = 868 control): 26.3% versus 34.6% premenopausal and 27.4% versus 24.0% pN1. One-sided 95% lower confidence limit of the 5y-iDFS difference was -3.3%, establishing prespecified noninferiority (P = .05). 5y-iDFS was 92.6% (95% CI, 90.8 to 94.0) in experimental versus 93.9% (95% CI, 91.8 to 95.4) in control arm; 5-year distant DFS was 95.6% versus 96.3%, and 5-year overall survival 97.3% versus 98.0%, respectively. Differences were similar in age and nodal subgroups. In N0-1 RS12-25, outcome of ET responders (ET alone) was comparable with that of ET nonresponders (CT) for age > 50 years and superior for age ≤ 50 years. ET response was more likely with aromatase inhibitors (mostly postmenopausal) than with tamoxifen (mostly premenopausal): 78.1% versus 41.1% (P < .001). ET response was 78.8% in RS0-11, 62.2% in RS12-25, and 32.7% in RS > 25 (n = 4,203, P < .001). CONCLUSION WSG-ADAPT-HR+/HER2- demonstrates that guiding systemic treatment by both RS and ET response is feasible in clinical routine and spares CT in pre- and postmenopausal patients with ≤ 3 involved lymph nodes.
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Affiliation(s)
- Ulrike A Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Breast Center Niederrhein, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Breast Center Niederrhein, Moenchengladbach, Germany.,University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Sherko Kümmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Clinic for Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Braun
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Munich, Germany
| | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | | | | | - Maren Darsow
- Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duesseldorf, Germany
| | - Katja Krauss
- University Clinics Aachen, Women's Clinic, Aachen, Germany
| | - Benno Nuding
- Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Marc Thill
- Markus Hospital, Breast Center, Frankfurt, Germany
| | | | | | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | - Wolfram Malter
- University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Neuruppin, Germany
| | | | - Monika Gräser
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Breast Center Niederrhein, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Würstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
| | | | | | - Hans H Kreipe
- Medical School Hannover, Institute for Pathology, Hannover, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
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12
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Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke EM, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N, von Schumann R, Kuhn W, Polata S, Bielecki W, Meyer R, Just M, Kraudelt S, Siggelkow W, Wortelmann H, Kleine-Tebbe A, Leitzen L, Kirchhof H, Krabisch P, Hackmann J, Depenbusch R, Gnauert K, Staib P, Lehnert A, Hoffmann O, Briest S, Lindner C, Heyl V, Bauer L, Uleer C, Mohrmann S, Viehstaedt N, Malter W, Link T, Buendgen N, Tio J. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23:625-635. [DOI: 10.1016/s1470-2045(22)00159-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
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13
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Nitz U, Gluz O, Christgen M, Grischke EM, Augustin D, Kuemmel S, Braun M, Potenberg J, Kohls A, Krauss K, Stefek A, Schumacher C, Forstbauer H, Reimer T, Fischer H, Liedtke C, Wuerstlein R, Schumacher J, Kates R, Kreipe H, Harbeck N. Corrigendum to “De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR− phase II trial: efficacy, safety, and predictive markers for 12weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab ± weekly paclitaxel”. Ann Oncol 2022; 33:355. [DOI: 10.1016/j.annonc.2021.12.008] [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: 11/15/2022] Open
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Grote I, Bartels S, Kandt L, Bollmann L, Christgen H, Gronewold M, Raap M, Lehmann U, Gluz O, Nitz U, Kuemmel S, Zu Eulenburg C, Braun M, Aktas B, Grischke EM, Schumacher C, Luedtke-Heckenkamp K, Kates R, Wuerstlein R, Graeser M, Harbeck N, Christgen M, Kreipe H. TP53 mutations are associated with primary endocrine resistance in luminal early breast cancer. Cancer Med 2021; 10:8581-8594. [PMID: 34779146 PMCID: PMC8633262 DOI: 10.1002/cam4.4376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background Whereas the genomic landscape of endocrine‐resistant breast cancer has been intensely characterized in previously treated cases with local or distant recurrence, comparably little is known about genomic alterations conveying primary non‐responsiveness to endocrine treatment in luminal early breast cancer. Methods In this study, 622 estrogen receptor‐expressing breast cancer cases treated with short‐term preoperative endocrine therapy (pET) from the WSG‐ADAPT trial (NCT01779206) were analyzed for genetic alterations associated with impaired endocrine proliferative response (EPR) to 3‐week pET with tamoxifen or aromatase inhibitors. EPR was categorized as optimal (post‐pET Ki67 <10%) versus slightly, moderately, and severely impaired (post‐pET Ki67 10%–19%, 20%–34%, and ≥35%, respectively). Recently described gene mutations frequently found in previously treated advanced breast cancer were analyzed (ARID1A, BRAF, ERBB2, ESR1, GATA3, HRAS, KRAS, NRAS, PIK3CA, and TP53) by next‐generation sequencing. Amplifications of CCND1, FGFR1, ERBB2, and PAK1 were determined by digital PCR or fluorescence in situ hybridization. Results ERBB2 amplification (p = 0.0015) and mutations of TP53 (p < 0.0001) were significantly associated with impaired EPR. Impaired EPR in TP53‐mutated breast cancer cases was independent from the Oncotype DX Recurrence Score group and was seen both with tamoxifen‐ and aromatase inhibitor‐based pET (p = 0.0005 each). Conclusion We conclude that impaired EPR to pET is suitable to identify cases with primary endocrine resistance in early luminal breast cancer and that TP53‐mutated luminal cancers might not be sufficiently treated by endocrine therapy alone.
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Affiliation(s)
- Isabel Grote
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Stephan Bartels
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Leonie Kandt
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Laura Bollmann
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | | | - Malte Gronewold
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Mieke Raap
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Ulrich Lehmann
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany.,University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany
| | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany.,Clinics Essen-Mitte, Breast Unit, Essen, Germany.,Charité, Women's Clinic, Berlin, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | | | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- Department OB&GYN and CCC Munich, LMU University Hospital, Breast Center, Munich, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department OB&GYN and CCC Munich, LMU University Hospital, Breast Center, Munich, Germany
| | | | - Hans Kreipe
- Hannover Medical School, Institute of Pathology, Hannover, Germany
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Gaillard V, Tricard T, Somme G, Rebel S, Schumacher C, Lang H. Lien ville–hôpital pour le suivi postopératoire en onco-urologie : résultats à 3 ans du réseau LiVHOU. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.068] [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: 11/26/2022]
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16
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Harbeck N, von Schumann R, Kates RE, Braun M, Kuemmel S, Schumacher C, Potenberg J, Malter W, Augustin D, Aktas B, Forstbauer H, Tio J, Grischke EM, Biehl C, Liedtke C, De Haas SL, Deurloo R, Wuerstlein R, Kreipe HH, Gluz O. Immune Markers and Tumor-Related Processes Predict Neoadjuvant Therapy Response in the WSG-ADAPT HER2-Positive/Hormone Receptor-Positive Trial in Early Breast Cancer. Cancers (Basel) 2021; 13:4884. [PMID: 34638369 PMCID: PMC8508505 DOI: 10.3390/cancers13194884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Prognostic or predictive biomarkers in HER2-positive early breast cancer (EBC) may inform treatment optimization. The ADAPT HER2-positive/hormone receptor-positive phase II trial (NCT01779206) demonstrated pathological complete response (pCR) rates of ~40% following de-escalated treatment with 12 weeks neoadjuvant ado-trastuzumab emtansine (T-DM1) ± endocrine therapy. In this exploratory analysis, we evaluated potential early predictors of response to neoadjuvant therapy. The effects of PIK3CA mutations and immune (CD8 and PD-L1) and apoptotic markers (BCL2 and MCL1) on pCR rates were assessed, along with intrinsic BC subtypes. Immune response and pCR were lower in PIK3CA-mutated tumors compared with wildtype. Increased BCL2 at baseline in all patients and at Cycle 2 in the T-DM1 arms was associated with lower pCR. In the T-DM1 arms only, the HER2-enriched subtype was associated with increased pCR rate (54% vs. 28%). These findings support further prospective pCR-driven de-escalation studies in patients with HER2-positive EBC.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCCLMU, University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany;
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
| | - Raquel von Schumann
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
| | - Ronald Ernest Kates
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
| | | | - Sherko Kuemmel
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
- Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany
- Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin, 10117 Berlin, Germany
| | | | | | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany;
| | - Doris Augustin
- Breast Center, Clinic Deggendorf, 94469 Deggendorf, Germany;
| | | | | | - Joke Tio
- University Hospital Münster, 48149 Münster, Germany;
| | | | - Claudia Biehl
- Westphalian Breast Center, City Hospital Dortmund, 44137 Dortmund, Germany;
| | | | | | - Regula Deurloo
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (S.L.D.H.); (R.D.)
| | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and CCCLMU, University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany;
| | | | - Oleg Gluz
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
- Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany;
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17
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Gluz O, Nitz U, Christgen M, Braun M, Luedtke-Heckenkamp K, Darsow M, Forstbauer H, Potenberg J, Uleer C, Grischke EM, Aktas B, Schumacher C, zu Eulenburg C, Jozwiak K, Kates RE, Graeser M, Wuerstlein R, Kreipe HH, Kuemmel S, Harbeck N. Prognostic impact of recurrence score, endocrine response and clinical-pathological factors in high-risk luminal breast cancer: Results from the WSG-ADAPT HR+/HER2- chemotherapy trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
504 Background: In HR+/HER2- N0-1 early BC, postmenopausal patients (pts) with RS™ > 25 and a substantial proportion of premenopausal pts seem to benefit from addition of adjuvant chemotherapy (CT) to endocrine therapy (ET). However, the magnitude of absolute benefit from this treatment intensification seems to depend on clinical-pathological and biological prognostic factors. For the first time, we present outcome from the CT part of the prospective phase III WSG-ADAPT HR+/HER- trial combining both static (RS in baseline core biopsy (CB) and dynamic (Ki67 response) biomarkers to optimize adjuvant therapy in luminal EBC. Methods: Pts with clinically high-risk HR+/HER2- EBC (cT2-4 OR clinically N+ OR G3 OR Ki67>15%) were initially treated by 3 (+/-1) weeks of standard ET (postmenopausal: mostly AI; premenopausal: TAM) before surgery or sequential CB. Pts with cN2-3 or G3/Ki67>40% were randomized directly to the CT trial. pN0-1 pts with RS0-11 OR RS12-25/ET-response (central Ki67postendocrine<10%) received ET alone; the remaining high-risk cohort was randomized to the CT trial: (neo)adjuvant dose-dense CT (4xPaclitaxelà4xEC q2w vs. 8xNab-Paclitaxel q1wà4xEC q2w) followed by ET. Primary endpoint is efficacy comparison of CT schedules for survival; secondary endpoints reported here involve impacts of key prognostic factors on survival. Kaplan-Meier and Cox proportional hazard models were used to estimate survival curves and hazard ratios. For this analysis, subgroups free of selection bias by RS/ET-response were defined. Results: 5625 pts were screened and 4621 (ITT) entered the trial. After 4.9y median follow-up, higher baseline and post-endocrine Ki-67 levels were associated with poorer iDFS (both p < 0.001). In the CT cohort (n = 2331), higher RS, nodal status, and tumor size were generally associated with poorer iDFS. However, iDFS differed between N1 and N0 status only among younger pts (<50 years). In pts with >4 positive LN (n = 390), lower RS was associated with improved iDFS (RS0-11 vs RS > 25: plog-rank= 0.016, 5y-iDFS 90% vs. 64%). In pts with RS > 25 (n = 965), low Ki67postendocrine, N0 status, and c/pT1 status were associated with improved iDFS. In particular, ET-responders had higher 5y-iDFS (84%) than ET-non-responders (77%; plog-rank= 0.040). Younger patients (<50 years old) with N0-1 RS 12-25/ ET-non-responders treated by CT had non-significantly poorer 5-year iDFS (89%) compared to those with ET-response treated by ET only (92%) (plog-rank= 0.249). Conclusion: First results from the prospective high risk cohort from a large prospective phase III ADAPT trial provide evidence for good prognosis in some pts with >4 positive LN and e.g. low RS. Moreover combination of lower post-endocrine Ki-67 and limited tumor burden may be a promising criterion for CT de-escalation strategies even in patients with high RS. Clinical trial information: NCT01779206.
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Affiliation(s)
- Oleg Gluz
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany and University Hospital Cologne, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group/Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Michael Braun
- Interdisciplinary Breast Center, Rotkreuz-Clinics Munich, Munich, Germany
| | | | - Maren Darsow
- Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duesseldorf, Germany, Duesseldorf, Germany
| | | | | | | | - Eva-Maria Grischke
- University Women´s Clinic Tuebingen, Eberhard Karls University, Tubingen, Germany
| | - Bahriye Aktas
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | | | | | - Katarzyna Jozwiak
- Medical School Brandenburg, Institute for Biometrics and Registry Research, Neuruppin, Neuruppin, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany and Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | - Sherko Kuemmel
- Breast Center, Ev. Clinics Essen-Mitte and West German Study Group, Essen, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany and Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU, Munich, Germany
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18
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Harbeck N, Gluz O, Christgen M, Kuemmel S, Grischke EM, Braun M, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, Graeser M, zu Eulenburg C, Kates RE, Wuerstlein R, Kreipe HH, Nitz U. De-escalated neoadjuvant pertuzumab+trastuzumab with or without paclitaxel weekly in HR-/HER2+ early breast cancer: ADAPT-HR-/HER2+ biomarker and survival results. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
503 Background: Optimal use of de-escalated, particularly chemotherapy(CT)-free, neoadjuvant regimens in HER2+ early breast cancer (EBC) is currently unclear as there are limited survival data so far. In ADAPT-HR-/HER2+, we previously showed an excellent pCR rate of 90% after 12-week neoadjuvant paclitaxel (Pac) +pertuzumab (P) +trastuzumab (T) and a substantial and clinically meaningful pCR rate of 34% after P+T alone in HR-/HER2+ EBC. Here, we present first survival data. Methods: The prospective multicenter WSG-ADAPT-HR-/HER2+ phase II-trial is part of the ADAPT-umbrella protocol. Patients with cT1-cT4c, cN0-3 HR-/HER2+ EBC (n = 134) were randomized to 4 cycles of P+T +/- pac d1,8,15 q3w. All tumors were HR-negative (ER and PR < 1%) and HER2-positive (central lab, i.e., 2+ FISH positive or 3+ by immunohistochemistry. Primary endpoint was pCR (ypT0/is/ypN0); omission of further CT was allowed in pts with pCR. Trial objective was to compare pCR in P+T+pac arm vs. early responders in P+T arm (defined as low cellularity and/or Ki67 decrease >30% after 3 weeks). The trial was stopped early due to the observed pCR superiority in the P+T+pac arm. Secondary endpoints included safety, 5-y (distant)-DFS, OS and translational research. Cox-regression analysis was applied. PAM50 subtype was assessed using the BC360 panel. Results: 134 patients were randomized to P+T (n = 92) or P+T+pac (n = 42). 60% of tumors were cT2-4, 42% clinically node-positive. After a median follow-up of 5 years, no significant differences between study arms were observed regarding DFS, dDFS, and OS; only 13 iDFS events (7 dDFS) were observed in the whole ITT population. pCR (vs. non-pCR) after the 12-week study treatment (irrespective of study arm) was strongly associated with improved iDFS (5y DFS 98.5% vs. 82%, HR = 0.14, 95% CI 0.03-0.64). Of the 69 patients with pCR, 39 (56.5%) received no further CT (P+T arm: n = 9, 29% vs. (P+T+pac arm n = 30, 79%); only 1 distant relapse (1.4%) was observed in these patients. In the CT-free P+T arm, no pCR was observed in patients with low HER2 expression (IHC 1+/2+ and FISH positive) and/or basal-like subtype by PAM50 (n = 17, 19%). In the total study population, low HER2 expression and/or no early response was strongly associated with worse dDFS (p =.029) and iDFS (p =.068). No new safety signals were observed. Conclusions: For the first time, we have shown both excellent pCR and survival in patients treated by de-escalated neoadjuvant CT+P+T irrespective of further CT use in a prospective multicenter study. Investigation of CT-free regimens may need to be focussed on selected patients only (e.g. with high HER2 expression/non-basal-like tumors). In ADAPT HR-/HER2+, early pCR after only 12 weeks of neoadjuvant P+T+pac was strongly associated with improved outcome and may thus serve as a predictive clinical marker for further treatment (de)-escalation. Clinical trial information: NCT01779206.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU and West German Study Group, Munich, Germany
| | - Oleg Gluz
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany and University Hospital Cologne, Cologne, Germany
| | | | - Sherko Kuemmel
- Breast Center, Ev. Clinics Essen-Mitte and Women’s Clinic, Charité Berlin and West German Study Group, Essen, Germany
| | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tuebingen, Eberhard Karls University, Tuebingen, Germany
| | - Michael Braun
- Interdisciplinary Breast Center, Rotkreuz-Clinics Munich, Munich, Germany
| | | | - Katja Krauss
- Breast Center, Dept. Obstetrics & Gynecology, RWTH Aachen, Aachen, Germany
| | | | | | - Toralf Reimer
- University Hospital Gynecology and Policlinic Rostock, Rostock, Germany
| | | | | | | | - Monika Graeser
- Breast Center Niederrhein, Ev. Bethesda Hospital and Department of Gynecology, University Medical Center Hamburg and West German Study Group, Mönchengladbach, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, West German Study Group, Munich, Germany
| | | | - Ulrike Nitz
- West German Study Group/Breast Center Niederrhein, Mönchengladbach, Germany
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Graeser M, Schrading S, Gluz O, Strobel K, Würstlein R, Kümmel S, Schumacher C, Grischke E, Forstbauer H, Braun M, Christgen M, Adams J, Nitzsche H, Just M, Fischer HH, Aktas B, Potenberg J, von Schumann R, Kolberg‐Liedtke C, Harbeck N, Kuhl CK, Nitz U. Early response by MR imaging and ultrasound as predictor of pathologic complete response to 12-week neoadjuvant therapy for different early breast cancer subtypes: Combined analysis from the WSG ADAPT subtrials. Int J Cancer 2021; 148:2614-2627. [PMID: 33533487 PMCID: PMC8048810 DOI: 10.1002/ijc.33495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
We evaluated the role of early response after 3 weeks of neoadjuvant treatment (NAT) assessed by ultrasound (US), magnetic resonance imaging (MRI) and Ki-67 dynamics for prediction of pathologic complete response (pCR) in different early breast cancer subtypes. Patients with HR+/HER2+, HR-/HER2- and HR-/HER2+ tumors enrolled into three neoadjuvant WSG ADAPT subtrials underwent US, MRI and Ki-67 assessment at diagnosis and after 3 weeks of NAT. Early response was defined as complete or partial response (US, MRI) and ≥30% proliferation decrease or <500 invasive tumor cells (Ki-67). Predictive values and area under the receiver operating characteristic (AUC) curves for prediction of pCR (ypT0/is ypN0) after 12-week NAT were calculated. Two hundred twenty-six had MRI and 401 US; 107 underwent both MRI and US. All three methods yielded a similar AUC in HR+/HER2+ (0.66-0.67) and HR-/HER2- tumors (0.53-0.63), while MRI and Ki-67 performed better than US in HR-/HER2+ tumors (0.83 and 0.79 vs 0.56). Adding MRI+/-Ki-67 increased AUC of US in HR-/HER2+ tumors to 0.64 to 0.75. MRI and Ki-67 demonstrated highest sensitivity in HR-/HER2- (0.8-1) and HR-/HER2+ tumors (1, both). Negative predictive value was similar for all methods in HR+/HER2+ (0.71-0.74) and HR-/HER2- tumors (0.85-1), while it was higher for MRI and Ki-67 compared to US in HR-/HER2+ subtype (1 vs 0.5). Early response assessed by US, MRI and Ki-67 is a strong predictor for pCR after 12-week NAT. Strength of pCR prediction varies according to tumor subtype. Adding MRI+/-Ki-67 to US did not improve pCR prediction in majority of our patients.
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Affiliation(s)
- Monika Graeser
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- Department of GynecologyUniversity Medical Center HamburgHamburgGermany
| | - Simone Schrading
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Oleg Gluz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- University Hospital CologneCologneGermany
| | - Kevin Strobel
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Rachel Würstlein
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Sherko Kümmel
- West German Study GroupMoenchengladbachGermany
- Breast UnitKliniken Essen‐MitteEssenGermany
- University Hospital Charité, Humboldt University BerlinBerlinGermany
| | | | | | | | - Michael Braun
- Department of GynecologyBreast Center, Red Cross Hospital MunichMunichGermany
| | | | | | - Henrik Nitzsche
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
| | | | | | - Bahriye Aktas
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
- Department of GynecologyUniversity Hospital LeipzigLeipzigGermany
| | | | | | - Cornelia Kolberg‐Liedtke
- University Hospital Charité, Humboldt University BerlinBerlinGermany
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
| | - Nadia Harbeck
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Christiane K. Kuhl
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Ulrike Nitz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
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20
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Graeser M, Feuerhake F, Gluz O, Volk V, Hauptmann M, Jozwiak K, Christgen M, Kuemmel S, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kolberg-Liedtke C, Kates R, Wuerstlein R, Nitz U, Kreipe HH, Harbeck N. Immune cell composition and functional marker dynamics from multiplexed immunohistochemistry to predict response to neoadjuvant chemotherapy in the WSG-ADAPT-TN trial. J Immunother Cancer 2021; 9:jitc-2020-002198. [PMID: 33963012 PMCID: PMC8108653 DOI: 10.1136/jitc-2020-002198] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The association of early changes in the immune infiltrate during neoadjuvant chemotherapy (NACT) with pathological complete response (pCR) in triple-negative breast cancer (TNBC) remains unexplored. Methods Multiplexed immunohistochemistry was performed in matched tumor biopsies obtained at baseline and after 3 weeks of NACT from 66 patients from the West German Study Group Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer - Triple Negative Breast Cancer (WSG-ADAPT-TN) trial. Association between CD4, CD8, CD73, T cells, PD1-positive CD4 and CD8 cells, and PDL1 levels in stroma and/or tumor at baseline, week 3 and 3-week change with pCR was evaluated with univariable logistic regression. Results Compared with no change in immune cell composition and functional markers, transition from ‘cold’ to ‘hot’ (below-median and above-median marker level at baseline, respectively) suggested higher pCR rates for PD1-positive CD4 (tumor: OR=1.55, 95% CI 0.45 to 5.42; stroma: OR=2.65, 95% CI 0.65 to 10.71) and PD1-positive CD8 infiltrates (tumor: OR=1.77, 95% CI 0.60 to 5.20; stroma: OR=1.25, 95% CI 0.41 to 3.84; tumor+stroma: OR=1.62, 95% CI 0.51 to 5.12). No pCR was observed after ‘hot-to-cold’ transition in PD1-positive CD8 cells. pCR rates appeared lower after hot-to-cold transitions in T cells (tumor: OR=0.26, 95% CI 0.03 to 2.34; stroma: OR=0.35, 95% CI 0.04 to 3.25; tumor+stroma: OR=0.00, 95% CI 0.00 to 1.04) and PD1-positive CD4 cells (tumor: OR=0.60, 95% CI 0.11 to 3.35; stroma: OR=0.22, 95% CI 0.03 to 1.92; tumor+stroma: OR=0.32, 95% CI 0.04 to 2.94). Higher pCR rates collated with ‘altered’ distribution (levels below-median and above-median in tumor and stroma, respectively) of T cell (OR=3.50, 95% CI 0.84 to 14.56) and PD1-positive CD4 cells (OR=4.50, 95% CI 1.01 to 20.14). Conclusion Our exploratory findings indicate that comprehensive analysis of early immune infiltrate dynamics complements currently investigated predictive markers for pCR and may have a potential to improve guidance for individualized de-escalation/escalation strategies in TNBC.
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Affiliation(s)
- Monika Graeser
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
- Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Friedrich Feuerhake
- Institute of Pathology, Medical School Hannover, Hannover, Germany
- Institute of Neuropathology, University Clinic Freiburg, Freiburg, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
- University Clinics Cologne, Cologne, Germany
| | - Valery Volk
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Katarzyna Jozwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- University Hospital Charité, Humboldt University, Berlin, Germany
| | | | | | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | - Mathias Warm
- Breast Center, City Hospital Holweide, Cologne, Germany
| | | | | | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany
- Women's Clinic, University Clinics Leipzig, Leipzig, Germany
| | | | - Cornelia Kolberg-Liedtke
- University Hospital Charité, Humboldt University, Berlin, Germany
- Women's Clinic, University Clinics Essen, Essen, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Munich, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
| | | | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Munich, Germany
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Kuemmel S, Gluz O, Nitz U, Braun M, Christgen M, Luedtke-Heckenkamp K, von Schumann R, Darsow M, Forstbauer H, Potenberg J, Grischke EM, Aktas B, Schumacher C, Kates R, Graeser M, Wuerstlein R, Uleer C, Hauptmann M, Shak S, Baehner R, Kreipe H, Harbeck N. Abstract GS4-03: Neoadjuvant nab-paclitaxel weekly versus dose-dense paclitaxel followed by dose-dense EC in high risk HR+/HER2- early BC by: Results from the neoadjuvant part of ADAPT HR+/HER2- trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs4-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathological complete response (pCR) is associated with improved outcome in patients with high-risk HR+/HER2- breast cancer (BC) but the use of (neo)adjuvant chemotherapy in early HR+/HER2- BC remains controversial. Oncotype DX / Recurrence Score (RS) and dynamic Ki67 response after short preoperative endocrine therapy are potentially predictive for pCR. Still, no prospective data are available so far to predict chemotherapy efficacy in this key patient group. Use of dose-dense chemotherapy is associated with improved outcome in meta-analysis, but its use in the neoadjuvant setting is less studied. Furthermore, use of nab-paclitaxel instead of solvent-based paclitaxel has shown promising results in some studies. Here, we present for the first time data from a randomized prospective trial comparing these risk-selection strategies according to RS and Ki67 decrease in high-risk HR+/HER2- BC. Methods: High-risk BC patients [cN0-1 with RS>25 or (RS 12-25 AND (centrally measured) post-endocrine Ki67 >10%] OR [cN2-3 status] OR [G3 AND Ki67>40%] were randomized to (neo)adjuvant 4x paclitaxel175 q2w or 8xnab-paclitaxel 125 mg/m2q1w followed by 4x E90C600 q2w. pCR was defined as no invasive tumor in breast and lymph nodes. Results: 858 patients with available surgery data randomized to neoadjuvant Pac-EC (N=423) or nab-Pac-EC (N=435) were analyzed. Median age was 51 years; median RS was 30 (N=572); 34% had node-positive; 46% (locally) G3 tumors. Baseline characteristics were well balanced between study arms. Patients receiving nab-Pac-EC had higher pCR than those with Pac-EC (20.3% vs. 12.3%, p=.002); patients with RS<25 (about 27%) had a lower pCR rate than those with RS>25 (6.5% vs. 15.8%, p=.003). The association of RS with pCR appeared more pronounced in premenopausal women, but a test of interaction was not significant; RS was about 3 points higher (mean 32.9 vs. 29.8, p<.001) in postmenopausal cases (p=.001). Clinical tumor stage cT2-4 was reported in 65%, with a lower pCR rate than in cT1 tumors (14% vs. 20%, p=.02). RS was moderately correlated (R=.45) with baseline Ki67. In multivariable analysis with tumor stage, RS, Ki67, menopausal status, and ER and PR positivity, higher RS and cT1 stage were favorable for pCR. Excluding RS, higher Ki67 and lower ER (as well as cT1) were favorable. In patients with RS<25, there was no pCR with Pac-EC (0/72 pCR); pCR was almost 20% with RS>25 and nab-Pac-EC. Further details and data including impacts of Ki67 dynamics and additional markers on pCR will be presented at the meeting. Conclusions: Use of neoadjuvant nab-paclitaxel instead of solvent-based paclitaxel appears promising within a short (16-weeks) dose-dense chemotherapy schedule in high-risk HR+/HER2- BC. For the first time, data from a large neoadjuvant randomized trial confirm RS could help to select patients for neoadjuvant chemotherapy in high-risk HR+/HER2- breast cancer (BC).
Citation Format: Sherko Kuemmel, Oleg Gluz, Ulrike Nitz, Michael Braun, Matthias Christgen, Kerstin Luedtke-Heckenkamp, Raquel von Schumann, Maren Darsow, Helmut Forstbauer, Jochem Potenberg, Eva-Maria Grischke, Bahriye Aktas, Claudia Schumacher, Ronald Kates, Monika Graeser, Rachel Wuerstlein, Christoph Uleer, Michael Hauptmann, Steve Shak, Rick Baehner, Hans Kreipe, Nadia Harbeck, West German Study Group. Neoadjuvant nab-paclitaxel weekly versus dose-dense paclitaxel followed by dose-dense EC in high risk HR+/HER2- early BC by: Results from the neoadjuvant part of ADAPT HR+/HER2- trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS4-03.
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Affiliation(s)
- Sherko Kuemmel
- 1Breast Unit, Clinics Essen-Mitte, Essen and West German Study Group, Essen, Germany
| | - Oleg Gluz
- 2Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group and University of Cologne, Moenchengaldbach, Germany
| | - Ulrike Nitz
- 3Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group, Moenchengladbach, Germany
| | | | - Matthias Christgen
- 5Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | | | - Raquel von Schumann
- 7Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach, Moenchengladbach, Germany
| | - Maren Darsow
- 8Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duesseldorf, Germany
| | | | | | | | - Bahriye Aktas
- 12University Clinics Leipzig, Women’s Clinic, Leipzig, Germany
| | | | - Ronald Kates
- 14West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- 3Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- 15Breast Center, Dept. OB&GYN and CCCLMU, LMU University Hospital, Munich, Germany
| | | | | | - Steve Shak
- 18Genomic Health, Inc., Redwood City, CA
| | | | - Hans Kreipe
- 5Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | - Nadia Harbeck
- 15Breast Center, Dept. OB&GYN and CCCLMU, LMU University Hospital, Munich, Germany
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Nitz U, Gluz O, Kreipe HH, Christgen M, Kuemmel S, Baehner FL, Shak S, Aktas B, Braun M, Lüdtke-Heckenkamp K, Forstbauer H, Grischke EM, Nuding B, Darsow M, Schumacher C, Krauss K, Malter W, Thill M, Warm M, Wuerstlein R, Kates RE, Harbeck N. The run-in phase of the prospective WSG-ADAPT HR+/HER2- trial demonstrates the feasibility of a study design combining static and dynamic biomarker assessments for individualized therapy in early breast cancer. Ther Adv Med Oncol 2020; 12:1758835920973130. [PMID: 33281950 PMCID: PMC7692353 DOI: 10.1177/1758835920973130] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Endocrine sensitivity, as determined by response of the proliferation marker Ki-67 to short-term preoperative endocrine therapy (ET), is currently not included in adjuvant treatment decisions in hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− breast cancer (BC). Methods: The prospective WSG-ADAPT HR+/HER2− trial included patients with N0/N1 early BC who were candidates for adjuvant chemotherapy based on clinical–pathological criteria alone. The trial utilized a genomic assessment [the Recurrence Score (RS)] plus endocrine sensitivity testing to guide treatment. All patients received 3 (±1) weeks of preoperative induction ET. According to protocol, patients with RS 0–11 or RS 12–25 plus endocrine proliferation response (EPR, post-induction Ki-67 ⩽ 10%) were to be spared adjuvant chemotherapy. Results: The ADAPT HR+/HER2− trial run-in phase included 407 patients with baseline RS, of whom 386 (median age: 54 years) had complete data for Ki-67 at both baseline and post-induction. RS distribution: 23.1% RS 0–11, 58.3% RS 12–25, and 18.7% RS 26–100. EPR occurred in 84.3%, 76.0%, and 36.1% of these RS groups, respectively. Differences in EPR proportions (RS 26–100 versus others, RS 0–11 versus others) were significant (both p < 0.001); Ki-67 quotients were higher for RS 26–100 (p = 0.02, Mann–Whitney). In premenopausal women (n = 146, mostly tamoxifen-treated), median quotient of Ki-67 level (post/pre) was significantly higher than in postmenopausal women (n = 222, mostly aromatase-inhibitor treated; 0.67 versus 0.25, p < 0.001). EPR was significantly associated with baseline estrogen-receptor status as determined by immunohistochemistry (p = 0.002) or real-time polymerase chain reaction (p < 0.001). Also, a strong correlation was observed between RS measured pre- and post-ET (RS = 0.7, n = 181). Conclusions: This phase of the WSG-ADAPT HR+/HER2− trial confirms trial design estimates of RS and EPR. It indicates that the ADAPT concept of combining static and dynamic biomarker assessment for individualized therapy decisions in early BC is feasible using the EPR criterion post-induction Ki-67 ⩽ 10%. Clinicaltrials.gov identifier: NCT01779206.
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Affiliation(s)
- Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Hans H Kreipe
- Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | | | | | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | | | | | - Benno Nuding
- Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Maren Darsow
- Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duessedorf, Germany
| | | | - Katja Krauss
- University Clinics Aachen, Women's Clinic, Aachen, Germany
| | - Wolfram Malter
- University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Marc Thill
- Markus Hospital, Breast Center, Frankfurt, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Nadia Harbeck
- Breast Center, Department OB&GYN and CCCLMU, LMU University Hospital, Marchioninistrasse 15, Munich DE-81377, Germany
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Schumacher C, Decker G, Ries F. Esophageal stent migration leading to distal small bowel perforation. Acta Gastroenterol Belg 2020; 83:663-665. [PMID: 33321027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Covered oesophageal stents are often used to treat dysphagia in patients with inoperable oesophageal cancer. Stent migration is a well-known but usually benign complication. We report the case of a patient whose esophageal stent migrated into the distal ileum with perforation hereof. A laparoscopic stent extraction and intestinal repair was necessary to treat the perforation.
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Affiliation(s)
- C Schumacher
- Medical Oncology Intern, CHU de Liège, Liège, Belgium
| | - G Decker
- Department of Thoracic and General Surgery, Hôpitaux Robert Schuman, Luxembourg
| | - F Ries
- Department of Medical Oncology, Centre Hospitalier Luxembourg
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Harbeck N, Nitz U, Christgen M, Kuemmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Malter W, Forstbauer H, von Schumann R, Just M, Jóźwiak K, Hauptmann M, Kates R, Gräser M, Wuerstlein R, Kreipe H. LBA14 De-escalated neoadjuvant T-DM1 with or without endocrine therapy (ET) vs trastuzumab+ET in early HR+/HER2+ breast cancer (BC): ADAPT-TP survival results. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fastner G, Reitsamer R, Urbański B, Kopp P, Murawa D, Adamczyk B, Karzcewska A, Milecki P, Hager E, Reiland J, Ciabattoni A, Matuschek C, Budach W, Nowell K, Schumacher C, Ricke A, Fusco V, Vidali C, Alessandro M, Ivaldi GB, Ziegler I, Fussl C, Zehentmayr F, Grambozov B, Sir A, Hitzl W, Ricardi U, Sedlmayer F. Toxicity and cosmetic outcome after hypofractionated whole breast irradiation and boost-IOERT in early stage breast cancer (HIOB): First results of a prospective multicenter trial (NCT01343459). Radiother Oncol 2020; 146:136-142. [PMID: 32151790 DOI: 10.1016/j.radonc.2020.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE To assess the role of intraoperative radiation with electrons (IOERT) as tumor bed boost followed by hypofractionated whole breast irradiation (HWBI) after breast conserving surgery (BCS) of patients with low to intermediate risk breast cancer focusing on acute/late toxicity and cosmetic outcome. MATERIAL AND METHODS In 2011, a prospective multicenter trial (NCT01343459) was started. Treatment consisted of BCS, IOERT (11.1 Gy) and HWBI (40.5 Gy in 15 fractions). In a single-arm design, 5-year IBR-rates are benchmarked by a sequential ratio test (SQRT) against best published evidences in 3 age groups (35-40 y, 41-50 y, >50 y). Acute/late toxicity and cosmesis were evaluated by validated scorings systems. RESULTS Of 627 eligible patients, 44 were excluded, leaving 583 to analyze. After a median follow-up (FUP) of 45 months (range 0-74), for acute effects CTCAE-score 0/1 was noted in 91% (end of HWBI) and 92% (4 weeks later), respectively. Late toxicity Grading 0/1 (mean values, ranges) by LENT-SOMA criteria were observed in 92.7% (89-97.3) at 4/5 months, rising to 96.5% (91-100) at 6 years post HWBI. Baseline cosmesis after wound healing prior to HWBI was scored as excellent/good in 86% of cases by subjective (patient) and in 74% by objective (doctor) assessment with no impairment thereafter. CONCLUSIONS Acute and late treatment tolerance of a combined Boost-IOERT/HWBI regimen is excellent in short/mid-term assessment. Postoperative cosmetic appearance is not impaired after 3 years FUP.
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Affiliation(s)
- Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria.
| | - Roland Reitsamer
- Department of Gynecology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Bartosz Urbański
- Department of Radiotherapy and Gynecological Oncology, Greater Poland Cancer Centre, Poznań, Poland
| | - Peter Kopp
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Dawid Murawa
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences University, Zielona Gora, Poland
| | - Beata Adamczyk
- Department of Surgical Oncology, Greater Poland Cancer Centre, Poznań, Poland
| | | | - Piotr Milecki
- Department of Radiotherapy Greater Poland Cancer Center and Chair of Electroradiology Poznan University of Medical Sciences, Poznań, Poland
| | - Eva Hager
- Department of Radiotherapy/Radiooncology, Klagenfurt, Austria
| | - Juliann Reiland
- Avera McKennan Hospitals and University Health System, Avera Medical Group, Comprehensive Breast Care, Sioux Falls, United States
| | | | - Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Düsseldorf, Germany
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Düsseldorf, Germany
| | - Kerri Nowell
- Department of General Surgery, UnityPoint Health-St.Lukes Hospital, Cedar Rapids, United States
| | - Claudia Schumacher
- Breast Center/Department of Senology, St.-Elisabeth Hospital Cologne-Hohenlind, Germany
| | - Angelika Ricke
- Radiation Institute-CDT-center for Diagnostic and Therapy GmbH, Cologne, Germany
| | - Vincenzo Fusco
- Radioterapia, IRCCS-CROB Reference Cancer Center Basilicata, Rionero in Vulture, Italy
| | - Cristiana Vidali
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Italy
| | - Marina Alessandro
- Division of Radiation Oncology, Ospedale di Città di Castello, USL UMBRIA 1, Città di Castello, Italy
| | | | - Ingrid Ziegler
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Christoph Fussl
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Franz Zehentmayr
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Brane Grambozov
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Andreas Sir
- Department of Gynecology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office - Biostatistics, Paracelsus Medical University Salzburg, Austria; Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | | | - Felix Sedlmayer
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, deGregorio deGregorio A, Tzschaschel M, Bekes I, Scholz C, Rack B, Janni W, Friedl TWP. Abstract P4-01-01: Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-01-01] [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: The prognostic relevance of circulating tumor cells (CTCs) during adjuvant breast cancer treatment and follow up has been well established. However, little information is available regarding CTC-detection and its association to site of first metastatic disease. Methods: The adjuvant phase III SUCCESS A trial, an open label, randomized, multicenter study, compared chemotherapy with three cycles of epirubicin, fluorouracil and cyclophosphamide followed by either three cycles of docetaxel or three cycles of docetaxel plus gemcitabine in patients with early high-risk breast cancer. Following chemotherapy, patients were randomized to two or five years of zoledronate treatment. CTC status was assessed before and after chemotherapy using the FDA-approved CellSearch® System (Menarini Silicon Biosystems; Bologna, Italy). The association between the presence of CTCs and the site of first distant disease was assessed using Chi Square tests. Findings: Of 3754 SUCCESS A patients, 373 developed metastatic disease. 206 of these patients participated in the translational research program of the trial so the CTC status at baseline was assessed. These patients were included into the analysis. At least one CTC before chemotherapy was detected in 70 (34.0%) of patients (median 2 CTCs, range 1 - 827 CTCs). For 159 patients, CTC status after chemotherapy could also be evaluated. Disease progression in terms of first distant disease occurred in 44 patients (21.4 %) in the bones, in 60 (29.1 %) in visceral sites (lung, liver), in 23 (11.2 %) in the brain or neural system, and in 51 patients (24.7 %) in other sites. In 28 patients (13.6 %), more than one site of metastatic disease was overt at the time of first distant recurrence. The median time to metastatic disease (measured from date of randomization) was 33.0 months (range 0.7 - 92.4 months). Overall, patients with bone-only first distant disease were numerically most likely to be CTC positive before chemotherapy (40.9 %); however, there was no significant association between site of first metastatic disease (bones, visceral, other) and the presence of CTCs before chemotherapy (p.224). Adding CTC status after chemotherapy did not change the results. However, patients with persistently positive CTCs were significantly more likely to show first distant disease at multiple sites than patients with a negative CTC status before and/or after chemotherapy. Interpretation: Although the presence of CTCs predicts poor prognosis in early breast cancer, no association of positive CTC status before and after chemotherapy with the site of metastatic disease was found. Therefore, a positive CTC status should trigger routine diagnostic intervention depending on clinical evaluation.
Citation Format: Elisabeth Katharina Trapp, Peter A Fasching, Tanja Fehm, Andreas Schneeweiss, Volkmar Mueller, Nadia Harbeck, R. Lorenz, Claudia Schumacher, Georg Heinrich, Amelie deGregorio deGregorio, Marie Tzschaschel, Inga Bekes, Christoph Scholz, Brigitte Rack, Wolfgang Janni, Thomas WP Friedl. Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
| | - Peter A Fasching
- 2Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- 3Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Andreas Schneeweiss
- 4National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Volkmar Mueller
- 5Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Harbeck
- 6Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - R. Lorenz
- 7Private Practice for Gynaecology Casparistreet, Braunschweig, Germany
| | - Claudia Schumacher
- 8Department of Obstetrics and Gynecology St. Elisabeth's Hospital of Cologne, Cologne, Germany
| | - Georg Heinrich
- 9Private Practice for Gynaecology, Fürstenwalde, Germany
| | | | - Marie Tzschaschel
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Inga Bekes
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Scholz
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Brigitte Rack
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Thomas WP Friedl
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Schumacher C, Sharbafi M, Seyfarth A, Rode C. Biarticular muscles in light of template models, experiments and robotics: a review. J R Soc Interface 2020; 17:20180413. [PMID: 32093540 PMCID: PMC7061696 DOI: 10.1098/rsif.2018.0413] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022] Open
Abstract
Leg morphology is an important outcome of evolution. A remarkable morphological leg feature is the existence of biarticular muscles that span adjacent joints. Diverse studies from different fields of research suggest a less coherent understanding of the muscles' functionality in cyclic, sagittal plane locomotion. We structured this review of biarticular muscle function by reflecting biomechanical template models, human experiments and robotic system designs. Within these approaches, we surveyed the contribution of biarticular muscles to the locomotor subfunctions (stance, balance and swing). While mono- and biarticular muscles do not show physiological differences, the reviewed studies provide evidence for complementary and locomotor subfunction-specific contributions of mono- and biarticular muscles. In stance, biarticular muscles coordinate joint movements, improve economy (e.g. by transferring energy) and secure the zig-zag configuration of the leg against joint overextension. These commonly known functions are extended by an explicit role of biarticular muscles in controlling the angular momentum for balance and swing. Human-like leg arrangement and intrinsic (compliant) properties of biarticular structures improve the controllability and energy efficiency of legged robots and assistive devices. Future interdisciplinary research on biarticular muscles should address their role for sensing and control as well as non-cyclic and/or non-sagittal motions, and non-static moment arms.
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Affiliation(s)
- C. Schumacher
- Lauflabor Locomotion Laboratory, Centre for Cognitive Science, Institute of Sport Science, Technische Universität Darmstadt, Darmstadt, Germany
| | - M. Sharbafi
- Lauflabor Locomotion Laboratory, Centre for Cognitive Science, Institute of Sport Science, Technische Universität Darmstadt, Darmstadt, Germany
| | - A. Seyfarth
- Lauflabor Locomotion Laboratory, Centre for Cognitive Science, Institute of Sport Science, Technische Universität Darmstadt, Darmstadt, Germany
| | - C. Rode
- Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
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Sondag M, Nguimpi Tambou M, Schumacher C, Reimund J, Serfaty L, Duclos B. Impact on survival of adjuvant chemotherapy following chemo-radiotherapy and surgery in locally advanced, non-metastatic rectal adenocarcinoma: a retrospective analysis among 331 patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.091] [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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Gluz O, Kolberg-Liedtke C, Prat A, Christgen M, Gebauer D, Kates R, Paré L, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Wuerstlein R, Pelz E, Nitz U, Kreipe HH, Harbeck N. Efficacy of deescalated chemotherapy according to PAM50 subtypes, immune and proliferation genes in triple-negative early breast cancer: Primary translational analysis of the WSG-ADAPT-TN trial. Int J Cancer 2019; 146:262-271. [PMID: 31162838 DOI: 10.1002/ijc.32488] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
In the neoadjuvant WSG-ADAPT-TN trial, 12-week nab-paclitaxel + carboplatin (nab-pac/carbo) was highly effective and superior to nab-paclitaxel + gemcitabine (nab-pac/gem) in triple-negative breast cancer regarding pathological complete response (pCR). Predictive markers for deescalated taxane/carbo use in TNBC need to be identified. Patients received 4 × nab-pac 125 mg/m2 (plus carbo AUC2 or gem 1,000 mg/m2 d1,8 q21). Expression of 119 genes and PAM50 scores by nCounter were available in 306/336 pretherapeutic samples. Interim survival analysis was planned after 36 months median follow-up. Basal-like (83.3%) compared to other subtypes was positively associated with pCR (38% vs. 20%, p = 0.015), as was lower HER2 score (p < 0.001). Proliferation biomarkers were positively associated with pCR, that is, PAM50 proliferation, ROR scores (all p < 0.004), higher Ki-67 (IHC; p < 0.001). For nab-pac/carbo, expression of immunological (CD8, PD1 and PFDL1) genes and proliferation markers (proliferation and ROR scores, MKI67, CDC20, NUF2, KIF2C, CENPF, EMP3 and TYMS) were positively associated with pCR (p < 0.05 for all). For nab-pac/gem, angiogenesis genes were negatively associated with pCR (ANGPTL4: p = 0.05; FGFR4: p = 0.02; VEGFA: p = 0.03). pCR after 12 weeks was strongly associated with favorable outcome (3y event-free survival: 92% vs. 71%, p < 0.001). In early TNBC, basal-like subtype, higher Ki-67 (IHC) and lower HER2 score were, associated with chemosensitivity. Chemoresistance pathways differed between the two taxane based combinations. Combination of proliferation/immune markers and PAM50 subtype could allow patient selection for further deescalated chemotherapy and/or immune treatment approaches.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Ronald Kates
- West German Study Group, Mönchengladbach, Germany
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Michael Braun
- Rotkreuz Clinics Munich, Breast Center, Munich, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany.,Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany.,Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
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Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. Abstract GS5-06: No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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:Immune markers such as tumor infiltrating lymphocytes (TILs), CD8, PDL1, PD1 and other protein or mRNA-based genomic markers have been identified as prognostic / predictive in TNBC regarding survival / chemotherapy (CTx) efficacy.
In the adjuvant WSG-PlanB trial, patients with high TILs and/or CD8 by mRNA had excellent outcome, irrespective of anthracycline use; in the neoadjuvant ADAPT-TN trial, high PDL1, PD1 and CD8 and/or TILs were predictive for pCR. Still, optimal markers for potential treatment de-escalation have yet to be determined. Here, we analyse for the first time impact of immune mRNA-based markers and TIL's as prognostic and predictive survival markers.
Methods: TNBC patients (ER/PR<1%, HER2-,) were randomized to neoadjuvant 4x nab-paclitaxel 125 mg/m2/gemcitabine 1000 mg/m2 d1/8 q3w (gem arm) or 4x nab-paclitaxel 125 mg/m2/carboplatin AUC2 day 1/8 3-weekly (q3w) (carbo arm). Primary endpoint of WSG-ADAPT-TN was pCR (ypT0/is/ypN0); secondary endpoints included translational analyses, e.g., TILs or expression of 119 genes by nCounter platform. Standard adjuvant chemotherapy (4xEC) was optional (not randomized) in patients achieving pCR after 12 weeks. According to protocol, 1st safety survival analysis was performed after 3y median follow-up.
Results: Present translational analysis included 306 of 336 TNBC patients (36 months median FU). pCR was associated with significantly better survival (3y EFS: 92% vs. 71%, p<.001), but despite substantially higher pCR in the carbo arm (46% vs. 29%), no significant EFS advantage was seen (p=.6) (gem: 78%; carbo: 80%; 3y-EFS).
Bivariate Spearman correlations among CD8, PD1, and PDL1 were strongly positive; their correlations with TILs were moderately positive.
Preliminary Cox analysis of EFS was performed with clinical variables (cN, cT, menopausal status); neoadjuvant study arm; pCR; TILs; proliferation markers (baseline Ki67 by IHC, scores derived from PAM50); baseline immune markers; risk scores; and individual gene expression scores previously identified as prognostic for pCR in one or both neoadjuvant arms. Independent prognostic factors included pCR, cN, Ki67, PD1, and CD8; these were entered into (prognostic) interaction analysis. The resulting model contained cN, high Ki67 and low TILs as (unfavorable) main effects and the interaction of (higher) PD1*pCR (favorable).
Among pCR patients, the groups with/without additional adjuvant CTX were similar with respect to explanatory factors. Baseline TILs, Ki67, cN, and PD1 were entered into exploratory predictive analysis; the model retained only the interaction [adjuvant CTx * (fractionally ranked) PD1]. In patients with pCR, those with low PD1 benefited from standard anthracycline-containing adjuvant CTx, whereas patients high PD1 did not with an 98% 3y-EFS.
Conclusions: Our exploratory results suggest independent prognostic impact of mRNA markers and TIL's in early TNBC. Patients with both pCR (after 12 weeks) and “high-immune” signature (defined here by PD1) had excellent 3y-EFS and may be candidates for treatment de-escalation (e.g. omission of anthracyclines), whereas “low-immune” pCR patients may benefit from standard adjuvant poly-chemotherapy.
Citation Format: Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke E-M, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN 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 GS5-06.
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Affiliation(s)
- O Gluz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - U Nitz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Liedtke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - A Prat
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Christgen
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - F Feuerhake
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Garke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E-M Grischke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - H Forstbauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Braun
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Warm
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - J Hackmann
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Uleer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - B Aktas
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Schumacher
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - S Kuemmel
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E Pelz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - D Gebauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - L Paré
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Kates
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Wuerstlein
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - HH Kreipe
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - N Harbeck
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
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Schumacher C, Lampertz S, Aidji EG, Badea L. [Image of the month. « CUP » : Cancer of unknown primary]. Rev Med Liege 2019; 74:4-6. [PMID: 30680966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- C Schumacher
- Service d'Oncologie et Hématologie, Centre Hospitalier du Bois de l'Abbaye, Liège, Belgique
| | - S Lampertz
- Service d'Oncologie et Hématologie, Centre Hospitalier du Bois de l'Abbaye, Liège, Belgique
| | - E G Aidji
- Service d'Oncologie et Hématologie, Centre Hospitalier du Bois de l'Abbaye, Liège, Belgique
| | - L Badea
- Service d'Oncologie et Hématologie, Centre Hospitalier du Bois de l'Abbaye, Liège, Belgique
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Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Lindner C, Kümmel S, Kates R, Potenberg J, Staib P, Wuerstlein R, Kreipe H, Harbeck N. Prognostic impact of anthracyclines and immune/proliferation markers in TNBC according to pCR after de-escalated neoadjuvant chemotherapy with 12 weeks of nab-paclitaxel/carboplatin or gemcitabine: Survival results of WSG-ADAPT-TN phase II trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun MW, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kummel S, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Impact of 12 weeks nab-paclitaxel + carboplatin or gemcitabine followed by anthracycline administration according to pCR in triple-negative early breast cancer: Survival results of WSG-ADAPT-TN phase II trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.573] [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)
- Oleg Gluz
- Breast Center Niederrhein and University Clinics Cologne, Moenchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group/ Breast Center Niederrhein, Moenchengladbach, Germany
| | | | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | - Mathias Warm
- City Hospital Cologne, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Hospital Essen/Univeristy Hospital Leipzig, Essen, Germany
| | | | | | | | | | | | | | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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Liedtke C, Feuerhake F, Garke M, Christgen M, Kates RE, Grischke EM, Forstbauer H, Braun MW, Warm MR, Hackmann C, Uleer C, Aktas B, Schumacher C, Kummel S, Wuerstlein R, Nitz U, Kreipe HH, Gluz O, Harbeck N. Impact of tumor-infiltrating lymphocytes on response to neoadjuvant chemotherapy in triple-negative early breast cancer: Translational subproject of the WSG-ADAPT TN trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
| | | | | | | | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | | | | | | | | | | | | | | | - Ulrike Nitz
- West German Study Group/ Breast Center Niederrhein, Moenchengladbach, Germany
| | | | - Oleg Gluz
- Breast Center Niederrhein and University Clinics Cologne, Moenchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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Harbeck N, Nitz U, Christgen M, Kates RE, Braun MW, Kummel S, Schumacher C, Potenberg J, Malter W, Augustin D, Aktas B, Forstbauer H, Tio J, Kleine-Tebbe A, Liedtke C, de Haas S, Deurloo R, Wuerstlein R, Kreipe HH, Gluz O. Impact of PIK3CA mutation status on immune marker response and pCR in the WSG-ADAPT HER2+/HR+ phase II trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.572] [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)
- Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
| | - Ulrike Nitz
- Evangelical Hospital Bethesda, Breast Cancer Niederrhein, Moenchengladbach, Germany
| | | | | | | | | | | | - Jochem Potenberg
- Department of Hematology, Waldkrankenhaus Spandau, Berlin, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | | | - Bahriye Aktas
- University Hospital Essen/Univeristy Hospital Leipzig, Essen, Germany
| | | | - Joke Tio
- Department of Gynecology and Obstetrics, University Hospital Muenster, Muenster, Germany
| | | | | | | | | | | | | | - Oleg Gluz
- Breast Center Niederrhein and University Clinics Cologne, Moenchengladbach, Germany
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Le Fèvre C, Antoni D, Thiéry A, Keller A, Truntzer P, Vigneron C, Clavier JB, Guihard S, Pop M, Schumacher C, Salze P, Noël G. [Radiotherapy of bone metastases in France: A descriptive monocentric retrospective study]. Cancer Radiother 2018; 22:148-162. [PMID: 29602695 DOI: 10.1016/j.canrad.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/03/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Bone metastases cause pain and affect patients' quality of life. Radiation therapy is one of the reference analgesic treatments. The objective of this study was to compare the current practices of a French radiotherapy department for the treatment of uncomplicated bone metastases with data from the literature in order to improve and optimize the management of patients. MATERIAL AND METHODS A retrospective monocentric study of patients who underwent palliative irradiation of uncomplicated bone metastases was performed. RESULTS Ninety-one patients had 116 treatments of uncomplicated bone metastases between January 2014 and December 2015, including 44 men (48%) and 47 women (52%) with an average age of 63years (25-88years). Primary tumours most commonly found were breast cancer (35%), lung cancer (16%) and prostate cancer (12%). The regimens used were in 29% of cases 30Gy in ten fractions (group 30Gy), in 21% of cases 20Gy in five fractions (group 20Gy), in 22% of cases 8Gy in one fraction (group 8Gy) and in 28% of cases 23.31Gy in three fractions of stereotactic body irradiation (stereotactic group). The general condition of the patient (P<0.001), pain score and analgesic (P<0.001), oligometastatic profile (P=0.003) and practitioner experience (P<0.001) were factors influencing the choice of the regimen irradiation. Age (P=0.46), sex (P=0.14), anticancer treatments (P=0.56), concomitant hospitalization (P=0.14) and the distance between the radiotherapy centre and home (P=0.87) did not influence the decision significantly. A total of three cases of spinal compression and one case of post-therapeutic fracture were observed, occurring between one and 128days and 577days after irradiation, respectively. Eight percent of all irradiated metastases were reirradiated with a delay ranging between 13 and 434days after the first irradiation. The re-irradiation rate was significantly higher after 8Gy (P=0.02). The rate of death was significantly lower in the stereotactic arm (P<0.001) and overall survival was significantly greater in the stereotactic arm (P<0.001). CONCLUSION This study showed that patients' analysed was comparable to the population of different studies. Predictive factors for the choice of the treatment regimen were identified. Non-fractionnated therapy was underutilised while stereotactic treatment was increasingly prescribed, showing an evolution in the management of patients.
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Affiliation(s)
- C Le Fèvre
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire EA 3430, Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 67000 Strasbourg, France
| | - A Thiéry
- Département de santé publique, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - A Keller
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - P Truntzer
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - C Vigneron
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - J-B Clavier
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - S Guihard
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - M Pop
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - C Schumacher
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - P Salze
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire EA 3430, Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 67000 Strasbourg, France.
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Lenoir D, De Pauw R, Ickmans K, Schumacher C, Timmers I, Kregel J, Coppieters I. Validity and Test-Retest Reliability of the Dutch Modified Perceived Deficits Questionnaire to Examine Cognitive Symptoms in Women with Chronic Whiplash, Chronic Idiopathic Neck Pain, and Fibromyalgia. Pain Pract 2018; 18:850-863. [PMID: 29383819 DOI: 10.1111/papr.12683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Until now, only reliability and validity of the English version of the modified Perceived Deficits Questionnaire (mPDQ) have been investigated. OBJECTIVE The aim of this study was to translate the mPDQ into Dutch and evaluate its validity and reliability as an assessment tool for self-perceived cognitive problems in patients with chronic whiplash-associated disorders (CWAD), chronic idiopathic neck pain (CINP), and fibromyalgia (FM). METHODS A case-control study was performed with a volunteer sample of 13 women with CWAD, 18 with CINP, and 33 with FM, and 33 women who were healthy and free of pain. The mPDQ was first translated into Dutch, and its test-retest reliability, internal consistency, and discriminative power were examined. RESULTS The intraclass correlation coefficients were higher than 0.74. Cronbach's α values ranged between 0.71 and 0.95. Total mPDQ scores were significantly higher (P < 0.017) in FM and CWAD patients compared to healthy controls. Furthermore, participants performed the Stroop task and the psychomotor vigilance task (PVT), 2 neuropsychological computer-based cognitive performance tests. Correlations between the mPDQ total score and the cognitive performance tests were evaluated. Significant moderate to high correlations were found in all study samples between total mPDQ score and objective cognitive tests (Spearman correlation coefficient = 0.35 to 0.80; P < 0.05). CONCLUSION Therefore, the Dutch version of the mPDQ showed high test-retest reliability and high internal consistency, and was able to distinguish CWAD and FM patients from healthy controls. PERSPECTIVE This article presents the validity and test-retest reliability of the Dutch mPDQ. This measure could help clinicians who seek a reliable and user-friendly way to assess cognitive symptoms in chronic pain patients.
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Affiliation(s)
- D Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
| | - R De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - C Schumacher
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Timmers
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - J Kregel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - I Coppieters
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
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Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, von Schumann R, Kates R, Kates R, Schumacher J, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of Neoadjuvant Nab-Paclitaxel+Carboplatin vs Nab-Paclitaxel+Gemcitabine in Triple-Negative Breast Cancer: Randomized WSG-ADAPT-TN Trial Results. J Natl Cancer Inst 2017; 110:628-637. [PMID: 29228315 DOI: 10.1093/jnci/djx258] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/08/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Oleg Gluz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
- University Clinics Cologne
| | - Ulrike Nitz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | - Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Clinics Schleswig-Holstein/Campus Luebeck
| | | | | | | | | | - Mathias Warm
- Breast Center, City Hospital of Cologne Holweide
| | | | | | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen
- Department of Gynecology, University Hospital Leipzig
| | | | | | - Christoph Lindner
- Clinic of Gynecology, Charité University Clinics Berlin
- Department of Gynecology and Obstetrics, Agaplesion Diakonie Clinic
| | | | | | | | - Peter Staib
- Department of Oncology, St. Antonius Hospital
| | - Andreas Kohls
- Department of Gynecology and Obstetrics, Evangelical Hospital Ludwigsfelde
| | - Raquel von Schumann
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | | | | | | | - Rachel Wuerstlein
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | - Nadia Harbeck
- Moenchengladabach, West German Study Group
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
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Nitz UA, Gluz O, Christgen M, Grischke EM, Augustin D, Kuemmel S, Braun M, Potenberg J, Kohls A, Krauss K, Stefek A, Schumacher C, Forstbauer H, Reimer T, Fischer H, Liedtke C, Wuerstlein R, Schumacher J, Kates R, Kreipe H, Harbeck N. De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR- phase II trial: efficacy, safety, and predictive markers for 12 weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab ± weekly paclitaxel. Ann Oncol 2017; 28:2768-2772. [PMID: 28945833 DOI: 10.1093/annonc/mdx494] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Response rates in HER2-overexpressing EBC treated with neoadjuvant chemotherapy and trastuzumab (T) have been improved by addition of pertuzumab (P). The prospective, phase II, neoadjuvant WSG-ADAPT HER2+/HR- trial assessed whether patients with strong early response to dual blockade alone might achieve pathological complete response (pCR) comparable to that of patients receiving dual blockade and chemotherapy. PATIENTS AND METHODS Female patients with HER2+/HR- EBC (M0) were randomized (5:2) to 12 weeks of T + P ± weekly paclitaxel (pac) at 80 mg/m2. Early response was defined as proliferation decrease ≥30% of Ki-67 (versus baseline) or low cellularity (<500 invasive tumor cells) in the 3-week biopsy. The trial was designed to test non-inferiority for pCR in early responding patients of the T + P arm versus all chemotherapy-treated patients. RESULTS From February 2014 to December 2015, 160 patients were screened, 92 were randomized to T + P and 42 to T + P+pac. Baseline characteristics were well balanced (median age 54 versus 51.5 years, cT2 51.1 versus 52.4%, cN0 54.3 versus 61.9%); 91.3% of patients completed T + P per protocol and 92.9% T + P+pac. The pCR rate in the T + P+pac arm was 90.5%, compared with 36.3% in the T + P arm as a whole. In the T + P arm, 24/92 were classified as non-responders, and their pCR rate was only 8.3% compared with 44.7% in responders (38/92) and 42.9% in patients with unclassified early response (30/92). No new safety signals were observed in the study population. CONCLUSION Addition of taxane monotherapy to dual HER2 blockade in a 12-week neoadjuvant setting substantially increases pCR rates in HER2+/HR- EBC compared with dual blockade alone, even within early responders to dual blockade. Early non-response under dual blockade strongly predicts failure to achieve pCR.
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Affiliation(s)
- U A Nitz
- West German Study Group GmbH, Moenchengladabach; Evangelical Hospital Johanniter Bethesda, Breast Center Niederrhein, Moenchengladbach
| | - O Gluz
- West German Study Group GmbH, Moenchengladabach; Evangelical Hospital Johanniter Bethesda, Breast Center Niederrhein, Moenchengladbach; University of Cologne, Cologne.
| | - M Christgen
- Institute of Pathology, Medical School Hannover, Hannover
| | - E-M Grischke
- Department of Gynecology and Obstetrics, University Clinics Tuebingen, Tuebingen
| | | | - S Kuemmel
- Breast Center, Clinics Essen-Mitte, Essen
| | - M Braun
- Rotkreuz Clinics Munich Breast Center, Munich
| | - J Potenberg
- Department of Oncology Evangelical Waldkrankenhaus Berlin, Berlin
| | - A Kohls
- Department of Gynecology and Obstetrics, Evangelical Hospital, Ludwigsfelde
| | - K Krauss
- Department of Gynecology and Obstetrics, University Clinics RWTH, Aachen
| | - A Stefek
- Breast Center, Evangelical Hospital Johanniter, Stendal
| | - C Schumacher
- Breast Center, St. Elisabeth Hospital Cologne, Cologne
| | | | - T Reimer
- Department of Gynecology and Obstetrics, University Clinics Rostock, Suedstadt
| | - H Fischer
- Breast Center, Evangelical Hospital Gelsenkirchen, Gelsenkirchen
| | - C Liedtke
- Department of Gynecology and Obstetrics, University Clinics Schleswig-Holstein/Campus Luebeck, Luebeck; Charite Berlin
| | - R Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, University of Munich (LMU) and CCCLMU, Munich
| | - J Schumacher
- Palleos Healthcare, Statistics, Wiesbaden, Germany
| | - R Kates
- West German Study Group GmbH, Moenchengladabach
| | | | - N Harbeck
- West German Study Group GmbH, Moenchengladabach; Breast Center, Department of Gynecology and Obstetrics, University of Munich (LMU) and CCCLMU, Munich
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Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA. De-Escalation Strategies in Human Epidermal Growth Factor Receptor 2 (HER2)–Positive Early Breast Cancer (BC): Final Analysis of the West German Study Group Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early BC HER2- and Hormone Receptor–Positive Phase II Randomized Trial—Efficacy, Safety, and Predictive Markers for 12 Weeks of Neoadjuvant Trastuzumab Emtansine With or Without Endocrine Therapy (ET) Versus Trastuzumab Plus ET. J Clin Oncol 2017; 35:3046-3054. [PMID: 28682681 DOI: 10.1200/jco.2016.71.9815] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [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
Purpose Human epidermal growth factor receptor 2 (HER2)–positive/hormone receptor (HR)–positive breast cancer is a distinct subgroup associated with lower chemotherapy sensitivity and slightly better outcome than HER2-positive/HR-negative disease. Little is known about the efficacy of the combination of endocrine therapy (ET) with trastuzumab or with the potent antibody-cytotoxic, anti-HER2 compound trastuzumab emtansine (T-DM1) with or without ET for this subgroup. The West German Study Group trial, ADAPT (Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer) compares pathologic complete response (pCR) rates of T-DM1 versus trastuzumab with ET in early HER2-positive/HR-positive breast cancer. Patients and Methods In this prospective, neoadjuvant, phase II trial, 375 patients with early breast cancer with HER2-positive and HR-positive status (n = 463 screened) were randomly assigned to 12 weeks of T-DM1 with or without ET or to trastuzumab with ET. The primary end point was pCR (ypT0/is/ypN0). Early response was assessed in 3-week post-therapeutic core biopsies (proliferation decrease ≥ 30% Ki-67 or cellularity response). Secondary end points included safety and predictive impact of early response on pCR. Adjuvant therapy followed national standards. Results Baseline characteristics were well balanced among the arms. More than 90% of patients completed the therapy per protocol. pCR was observed in 41.0% of patients treated with T-DM1, 41.5% of patients treated with T-DM1 and ET, and 15.1% with trastuzumab and ET ( P < .001). Early responders (67% of patients with assessable response) achieved pCR in 35.7% compared with 19.8% in nonresponders (odds ratio, 2.2; 95% CI, 1.24 to 4.19). T-DM1 was associated with a significantly higher prevalence of grade 1 to 2 toxicities, especially thrombocytopenia, nausea, and elevation of liver enzymes. Overall toxicity was low; seventeen therapy-related severe adverse events (T-DM1 arms v trastuzumab plus ET; 5.3% v 3.1%, respectively) were reported. Conclusion The ADAPT HER2-positive/HR-positive trial demonstrates that neoadjuvant T-DM1 (with or without ET) given for only 12 weeks results in a clinically meaningful pCR rate. Thus, a substantial number of patients are spared the adverse effects of systemic chemotherapy.
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Affiliation(s)
- Nadia Harbeck
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Oleg Gluz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Matthias Christgen
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ronald Ernest Kates
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Michael Braun
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Sherko Küemmel
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Claudia Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Jochem Potenberg
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Stefan Kraemer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Anke Kleine-Tebbe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Doris Augustin
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Bahriye Aktas
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Helmut Forstbauer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Joke Tio
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Raquel von Schumann
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Cornelia Liedtke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Eva-Maria Grischke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Johannes Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Rachel Wuerstlein
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Hans Heinrich Kreipe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ulrike Anneliese Nitz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
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Martignetti J, Nair N, Vanegas O, Rykunov D, Dashkoff M, Camacho S, Harkins T, Schumacher C, Irish J, Pereira E, Kendall S, Kalir T, Sebra R, Reva B, Dottino P. Mutation profiling of uterine lavage fluid detects early-stage endometrial cancers and discovers a prevalent landscape of driver mutations in women without cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.294] [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: 10/19/2022]
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Gluz O, Liedtke C, Prat A, Christgen M, Gebauer D, Kates RE, Grischke EM, Forstbauer H, Braun MW, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kummel S, Wuerstlein R, Pelz E, Nitz U, Kreipe HH, Harbeck N. Association of molecular subtype, proliferation, and immune genes with efficacy of carboplatin versus gemcitabine addition to taxane-based, anthracycline-free neoadjuvant chemotherapy in early triple-negative breast cancer (TNBC): Results of the randomized WSG ADAPT-TN trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
573 Background: In the ADAPT-TN neoadjuvant trial, 12-week nab-paclitaxel (nab- pac)+carboplatin (carbo) was highly effective and superior to nab-pac+gemcitabine (gem). However, within TNBC, reliable predictive markers for carbo use have yet to be identified. Methods: Patients with early TNBC (centrally confirmed) were treated by nab-pac 125 mg/m2 with either carbo AUC2 or gem 1000 mg/m2 d 1,8 q21 given for 4 cycles. Genomic data (80 genes) and Prosigna (PAM-50) scores were available in 306 pre-therapeutic samples of 331 treated patients. Fisher’s exact test was performed for pCR differences; associations of continuous measurements or scores with pCR were analyzed by the Mann-Whitney statistic. Results: pCR was 44.5% to 28.4% (p=.004) in favor of nab-pac - carbo. Specifically within the carbo- containing arm, immunological (CD8, PD1, PFDL1) genes and proliferation markers (proliferation score and ROR scores, MKI67, CDC20, NUF2, KIF2C, CENPF, EMP3, TYMS) were positively associated with pCR (p<.05 for all). Specifically within the gem-arm, angiogenesis genes were negatively associated with pCR (ANGPTL4: p=.05; FGFR4: p=.02; VEGFA: p=.03). In the whole collective, basal-like (83.3%) was favorable for pCR (38% vs. 20%, p=.015) compared to other subtypes (HER: 6.4%; luminal-A: 1.7%; normal: 8.7%), as was lower HER-2 score (p<.001). Proliferation was positively associated with pCR: i.e., Pam50 proliferation score, ROR scores (all p<.004), and higher Ki67 by central IHC (p<.001) -- though not MKI67 RNA expression, despite their moderate correlation. Conclusions: In early TNBC, basal-like subtype, higher Ki67 (by IHC), and lower HER-2 score were associated with chemo-sensitivity for both neoadjuvant arms. Chemo-resistance pathways differed between the two taxane-based combinations (low proliferation and immune marker gene expression for carbo, high angiogenesis for gem). The positive predictive impact of immunological genes in the nab-pac - carbo arm could influence optimal patient selection for immune-modulative therapy. Clinical trial information: NCT01815242.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Aleix Prat
- Medical Oncology Department. Hospital Clinic, Barcelona, Spain
| | | | | | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Ulrike Nitz
- West German Study Group, Evangelic Hospital Bethesda, Moenchengladbach, Germany
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Krengli M, Calvo F, Sedlmayer F, Schumacher C, Cazzaniga F, Alessandro M, De Paoli A, Russi E, Kruszyna M, Corvò R, Wenz F, Mazzarotto R, Fusconi F, Ciabattoni A, Weytjens R, Ivaldi G, Baldissera A, Pisani C, Morillo V, Osti M, Bese N, Catalano G, Stefanelli A, Iotti C, Tomio L. PO-0754: ISIORT pooled analysis 2016: characteristics of intraoperative radiotherapy in 11,025 patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31191-x] [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: 11/26/2022]
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Harbeck N, Nitz UA, Matthias C, Kates R, Braun M, Kümmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, Liedtke C, Grischke EM, de Haas SL, Deurloo R, Schumacher J, Wuerstlein R, Kreipe HH, Gluz O. Abstract P1-09-05: The role of immune and apoptosis markers for prediction of pCR in the WSG-ADAPT HER2+/HR+ phase II trial evaluating 12-weeks of neoadjuvant TDM1 ± endocrine therapy (ET) versus T + ET in HER2-positive hormone-receptor-positive early breast cancer (EBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-05] [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: Immune and apoptosis biomarkers are potential prognostic/predictive markers in HER2+ EBC. High PD-L1 expression was shown to be predictive for lower pCR after chemotherapy+trastuzumab+/-pertuzumab, particularly in HER2+, ER- disease. Yet, HER2+ EBC co-expressing hormone receptors is a distinct entity.
The ADAPT HER2+/HR+ phase II trial (n=376) compared 12 weeks of neoadjuvant T-DM1 + ET vs. trastuzumab (T)+ET and demonstrated pCR rates of about 41% in both (well tolerated) T-DM1 arms.
Methods: In order to identify potential early predictors for pCR (i.e. no invasive tumor in breast and lymph nodes), immune markers (PDL1 on infiltrating immune cells (IIC) and on tumor cells (TC); CD8 in invasive margin and in tumor center) and apoptosis markers (bcl-2; mcl-2) were determined by immunohistochemistry (IHC; H-scores) in core biopsy sections obtained at primary diagnosis and at cycle 2. For multivariate logistic regression, each biomarker (separately), clinical factors (Ki-67, cT, cN) and therapy were entered. All analyses were exploratory.
Results:Biomarkers were available in up to 326 patients (pts) at baseline and up to 170 pts at 3 weeks (due to low tumor content in 2nd core biopsy).
Baseline IIC-PDL1 was associated with pCR in the T-DM1 arm (OR 2.89; 95%CI: 1.11-7.51); IIC-PDL1 at cycle 2 was not associated with pCR.
PD-L1 expression in TC was rare (2%); cycle-2 TC-PD-L1 was associated with pCR in all pts and in the pooled TDM-1 arms.
High baseline CD8 in tumor center was associated with pCR in the whole cohort (OR 2.4; CI: 1.04 – 5.5) and in the T+ET arm (OR=10.1; CI: 1.12 - 91.6) and at cycle 2 in all pts (OR=9.52; CI: 2.17 – 41), in pooled TDM-1 arms (OR=15.7; CI: 2.49 – 99), and in TDM-1+ET (OR=25.05; CI: 2.12 – 295). Increases in this marker also predicted pCR in all pts, pooled TDM-1, and in TDM-1+ET. Association of cycle-2 CD8 in tumor center with pCR persisted in multivariate models.
Lower baseline CD8 in invasive margin was associated with pCR in the T-DM1 arm (OR=0.09; CI: 0.01-0.69), but at cycle 2 in all pts (OR=18.1; CI: 1.60 – 204) and in pooled TDM-1 arms (OR=23.5; CI: 1.1 - 500). This positive impact persisted in multivariate models.
Bcl-2 expression at baseline was associated with non-pCR in all pts (OR=0.28, CI: 0.12 - 0.66), in the pooled T-DM1 arms (OR=0.216, CI: 0.08 - 0.61), and particularly in the T-DM1+ET arm (OR=0.14; CI: 0.03 - 0.71). This association persisted in multivariate analysis. At cycle 2, lower bcl-2 had OR=0.16 (CI: 0.03 - 0.96) in the pooled T-DM1 arms. No association with efficacy was seen for mcl-1.
Conclusions: The WSG-ADAPT HER2+/HR+ phase II trial is the first international trial to focus on HER2+/HR+ EBC alone and the first to show substantial pCR rates of > 40% after only 12 weeks of T-DM1 -- without standard chemotherapy.
Expression of bcl-2 may affect resistance to T-DM1. High immune activity at baseline and/or cycle 2 seems to be associated with pCR. The association of CD8 expression and its changes with therapy efficacy is complex and could depend on ET.
Further biomarker analyses are ongoing and will be presented at the meeting.
Citation Format: Harbeck N, Nitz UA, Matthias C, Kates R, Braun M, Kümmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, Liedtke C, Grischke E-M, de Haas SL, Deurloo R, Schumacher J, Wuerstlein R, Kreipe HH, Gluz O. The role of immune and apoptosis markers for prediction of pCR in the WSG-ADAPT HER2+/HR+ phase II trial evaluating 12-weeks of neoadjuvant TDM1 ± endocrine therapy (ET) versus T + ET in HER2-positive hormone-receptor-positive early breast cancer (EBC) [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 P1-09-05.
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Affiliation(s)
- N Harbeck
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - UA Nitz
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - C Matthias
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - R Kates
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - M Braun
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - S Kümmel
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - C Schumacher
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - J Potenberg
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - S Kraemer
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - A Kleine-Tebbe
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - D Augustin
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - B Aktas
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - H Forstbauer
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - J Tio
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - C Liedtke
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - E-M Grischke
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - SL de Haas
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - R Deurloo
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - J Schumacher
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - R Wuerstlein
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - HH Kreipe
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
| | - O Gluz
- Breast Center, University of Munich and CCCLMU, Munich, Bavaria, Germany; West German Study Group, Moenchengladbach, North Rhine Westfalia, Germany; Medical School Hannover, Institute of Pathology, Hannover, Niedersachsen, Germany; Rotkreuz Clinic Munich, Breast Center, Munich, Bavaria, Germany; Clinics Essen-Mitte Breast Center, Essen, North Rhine Westfalia, Germany; St. Elisabeth Hospital Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; Ev. Waldkrankenhaus Berlin, Berlin, Germany; University Clinic Cologne, Breast Center, Cologne, North Rhine Westfalia, Germany; DRK Clinic Berlin Koepenick, Breast Center, Berlin, Germany; Clinic Deggendorf, Breast Center, Deggendorf, Bavaria, Germany; University Clinic Essen, Women's Clinic, Essen, North Rhine Westfalia, Germany; Oncology Practice Network Troisdorf, Troisdorf, North Rhine Westfalia, Germany; University Clinic Muenster, Women's Clinic, Muenster, North Rhine Westfalia, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Cli
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Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn HP. Abstract P2-05-25: Predictive value of ultra-high ESR1 mRNA expression in early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-25] [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
Quantitative determination of estrogen receptor mRNA expression in luminal breast tumors is predictive for benefit from adjuvant tamoxifen compared to placebo treatment as has been shown in the large randomized NSABP B-14 trial, while protein determination by IHC or LBA is not (Kim et al JCO 2011). Interestingly, the ultrahigh expression of ESR1 mRNA (above ER score 10 by Oncotype test) has been indicative for tamoxifen benefit. This predictive cut-off value of mRNA expression is significantly higher than the diagnostic cut-off (at ER score 6.5). Here we tested wether the ultrahigh expression of ESR1 mRNA determined by commercial MammaTyper® testing is predictive for survival after neoadjuvant chemotherapy treatment of advanced breast cancer.
Materials and Methods
Pretreatment core cut biopsies from n=54 patients with PBC treated within a randomized phase II trial (2) of anthracyline/taxane based NAC with available clinical follow-up information were examined. RNA was extracted from the FFPE sections and ESR1 mRNA from each section was measured by commercial assays. For technical comparison of ESR1 mRNA values by Oncotype DX versus MammaTyper® from n=113 surgical samples were analyzed by both commercial assays in a blinded fashion. Statistical analysis was performed using the SAS JMP® 9.0.0 software.
Results
Quantification of ESR1 mRNA expression after RNA extraction from separate slices of 113 primary breast tumors and determination by different commercial RT-qPCR assays resulted in high correlation of continuous expression results (Spearman r=0,85; p<0,0001). The rate of ESR1 mRNA negative cases by both methods by predefined diagnostic cut-offs was low in this cohort (1/113 and 6/113, respectively) resulting in high concordance for positive ER status by both methods.The median expression of ER score and ESR1 40-DDCq was high (10,2 and 39,8, respectively) and almost exactly at the predictive ER score cut-off. Hence, the Tamoxifen benefit cut-off of ER score 10 by Oncotype is comparable with a 40-DDCqvalue of 39,6 for ESR1 mRNA determination by MammaTyper®, which resembles an ESR1 mRNA expression 3fold above the diagnostic cut-off. In the independent chemotherapy cohort theoptimal discrimination for overall survival could be achieved by an elevated ESR1 mRNA expression exactly at 39,6 resulting in 100% overall survival for ultra-high expressors and 75 % overall survival for lower ESR1 mRNA expression after 5 years (p=0,006).
Conclusion
Previous data suggest that ultrahigh expression of ESR1 mRNA is predictive for improved overall survival and tamoxifen benefit (1). Here we show that ultrahigh expression of ESR1 mRNA is also prognostic in more advanced breast tumors after neoadjuvant chemotherapy. These findings validate the importance of quantitative determination of estrogen receptor expression and substantiate the understanding of receptor expression being a continuous determinant with indication specific cut-off values. Ultrahigh expression of ESR1 seems to identify a distinct subset of luminal breast tumors with superior prognosis and benefit from tamoxifen treatment. These findings warrant further investigation, which are currently being done in independent large breast cancer cohorts.
Citation Format: Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn H-P. Predictive value of ultra-high ESR1 mRNA expression in early 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 P2-05-25.
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Affiliation(s)
- RM Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - I Scheffen
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - F Marme
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - M Laible
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - K Sclombs
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - C Schumacher
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - S Eidt
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - H-P Sinn
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
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Paepke S, Klein E, Kiechle M, Ankel C, Faridi A, Schumacher C, Meiré A, Blohmer JU, Mau C, Untch M, Ohlinger R, Strittmatter HJ, Thill M. Results of an pre-planned interim analysis of a national multicenter Patient Reported Outcome Study (PRO-Bra) in breast reconstruction with titaniferously coated polypropylene mesh (TiloopBra). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rhiem K, Richters L, Hahnen E, Lampe B, Rezai M, Göhring UJ, Schumacher C, Kümmel S, Ataseven B, Schmutzler R. Benchmarking der Checkliste zur Erfassung einer erblichen Belastung für Brust- und/oder Eierstockkrebs. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bischoff J, Barinoff J, Mundhenke C, Bauerschlag D, Costa S, Herr D, Lübe K, Marmé F, Maass N, von Minckwitz G, Grischke EM, Müller V, Schmidt M, Gerber B, Kümmel S, Schumacher C, Krabisch P, Thill M, Nekljudova V, Loibl S. A randomized phase II study to determine the efficacy and tolerability of two doses of eribulin plus lapatinib in trastuzumab pre-treated patients with Her2-positive metastatic breast cancer - E-Vita -. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.52] [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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Srivastava AK, Wang Y, Huang R, Skinner C, Thompson T, Pollard L, Wood T, Luo F, Stevenson R, Polimanti R, Gelernter J, Lin X, Lim IY, Wu Y, Teh AL, Chen L, Aris IM, Soh SE, Tint MT, MacIsaac JL, Yap F, Kwek K, Saw SM, Kobor MS, Meaney MJ, Godfrey KM, Chong YS, Holbrook JD, Lee YS, Gluckman PD, Karnani N, Kapoor A, Lee D, Chakravarti A, Maercker C, Graf F, Boutros M, Stamoulis G, Santoni F, Makrythanasis P, Letourneau A, Guipponi M, Panousis N, Garieri M, Ribaux P, Falconnet E, Borel C, Antonarakis SE, Kumar S, Curran J, Blangero J, Chatterjee S, Kapoor A, Akiyama J, Auer D, Berrios C, Pennacchio L, Chakravarti A, Donti TR, Cappuccio G, Miller M, Atwal P, Kennedy A, Cardon A, Bacino C, Emrick L, Hertecant J, Baumer F, Porter B, Bainbridge M, Bonnen P, Graham B, Sutton R, Sun Q, Elsea S, Hu Z, Wang P, Zhu Y, Zhao J, Xiong M, Bennett DA, Hidalgo-Miranda A, Romero-Cordoba S, Rodriguez-Cuevas S, Rebollar-Vega R, Tagliabue E, Iorio M, D’Ippolito E, Baroni S, Kaczkowski B, Tanaka Y, Kawaji H, Sandelin A, Andersson R, Itoh M, Lassmann T, Hayashizaki Y, Carninci P, Forrest ARR, Semple CA, Rosenthal EA, Shirts B, Amendola L, Gallego C, Horike-Pyne M, Burt A, Robertson P, Beyers P, Nefcy C, Veenstra D, Hisama F, Bennett R, Dorschner M, Nickerson D, Smith J, Patterson K, Crosslin D, Nassir R, Zubair N, Harrison T, Peters U, Jarvik G, Menghi F, Inaki K, Woo X, Kumar P, Grzeda K, Malhotra A, Kim H, Ucar D, Shreckengast P, Karuturi K, Keck J, Chuang J, Liu ET, Ji B, Tyler A, Ananda G, Carter G, Nikbakht H, Montagne M, Zeinieh M, Harutyunyan A, Mcconechy M, Jabado N, Lavigne P, Majewski J, Goldstein JB, Overman M, Varadhachary G, Shroff R, Wolff R, Javle M, Futreal A, Fogelman D, Bravo L, Fajardo W, Gomez H, Castaneda C, Rolfo C, Pinto JA, Akdemir KC, Chin L, Futreal A, Patterson S, Statz C, Mockus S, Nikolaev SN, Bonilla XI, Parmentier L, King B, Bezrukov F, Kaya G, Zoete V, Seplyarskiy V, Sharpe H, McKee T, Letourneau A, Ribaux P, Popadin K, Basset-Seguin N, Chaabene RB, Santoni F, Andrianova M, Guipponi M, Garieri M, Verdan C, Grosdemange K, Sumara O, Eilers M, Aifantis I, Michielin O, de Sauvage F, Antonarakis S, Likhitrattanapisal S, Lincoln S, Kurian A, Desmond A, Yang S, Kobayashi Y, Ford J, Ellisen L, Peters TL, Alvarez KR, Hollingsworth EF, Lopez-Terrada DH, Hastie A, Dzakula Z, Pang AW, Lam ET, Anantharaman T, Saghbini M, Cao H, Gonzaga-Jauregui C, Ma L, King A, Rosenzweig EB, Krishnan U, Reid JG, Overton JD, Dewey F, Chung WK, Small K, DeLuca A, Cremers F, Lewis RA, Puech V, Bakall B, Silva-Garcia R, Rohrschneider K, Leys M, Shaya FS, Stone E, Sobreira NL, Schiettecatte F, Ling H, Pugh E, Witmer D, Hetrick K, Zhang P, Doheny K, Valle D, Hamosh A, Jhangiani SN, Akdemir ZC, Bainbridge MN, Charng W, Wiszniewski W, Gambin T, Karaca E, Bayram Y, Eldomery MK, Posey J, Doddapaneni H, Hu J, Sutton VR, Muzny DM, Boerwinkle EA, Valle D, Lupski JR, Gibbs RA, Shekar S, Salerno W, English A, Mangubat A, Bruestle J, Thorogood A, Knoppers BM, Takahashi H, Nitta KR, Kozhuharova A, Suzuki AM, Sharma H, Cotella D, Santoro C, Zucchelli S, Gustincich S, Carninci P, Mulvihill JJ, Baynam G, Gahl W, Groft SC, Kosaki K, Lasko P, Melegh B, Taruscio D, Ghosh R, Plon S, Scherer S, Qin X, Sanghvi R, Walker K, Chiang T, Muzny D, Wang L, Black J, Boerwinkle E, Weinshilboum R, Gibbs R, Karpinets T, Calderone T, Wani K, Yu X, Creasy C, Haymaker C, Forget M, Nanda V, Roszik J, Wargo J, Haydu L, Song X, Lazar A, Gershenwald J, Davies M, Bernatchez C, Zhang J, Futreal A, Woodman S, Chesler EJ, Reynolds T, Bubier JA, Phillips C, Langston MA, Baker EJ, Xiong M, Ma L, Lin N, Amos C, Lin N, Wang P, Zhu Y, Zhao J, Calhoun V, Xiong M, Dobretsberger O, Egger M, Leimgruber F, Sadedin S, Oshlack A, Antonio VAA, Ono N, Ahmed Z, Bolisetty M, Zeeshan S, Anguiano E, Ucar D, Sarkar A, Nandineni MR, Zeng C, Shao J, Cao H, Hastie A, Pang AW, Lam ET, Liang T, Pham K, Saghbini M, Dzakula Z, Chee-Wei Y, Dongsheng L, Lai-Ping W, Lian D, Hee ROT, Yunus Y, Aghakhanian F, Mokhtar SS, Lok-Yung CV, Bhak J, Phipps M, Shuhua X, Yik-Ying T, Kumar V, Boon-Peng H, Campbell I, Young MA, James P, Rain M, Mohammad G, Kukreti R, Pasha Q, Akilzhanova AR, Guelly C, Abilova Z, Rakhimova S, Akhmetova A, Kairov U, Trajanoski S, Zhumadilov Z, Bekbossynova M, Schumacher C, Sandhu S, Harkins T, Makarov V, Doddapaneni H, Glenn R, Momin Z, Dilrukshi B, Chao H, Meng Q, Gudenkauf B, Kshitij R, Jayaseelan J, Nessner C, Lee S, Blankenberg K, Lewis L, Hu J, Han Y, Dinh H, Jireh S, Walker K, Boerwinkle E, Muzny D, Gibbs R, Hu J, Walker K, Buhay C, Liu X, Wang Q, Sanghvi R, Doddapaneni H, Ding Y, Veeraraghavan N, Yang Y, Boerwinkle E, Beaudet AL, Eng CM, Muzny DM, Gibbs RA, Worley KCC, Liu Y, Hughes DST, Murali SC, Harris RA, English AC, Qin X, Hampton OA, Larsen P, Beck C, Han Y, Wang M, Doddapaneni H, Kovar CL, Salerno WJ, Yoder A, Richards S, Rogers J, Lupski JR, Muzny DM, Gibbs RA, Meng Q, Bainbridge M, Wang M, Doddapaneni H, Han Y, Muzny D, Gibbs R, Harris RA, Raveenedran M, Xue C, Dahdouli M, Cox L, Fan G, Ferguson B, Hovarth J, Johnson Z, Kanthaswamy S, Kubisch M, Platt M, Smith D, Vallender E, Wiseman R, Liu X, Below J, Muzny D, Gibbs R, Yu F, Rogers J, Lin J, Zhang Y, Ouyang Z, Moore A, Wang Z, Hofmann J, Purdue M, Stolzenberg-Solomon R, Weinstein S, Albanes D, Liu CS, Cheng WL, Lin TT, Lan Q, Rothman N, Berndt S, Chen ES, Bahrami H, Khoshzaban A, Keshal SH, Bahrami H, Khoshzaban A, Keshal SH, Alharbi KKR, Zhalbinova M, Akilzhanova A, Rakhimova S, Bekbosynova M, Myrzakhmetova S, Matar M, Mili N, Molinari R, Ma Y, Guerrier S, Elhawary N, Tayeb M, Bogari N, Qotb N, McClymont SA, Hook PW, Goff LA, McCallion A, Kong Y, Charette JR, Hicks WL, Naggert JK, Zhao L, Nishina PM, Edrees BM, Athar M, Al-Allaf FA, Taher MM, Khan W, Bouazzaoui A, Harbi NA, Safar R, Al-Edressi H, Anazi A, Altayeb N, Ahmed MA, Alansary K, Abduljaleel Z, Kratz A, Beguin P, Poulain S, Kaneko M, Takahiko C, Matsunaga A, Kato S, Suzuki AM, Bertin N, Lassmann T, Vigot R, Carninci P, Plessy C, Launey T, Graur D, Lee D, Kapoor A, Chakravarti A, Friis-Nielsen J, Izarzugaza JM, Brunak S, Chakraborty A, Basak J, Mukhopadhyay A, Soibam BS, Das D, Biswas N, Das S, Sarkar S, Maitra A, Panda C, Majumder P, Morsy H, Gaballah A, Samir M, Shamseya M, Mahrous H, Ghazal A, Arafat W, Hashish M, Gruber JJ, Jaeger N, Snyder M, Patel K, Bowman S, Davis T, Kraushaar D, Emerman A, Russello S, Henig N, Hendrickson C, Zhang K, Rodriguez-Dorantes M, Cruz-Hernandez CD, Garcia-Tobilla CDP, Solorzano-Rosales S, Jäger N, Chen J, Haile R, Hitchins M, Brooks JD, Snyder M, Jiménez-Morales S, Ramírez M, Nuñez J, Bekker V, Leal Y, Jiménez E, Medina A, Hidalgo A, Mejía J, Halytskiy V, Naggert J, Collin GB, DeMauro K, Hanusek R, Nishina PM, Belhassa K, Belhassan K, Bouguenouch L, Samri I, Sayel H, moufid FZ, El Bouchikhi I, Trhanint S, Hamdaoui H, Elotmani I, Khtiri I, Kettani O, Quibibo L, Ahagoud M, Abbassi M, Ouldim K, Marusin AV, Kornetov AN, Swarovskaya M, Vagaiceva K, Stepanov V, De La Paz EMC, Sy R, Nevado J, Reganit P, Santos L, Magno JD, Punzalan FE, Ona D, Llanes E, Santos-Cortes RL, Tiongco R, Aherrera J, Abrahan L, Pagauitan-Alan P, Morelli KH, Domire JS, Pyne N, Harper S, Burgess R, Zhalbinova M, Akilzhanova A, Rakhimova S, Bekbosynova M, Myrzakhmetova S, Gari MA, Dallol A, Alsehli H, Gari A, Gari M, Abuzenadah A, Thomas M, Sukhai M, Garg S, Misyura M, Zhang T, Schuh A, Stockley T, Kamel-Reid S, Sherry S, Xiao C, Slotta D, Rodarmer K, Feolo M, Kimelman M, Godynskiy G, O’Sullivan C, Yaschenko E, Xiao C, Yaschenko E, Sherry S, Rangel-Escareño C, Rueda-Zarate H, Tayubi IA, Mohammed R, Ahmed I, Ahmed T, Seth S, Amin S, Song X, Mao X, Sun H, Verhaak RG, Futreal A, Zhang J, Whiite SJ, Chiang T, English A, Farek J, Kahn Z, Salerno W, Veeraraghavan N, Boerwinkle E, Gibbs R, Kasukawa T, Lizio M, Harshbarger J, Hisashi S, Severin J, Imad A, Sahin S, Freeman TC, Baillie K, Sandelin A, Carninci P, Forrest ARR, Kawaji H, Salerno W, English A, Shekar SN, Mangubat A, Bruestle J, Boerwinkle E, Gibbs RA, Salem AH, Ali M, Ibrahim A, Ibrahim M, Barrera HA, Garza L, Torres JA, Barajas V, Ulloa-Aguirre A, Kershenobich D, Mortaji S, Guizar P, Loera E, Moreno K, De León A, Monsiváis D, Gómez J, Cardiel R, Fernandez-Lopez JC, Bonifaz-Peña V, Rangel-Escareño C, Hidalgo-Miranda A, Contreras AV, Polfus L, Wang X, Philip V, Carter G, Abuzenadah AA, Gari M, Turki R, Dallol A, Uyar A, Kaygun A, Zaman S, Marquez E, George J, Ucar D, Hendrickson CL, Emerman A, Kraushaar D, Bowman S, Henig N, Davis T, Russello S, Patel K, Starr DB, Baird M, Kirkpatrick B, Sheets K, Nitsche R, Prieto-Lafuente L, Landrum M, Lee J, Rubinstein W, Maglott D, Thavanati PKR, de Dios AE, Hernandez REN, Aldrate MEA, Mejia MRR, Kanala KRR, Abduljaleel Z, Khan W, Al-Allaf FA, Athar M, Taher MM, Shahzad N, Bouazzaoui A, Huber E, Dan A, Al-Allaf FA, Herr W, Sprotte G, Köstler J, Hiergeist A, Gessner A, Andreesen R, Holler E, Al-Allaf F, Alashwal A, Abduljaleel Z, Taher M, Bouazzaoui A, Abalkhail H, Al-Allaf A, Bamardadh R, Athar M, Filiptsova O, Kobets M, Kobets Y, Burlaka I, Timoshyna I, Filiptsova O, Kobets MN, Kobets Y, Burlaka I, Timoshyna I, Filiptsova O, Kobets MN, Kobets Y, Burlaka I, Timoshyna I, Al-allaf FA, Mohiuddin MT, Zainularifeen A, Mohammed A, Abalkhail H, Owaidah T, Bouazzaoui A. Human genome meeting 2016 : Houston, TX, USA. 28 February - 2 March 2016. Hum Genomics 2016; 10 Suppl 1:12. [PMID: 27294413 PMCID: PMC4896275 DOI: 10.1186/s40246-016-0063-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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] [Indexed: 02/08/2023] Open
Abstract
O1 The metabolomics approach to autism: identification of biomarkers for early detection of autism spectrum disorder A. K. Srivastava, Y. Wang, R. Huang, C. Skinner, T. Thompson, L. Pollard, T. Wood, F. Luo, R. Stevenson O2 Phenome-wide association study for smoking- and drinking-associated genes in 26,394 American women with African, Asian, European, and Hispanic descents R. Polimanti, J. Gelernter O3 Effects of prenatal environment, genotype and DNA methylation on birth weight and subsequent postnatal outcomes: findings from GUSTO, an Asian birth cohort X. Lin, I. Y. Lim, Y. Wu, A. L. Teh, L. Chen, I. M. Aris, S. E. Soh, M. T. Tint, J. L. MacIsaac, F. Yap, K. Kwek, S. M. Saw, M. S. Kobor, M. J. Meaney, K. M. Godfrey, Y. S. Chong, J. D. Holbrook, Y. S. Lee, P. D. Gluckman, N. Karnani, GUSTO study group O4 High-throughput identification of specific qt interval modulating enhancers at the SCN5A locus A. Kapoor, D. Lee, A. Chakravarti O5 Identification of extracellular matrix components inducing cancer cell migration in the supernatant of cultivated mesenchymal stem cells C. Maercker, F. Graf, M. Boutros O6 Single cell allele specific expression (ASE) IN T21 and common trisomies: a novel approach to understand DOWN syndrome and other aneuploidies G. Stamoulis, F. Santoni, P. Makrythanasis, A. Letourneau, M. Guipponi, N. Panousis, M. Garieri, P. Ribaux, E. Falconnet, C. Borel, S. E. Antonarakis O7 Role of microRNA in LCL to IPSC reprogramming S. Kumar, J. Curran, J. Blangero O8 Multiple enhancer variants disrupt gene regulatory network in Hirschsprung disease S. Chatterjee, A. Kapoor, J. Akiyama, D. Auer, C. Berrios, L. Pennacchio, A. Chakravarti O9 Metabolomic profiling for the diagnosis of neurometabolic disorders T. R. Donti, G. Cappuccio, M. Miller, P. Atwal, A. Kennedy, A. Cardon, C. Bacino, L. Emrick, J. Hertecant, F. Baumer, B. Porter, M. Bainbridge, P. Bonnen, B. Graham, R. Sutton, Q. Sun, S. Elsea O10 A novel causal methylation network approach to Alzheimer’s disease Z. Hu, P. Wang, Y. Zhu, J. Zhao, M. Xiong, David A Bennett O11 A microRNA signature identifies subtypes of triple-negative breast cancer and reveals MIR-342-3P as regulator of a lactate metabolic pathway A. Hidalgo-Miranda, S. Romero-Cordoba, S. Rodriguez-Cuevas, R. Rebollar-Vega, E. Tagliabue, M. Iorio, E. D’Ippolito, S. Baroni O12 Transcriptome analysis identifies genes, enhancer RNAs and repetitive elements that are recurrently deregulated across multiple cancer types B. Kaczkowski, Y. Tanaka, H. Kawaji, A. Sandelin, R. Andersson, M. Itoh, T. Lassmann, the FANTOM5 consortium, Y. Hayashizaki, P. Carninci, A. R. R. Forrest O13 Elevated mutation and widespread loss of constraint at regulatory and architectural binding sites across 11 tumour types C. A. Semple O14 Exome sequencing provides evidence of pathogenicity for genes implicated in colorectal cancer E. A. Rosenthal, B. Shirts, L. Amendola, C. Gallego, M. Horike-Pyne, A. Burt, P. Robertson, P. Beyers, C. Nefcy, D. Veenstra, F. Hisama, R. Bennett, M. Dorschner, D. Nickerson, J. Smith, K. Patterson, D. Crosslin, R. Nassir, N. Zubair, T. Harrison, U. Peters, G. Jarvik, NHLBI GO Exome Sequencing Project O15 The tandem duplicator phenotype as a distinct genomic configuration in cancer F. Menghi, K. Inaki, X. Woo, P. Kumar, K. Grzeda, A. Malhotra, H. Kim, D. Ucar, P. Shreckengast, K. Karuturi, J. Keck, J. Chuang, E. T. Liu O16 Modeling genetic interactions associated with molecular subtypes of breast cancer B. Ji, A. Tyler, G. Ananda, G. Carter O17 Recurrent somatic mutation in the MYC associated factor X in brain tumors H. Nikbakht, M. Montagne, M. Zeinieh, A. Harutyunyan, M. Mcconechy, N. Jabado, P. Lavigne, J. Majewski O18 Predictive biomarkers to metastatic pancreatic cancer treatment J. B. Goldstein, M. Overman, G. Varadhachary, R. Shroff, R. Wolff, M. Javle, A. Futreal, D. Fogelman O19 DDIT4 gene expression as a prognostic marker in several malignant tumors L. Bravo, W. Fajardo, H. Gomez, C. Castaneda, C. Rolfo, J. A. Pinto O20 Spatial organization of the genome and genomic alterations in human cancers K. C. Akdemir, L. Chin, A. Futreal, ICGC PCAWG Structural Alterations Group O21 Landscape of targeted therapies in solid tumors S. Patterson, C. Statz, S. Mockus O22 Genomic analysis reveals novel drivers and progression pathways in skin basal cell carcinoma S. N. Nikolaev, X. I. Bonilla, L. Parmentier, B. King, F. Bezrukov, G. Kaya, V. Zoete, V. Seplyarskiy, H. Sharpe, T. McKee, A. Letourneau, P. Ribaux, K. Popadin, N. Basset-Seguin, R. Ben Chaabene, F. Santoni, M. Andrianova, M. Guipponi, M. Garieri, C. Verdan, K. Grosdemange, O. Sumara, M. Eilers, I. Aifantis, O. Michielin, F. de Sauvage, S. Antonarakis O23 Identification of differential biomarkers of hepatocellular carcinoma and cholangiocarcinoma via transcriptome microarray meta-analysis S. Likhitrattanapisal O24 Clinical validity and actionability of multigene tests for hereditary cancers in a large multi-center study S. Lincoln, A. Kurian, A. Desmond, S. Yang, Y. Kobayashi, J. Ford, L. Ellisen O25 Correlation with tumor ploidy status is essential for correct determination of genome-wide copy number changes by SNP array T. L. Peters, K. R. Alvarez, E. F. Hollingsworth, D. H. Lopez-Terrada O26 Nanochannel based next-generation mapping for interrogation of clinically relevant structural variation A. Hastie, Z. Dzakula, A. W. Pang, E. T. Lam, T. Anantharaman, M. Saghbini, H. Cao, BioNano Genomics O27 Mutation spectrum in a pulmonary arterial hypertension (PAH) cohort and identification of associated truncating mutations in TBX4 C. Gonzaga-Jauregui, L. Ma, A. King, E. Berman Rosenzweig, U. Krishnan, J. G. Reid, J. D. Overton, F. Dewey, W. K. Chung O28 NORTH CAROLINA macular dystrophy (MCDR1): mutations found affecting PRDM13 K. Small, A. DeLuca, F. Cremers, R. A. Lewis, V. Puech, B. Bakall, R. Silva-Garcia, K. Rohrschneider, M. Leys, F. S. Shaya, E. Stone O29 PhenoDB and genematcher, solving unsolved whole exome sequencing data N. L. Sobreira, F. Schiettecatte, H. Ling, E. Pugh, D. Witmer, K. Hetrick, P. Zhang, K. Doheny, D. Valle, A. Hamosh O30 Baylor-Johns Hopkins Center for Mendelian genomics: a four year review S. N. Jhangiani, Z. Coban Akdemir, M. N. Bainbridge, W. Charng, W. Wiszniewski, T. Gambin, E. Karaca, Y. Bayram, M. K. Eldomery, J. Posey, H. Doddapaneni, J. Hu, V. R. Sutton, D. M. Muzny, E. A. Boerwinkle, D. Valle, J. R. Lupski, R. A. Gibbs O31 Using read overlap assembly to accurately identify structural genetic differences in an ashkenazi jewish trio S. Shekar, W. Salerno, A. English, A. Mangubat, J. Bruestle O32 Legal interoperability: a sine qua non for international data sharing A. Thorogood, B. M. Knoppers, Global Alliance for Genomics and Health - Regulatory and Ethics Working Group O33 High throughput screening platform of competent sineups: that can enhance translation activities of therapeutic target H. Takahashi, K. R. Nitta, A. Kozhuharova, A. M. Suzuki, H. Sharma, D. Cotella, C. Santoro, S. Zucchelli, S. Gustincich, P. Carninci O34 The undiagnosed diseases network international (UDNI): clinical and laboratory research to meet patient needs J. J. Mulvihill, G. Baynam, W. Gahl, S. C. Groft, K. Kosaki, P. Lasko, B. Melegh, D. Taruscio O36 Performance of computational algorithms in pathogenicity predictions for activating variants in oncogenes versus loss of function mutations in tumor suppressor genes R. Ghosh, S. Plon O37 Identification and electronic health record incorporation of clinically actionable pharmacogenomic variants using prospective targeted sequencing S. Scherer, X. Qin, R. Sanghvi, K. Walker, T. Chiang, D. Muzny, L. Wang, J. Black, E. Boerwinkle, R. Weinshilboum, R. Gibbs O38 Melanoma reprogramming state correlates with response to CTLA-4 blockade in metastatic melanoma T. Karpinets, T. Calderone, K. Wani, X. Yu, C. Creasy, C. Haymaker, M. Forget, V. Nanda, J. Roszik, J. Wargo, L. Haydu, X. Song, A. Lazar, J. Gershenwald, M. Davies, C. Bernatchez, J. Zhang, A. Futreal, S. Woodman O39 Data-driven refinement of complex disease classification from integration of heterogeneous functional genomics data in GeneWeaver E. J. Chesler, T. Reynolds, J. A. Bubier, C. Phillips, M. A. Langston, E. J. Baker O40 A general statistic framework for genome-based disease risk prediction M. Xiong, L. Ma, N. Lin, C. Amos O41 Integrative large-scale causal network analysis of imaging and genomic data and its application in schizophrenia studies N. Lin, P. Wang, Y. Zhu, J. Zhao, V. Calhoun, M. Xiong O42 Big data and NGS data analysis: the cloud to the rescue O. Dobretsberger, M. Egger, F. Leimgruber O43 Cpipe: a convergent clinical exome pipeline specialised for targeted sequencing S. Sadedin, A. Oshlack, Melbourne Genomics Health Alliance O44 A Bayesian classification of biomedical images using feature extraction from deep neural networks implemented on lung cancer data V. A. A. Antonio, N. Ono, Clark Kendrick C. Go O45 MAV-SEQ: an interactive platform for the Management, Analysis, and Visualization of sequence data Z. Ahmed, M. Bolisetty, S. Zeeshan, E. Anguiano, D. Ucar O47 Allele specific enhancer in EPAS1 intronic regions may contribute to high altitude adaptation of Tibetans C. Zeng, J. Shao O48 Nanochannel based next-generation mapping for structural variation detection and comparison in trios and populations H. Cao, A. Hastie, A. W. Pang, E. T. Lam, T. Liang, K. Pham, M. Saghbini, Z. Dzakula O49 Archaic introgression in indigenous populations of Malaysia revealed by whole genome sequencing Y. Chee-Wei, L. Dongsheng, W. Lai-Ping, D. Lian, R. O. Twee Hee, Y. Yunus, F. Aghakhanian, S. S. Mokhtar, C. V. Lok-Yung, J. Bhak, M. Phipps, X. Shuhua, T. Yik-Ying, V. Kumar, H. Boon-Peng O50 Breast and ovarian cancer prevention: is it time for population-based mutation screening of high risk genes? I. Campbell, M.-A. Young, P. James, Lifepool O53 Comprehensive coverage from low DNA input using novel NGS library preparation methods for WGS and WGBS C. Schumacher, S. Sandhu, T. Harkins, V. Makarov O54 Methods for large scale construction of robust PCR-free libraries for sequencing on Illumina HiSeqX platform H. DoddapaneniR. Glenn, Z. Momin, B. Dilrukshi, H. Chao, Q. Meng, B. Gudenkauf, R. Kshitij, J. Jayaseelan, C. Nessner, S. Lee, K. Blankenberg, L. Lewis, J. Hu, Y. Han, H. Dinh, S. Jireh, K. Walker, E. Boerwinkle, D. Muzny, R. Gibbs O55 Rapid capture methods for clinical sequencing J. Hu, K. Walker, C. Buhay, X. Liu, Q. Wang, R. Sanghvi, H. Doddapaneni, Y. Ding, N. Veeraraghavan, Y. Yang, E. Boerwinkle, A. L. Beaudet, C. M. Eng, D. M. Muzny, R. A. Gibbs O56 A diploid personal human genome model for better genomes from diverse sequence data K. C. C. Worley, Y. Liu, D. S. T. Hughes, S. C. Murali, R. A. Harris, A. C. English, X. Qin, O. A. Hampton, P. Larsen, C. Beck, Y. Han, M. Wang, H. Doddapaneni, C. L. Kovar, W. J. Salerno, A. Yoder, S. Richards, J. Rogers, J. R. Lupski, D. M. Muzny, R. A. Gibbs O57 Development of PacBio long range capture for detection of pathogenic structural variants Q. Meng, M. Bainbridge, M. Wang, H. Doddapaneni, Y. Han, D. Muzny, R. Gibbs O58 Rhesus macaques exhibit more non-synonymous variation but greater impact of purifying selection than humans R. A. Harris, M. Raveenedran, C. Xue, M. Dahdouli, L. Cox, G. Fan, B. Ferguson, J. Hovarth, Z. Johnson, S. Kanthaswamy, M. Kubisch, M. Platt, D. Smith, E. Vallender, R. Wiseman, X. Liu, J. Below, D. Muzny, R. Gibbs, F. Yu, J. Rogers O59 Assessing RNA structure disruption induced by single-nucleotide variation J. Lin, Y. Zhang, Z. Ouyang P1 A meta-analysis of genome-wide association studies of mitochondrial dna copy number A. Moore, Z. Wang, J. Hofmann, M. Purdue, R. Stolzenberg-Solomon, S. Weinstein, D. Albanes, C.-S. Liu, W.-L. Cheng, T.-T. Lin, Q. Lan, N. Rothman, S. Berndt P2 Missense polymorphic genetic combinations underlying down syndrome susceptibility E. S. Chen P4 The evaluation of alteration of ELAM-1 expression in the endometriosis patients H. Bahrami, A. Khoshzaban, S. Heidari Keshal P5 Obesity and the incidence of apolipoprotein E polymorphisms in an assorted population from Saudi Arabia population K. K. R. Alharbi P6 Genome-associated personalized antithrombotical therapy for patients with high risk of thrombosis and bleeding M. Zhalbinova, A. Akilzhanova, S. Rakhimova, M. Bekbosynova, S. Myrzakhmetova P7 Frequency of Xmn1 polymorphism among sickle cell carrier cases in UAE population M. Matar P8 Differentiating inflammatory bowel diseases by using genomic data: dimension of the problem and network organization N. Mili, R. Molinari, Y. Ma, S. Guerrier P9 Vulnerability of genetic variants to the risk of autism among Saudi children N. Elhawary, M. Tayeb, N. Bogari, N. Qotb P10 Chromatin profiles from ex vivo purified dopaminergic neurons establish a promising model to support studies of neurological function and dysfunction S. A. McClymont, P. W. Hook, L. A. Goff, A. McCallion P11 Utilization of a sensitized chemical mutagenesis screen to identify genetic modifiers of retinal dysplasia in homozygous Nr2e3rd7 mice Y. Kong, J. R. Charette, W. L. Hicks, J. K. Naggert, L. Zhao, P. M. Nishina P12 Ion torrent next generation sequencing of recessive polycystic kidney disease in Saudi patients B. M. Edrees, M. Athar, F. A. Al-Allaf, M. M. Taher, W. Khan, A. Bouazzaoui, N. A. Harbi, R. Safar, H. Al-Edressi, A. Anazi, N. Altayeb, M. A. Ahmed, K. Alansary, Z. Abduljaleel P13 Digital expression profiling of Purkinje neurons and dendrites in different subcellular compartments A. Kratz, P. Beguin, S. Poulain, M. Kaneko, C. Takahiko, A. Matsunaga, S. Kato, A. M. Suzuki, N. Bertin, T. Lassmann, R. Vigot, P. Carninci, C. Plessy, T. Launey P14 The evolution of imperfection and imperfection of evolution: the functional and functionless fractions of the human genome D. Graur P16 Species-independent identification of known and novel recurrent genomic entities in multiple cancer patients J. Friis-Nielsen, J. M. Izarzugaza, S. Brunak P18 Discovery of active gene modules which are densely conserved across multiple cancer types reveal their prognostic power and mutually exclusive mutation patterns B. S. Soibam P19 Whole exome sequencing of dysplastic leukoplakia tissue indicates sequential accumulation of somatic mutations from oral precancer to cancer D. Das, N. Biswas, S. Das, S. Sarkar, A. Maitra, C. Panda, P. Majumder P21 Epigenetic mechanisms of carcinogensis by hereditary breast cancer genes J. J. Gruber, N. Jaeger, M. Snyder P22 RNA direct: a novel RNA enrichment strategy applied to transcripts associated with solid tumors K. Patel, S. Bowman, T. Davis, D. Kraushaar, A. Emerman, S. Russello, N. Henig, C. Hendrickson P23 RNA sequencing identifies gene mutations for neuroblastoma K. Zhang P24 Participation of SFRP1 in the modulation of TMPRSS2-ERG fusion gene in prostate cancer cell lines M. Rodriguez-Dorantes, C. D. Cruz-Hernandez, C. D. P. Garcia-Tobilla, S. Solorzano-Rosales P25 Targeted Methylation Sequencing of Prostate Cancer N. Jäger, J. Chen, R. Haile, M. Hitchins, J. D. Brooks, M. Snyder P26 Mutant TPMT alleles in children with acute lymphoblastic leukemia from México City and Yucatán, Mexico S. Jiménez-Morales, M. Ramírez, J. Nuñez, V. Bekker, Y. Leal, E. Jiménez, A. Medina, A. Hidalgo, J. Mejía P28 Genetic modifiers of Alström syndrome J. Naggert, G. B. Collin, K. DeMauro, R. Hanusek, P. M. Nishina P31 Association of genomic variants with the occurrence of angiotensin-converting-enzyme inhibitor (ACEI)-induced coughing among Filipinos E. M. Cutiongco De La Paz, R. Sy, J. Nevado, P. Reganit, L. Santos, J. D. Magno, F. E. Punzalan , D. Ona , E. Llanes, R. L. Santos-Cortes , R. Tiongco, J. Aherrera, L. Abrahan, P. Pagauitan-Alan; Philippine Cardiogenomics Study Group P32 The use of “humanized” mouse models to validate disease association of a de novo GARS variant and to test a novel gene therapy strategy for Charcot-Marie-Tooth disease type 2D K. H. Morelli, J. S. Domire, N. Pyne, S. Harper, R. Burgess P34 Molecular regulation of chondrogenic human induced pluripotent stem cells M. A. Gari, A. Dallol, H. Alsehli, A. Gari, M. Gari, A. Abuzenadah P35 Molecular profiling of hematologic malignancies: implementation of a variant assessment algorithm for next generation sequencing data analysis and clinical reporting M. Thomas, M. Sukhai, S. Garg, M. Misyura, T. Zhang, A. Schuh, T. Stockley, S. Kamel-Reid P36 Accessing genomic evidence for clinical variants at NCBI S. Sherry, C. Xiao, D. Slotta, K. Rodarmer, M. Feolo, M. Kimelman, G. Godynskiy, C. O’Sullivan, E. Yaschenko P37 NGS-SWIFT: a cloud-based variant analysis framework using control-accessed sequencing data from DBGAP/SRA C. Xiao, E. Yaschenko, S. Sherry P38 Computational assessment of drug induced hepatotoxicity through gene expression profiling C. Rangel-Escareño, H. Rueda-Zarate P40 Flowr: robust and efficient pipelines using a simple language-agnostic approach;ultraseq; fast modular pipeline for somatic variation calling using flowr S. Seth, S. Amin, X. Song, X. Mao, H. Sun, R. G. Verhaak, A. Futreal, J. Zhang P41 Applying “Big data” technologies to the rapid analysis of heterogenous large cohort data S. J. Whiite, T. Chiang, A. English, J. Farek, Z. Kahn, W. Salerno, N. Veeraraghavan, E. Boerwinkle, R. Gibbs P42 FANTOM5 web resource for the large-scale genome-wide transcription start site activity profiles of wide-range of mammalian cells T. Kasukawa, M. Lizio, J. Harshbarger, S. Hisashi, J. Severin, A. Imad, S. Sahin, T. C. Freeman, K. Baillie, A. Sandelin, P. Carninci, A. R. R. Forrest, H. Kawaji, The FANTOM Consortium P43 Rapid and scalable typing of structural variants for disease cohorts W. Salerno, A. English, S. N. Shekar, A. Mangubat, J. Bruestle, E. Boerwinkle, R. A. Gibbs P44 Polymorphism of glutathione S-transferases and sulphotransferases genes in an Arab population A. H. Salem, M. Ali, A. Ibrahim, M. Ibrahim P46 Genetic divergence of CYP3A5*3 pharmacogenomic marker for native and admixed Mexican populations J. C. Fernandez-Lopez, V. Bonifaz-Peña, C. Rangel-Escareño, A. Hidalgo-Miranda, A. V. Contreras P47 Whole exome sequence meta-analysis of 13 white blood cell, red blood cell, and platelet traits L. Polfus, CHARGE and NHLBI Exome Sequence Project Working Groups P48 Association of adipoq gene with type 2 diabetes and related phenotypes in african american men and women: The jackson heart study S. Davis, R. Xu, S. Gebeab, P Riestra, A Gaye, R. Khan, J. Wilson, A. Bidulescu P49 Common variants in casr gene are associated with serum calcium levels in koreans S. H. Jung, N. Vinayagamoorthy, S. H. Yim, Y. J. Chung P50 Inference of multiple-wave population admixture by modeling decay of linkage disequilibrium with multiple exponential functions Y. Zhou, S. Xu P51 A Bayesian framework for generalized linear mixed models in genome-wide association studies X. Wang, V. Philip, G. Carter P52 Targeted sequencing approach for the identification of the genetic causes of hereditary hearing impairment A. A. Abuzenadah, M. Gari, R. Turki, A. Dallol P53 Identification of enhancer sequences by ATAC-seq open chromatin profiling A. Uyar, A. Kaygun, S. Zaman, E. Marquez, J. George, D. Ucar P54 Direct enrichment for the rapid preparation of targeted NGS libraries C. L. Hendrickson, A. Emerman, D. Kraushaar, S. Bowman, N. Henig, T. Davis, S. Russello, K. Patel P56 Performance of the Agilent D5000 and High Sensitivity D5000 ScreenTape assays for the Agilent 4200 Tapestation System R. Nitsche, L. Prieto-Lafuente P57 ClinVar: a multi-source archive for variant interpretation M. Landrum, J. Lee, W. Rubinstein, D. Maglott P59 Association of functional variants and protein physical interactions of human MUTY homolog linked with familial adenomatous polyposis and colorectal cancer syndrome Z. Abduljaleel, W. Khan, F. A. Al-Allaf, M. Athar , M. M. Taher, N. Shahzad P60 Modification of the microbiom constitution in the gut using chicken IgY antibodies resulted in a reduction of acute graft-versus-host disease after experimental bone marrow transplantation A. Bouazzaoui, E. Huber, A. Dan, F. A. Al-Allaf, W. Herr, G. Sprotte, J. Köstler, A. Hiergeist, A. Gessner, R. Andreesen, E. Holler P61 Compound heterozygous mutation in the LDLR gene in Saudi patients suffering severe hypercholesterolemia F. Al-Allaf, A. Alashwal, Z. Abduljaleel, M. Taher, A. Bouazzaoui, H. Abalkhail, A. Al-Allaf, R. Bamardadh, M. Athar
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Affiliation(s)
| | - Y. Wang
- School of Computing, Clemson University, Clemson, SC USA
| | - R. Huang
- Biochemical Genetics Laboratory, Greenwood Genetic Center, Greenwood, SC USA
| | - C. Skinner
- JCSRI, Greenwood Genetic Center, Greenwood, SC USA
| | - T. Thompson
- Biochemical Genetics Laboratory, Greenwood Genetic Center, Greenwood, SC USA
| | - L. Pollard
- Biochemical Genetics Laboratory, Greenwood Genetic Center, Greenwood, SC USA
| | - T. Wood
- Biochemical Genetics Laboratory, Greenwood Genetic Center, Greenwood, SC USA
| | - F. Luo
- School of Computing, Clemson University, Clemson, SC USA
| | - R. Stevenson
- JCSRI, Greenwood Genetic Center, Greenwood, SC USA
| | - R. Polimanti
- Department Psychiatry, Yale Sch Med and VA CT Healthcare Center, West Haven, CT USA
| | - J. Gelernter
- Department Psychiatry, Yale Sch Med and VA CT Healthcare Center, West Haven, CT USA
- Department Genetics, Yale Sch Med and VA CT Healthcare Center, West Haven, CT USA
- Department Neurobiology, Yale Sch Med and VA CT Healthcare Center, West Haven, CT USA
| | - X. Lin
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - I. Y. Lim
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Y. Wu
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - A. L. Teh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - L. Chen
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - I. M. Aris
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - S. E. Soh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - M. T. Tint
- National University of Singapore, Singapore, Singapore
| | - J. L. MacIsaac
- University of British Columbia, Vancouver, British Columbia Canada
| | - F. Yap
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - K. Kwek
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - S. M. Saw
- National University of Singapore, Singapore, Singapore
| | - M. S. Kobor
- University of British Columbia, Vancouver, British Columbia Canada
| | - M. J. Meaney
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - K. M. Godfrey
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Y. S. Chong
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - J. D. Holbrook
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Y. S. Lee
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - P. D. Gluckman
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- University of Auckland, Auckland, New Zealand
| | - N. Karnani
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | | | - A. Kapoor
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - D. Lee
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - A. Chakravarti
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - C. Maercker
- Esslingen University of Applied Sciences, Esslingen, Germany
| | - F. Graf
- German Cancer Research Center, Heidelberg, Germany
| | - M. Boutros
- German Cancer Research Center, Heidelberg, Germany
| | - G. Stamoulis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - F. Santoni
- Geneva University Hospitals-HUG, Service of Genetic Medicine, Geneva, Switzerland
| | - P. Makrythanasis
- Geneva University Hospitals-HUG, Service of Genetic Medicine, Geneva, Switzerland
| | - A. Letourneau
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - M. Guipponi
- Geneva University Hospitals-HUG, Service of Genetic Medicine, Geneva, Switzerland
| | - N. Panousis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - M. Garieri
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - P. Ribaux
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - E. Falconnet
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - C. Borel
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - S. E. Antonarakis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
- Geneva University Hospitals-HUG, Service of Genetic Medicine, Geneva, Switzerland
- iGE3 Institute of Genetics and Genomics of Geneva, University of Geneva Medical School, Geneva, Switzerland
| | - S. Kumar
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio-Grande Valley, Edinburg, TX USA
| | - J. Curran
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio-Grande Valley, Brownsville, TX USA
| | - J. Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio-Grande Valley, Brownsville, TX USA
| | - S. Chatterjee
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD USA
| | - A. Kapoor
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD USA
| | - J. Akiyama
- Genomics Division, Lawrence Berkeley National Laboratory, Berkeley, CA USA
| | - D. Auer
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD USA
| | - C. Berrios
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD USA
| | - L. Pennacchio
- Genomics Division, Lawrence Berkeley National Laboratory, Berkeley, CA USA
| | - A. Chakravarti
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD USA
| | - T. R. Donti
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - G. Cappuccio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - M. Miller
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - P. Atwal
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | | | - A. Cardon
- Section of Pediatric Neurology and Neuroscience, Baylor College of Medicine, Houston, TX USA
| | - C. Bacino
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - L. Emrick
- Section of Pediatric Neurology and Neuroscience, Baylor College of Medicine, Houston, TX USA
| | | | - F. Baumer
- Stanford Medical School, Stanford, CA USA
| | - B. Porter
- Stanford Medical School, Stanford, CA USA
| | - M. Bainbridge
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - P. Bonnen
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - B. Graham
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - R. Sutton
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Q. Sun
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - S. Elsea
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Z. Hu
- School of Public Health, Houston Health Science Center, Houston, TX USA
| | - P. Wang
- University of Texas, Houston Health Science Center, Houston, TX USA
| | - Y. Zhu
- Tulane University, New Orleans, LO USA
| | - J. Zhao
- Tulane University, New Orleans, LO USA
| | - M. Xiong
- University of Texas, Houston Health Science Center, Houston, TX USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL USA
| | - A. Hidalgo-Miranda
- Cancer Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | - S. Romero-Cordoba
- Cancer Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | | | - R. Rebollar-Vega
- Cancer Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | | | - M. Iorio
- National Tumor Institute, Milan, Italy
| | | | - S. Baroni
- National Tumor Institute, Milan, Italy
| | - B. Kaczkowski
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Japan
| | - Y. Tanaka
- Preventive Medicine and Applied Genomics unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Japan
| | - H. Kawaji
- Preventive Medicine and Applied Genomics unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Japan
| | - A. Sandelin
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - R. Andersson
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - M. Itoh
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Japan
| | - T. Lassmann
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Y. Hayashizaki
- RIKEN Preventive Medicine & Diagnosis Innovation Program, Wako, Japan
| | - P. Carninci
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Japan
| | - A. R. R. Forrest
- Harry Perkins Institute of Medical Research, The University of Western Australia, Nedlands, Australia
| | - C. A. Semple
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | | | | | | | - C. Gallego
- University of Michigan, Ann Arbor, MI USA
| | | | - A. Burt
- Univ of Washington, Seattle, WA USA
| | | | | | - C. Nefcy
- Univ of Washington, Seattle, WA USA
| | | | | | | | | | | | - J. Smith
- Univ of Washington, Seattle, WA USA
| | | | | | - R. Nassir
- University California, Davis, CA USA
| | | | | | - U. Peters
- Univ of Washington, Seattle, WA USA
- Fred Hutch, Seattle, WA USA
| | | | | | - F. Menghi
- The Jackson Laboratory, Farmington, CT USA
| | - K. Inaki
- The Jackson Laboratory, Farmington, CT USA
| | - X. Woo
- The Jackson Laboratory, Farmington, CT USA
| | - P. Kumar
- The Jackson Laboratory, Farmington, CT USA
| | - K. Grzeda
- The Jackson Laboratory, Farmington, CT USA
| | | | - H. Kim
- The Jackson Laboratory, Farmington, CT USA
| | - D. Ucar
- The Jackson Laboratory, Farmington, CT USA
| | | | | | - J. Keck
- The Jackson Laboratory, Sacramento, CA USA
| | - J. Chuang
- The Jackson Laboratory, Farmington, CT USA
| | - E. T. Liu
- The Jackson Laboratory, Farmington, CT USA
| | - B. Ji
- The Jackson Laboratory, Bar Harbor, ME USA
| | - A. Tyler
- The Jackson Laboratory, Bar Harbor, ME USA
| | - G. Ananda
- The Jackson Laboratory, Bar Harbor, ME USA
| | - G. Carter
- The Jackson Laboratory, Bar Harbor, ME USA
| | - H. Nikbakht
- Human Genetics, McGill University, Montreal, Quebec Canada
| | - M. Montagne
- Biochemistry, Sherbrooke University, Sherbrooke, Quebec Canada
| | - M. Zeinieh
- Human Genetics, McGill University, Montreal, Quebec Canada
| | - A. Harutyunyan
- Human Genetics, McGill University, Montreal, Quebec Canada
| | - M. Mcconechy
- Human Genetics, McGill University, Montreal, Quebec Canada
| | - N. Jabado
- Pediatrics, McGill University, Montreal, Quebec Canada
| | - P. Lavigne
- Biochemistry, Sherbrooke University, Sherbrooke, Quebec Canada
| | - J. Majewski
- Human Genetics, McGill University, Montreal, Quebec Canada
| | - J. B. Goldstein
- Genomic Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - M. Overman
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - G. Varadhachary
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - R. Shroff
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - R. Wolff
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - M. Javle
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - A. Futreal
- Genomic Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - D. Fogelman
- Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - L. Bravo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - W. Fajardo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - H. Gomez
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - C. Castaneda
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - C. Rolfo
- Oncology Department, University Hospital Antwerp, Antwerp, Belgium
| | - J. A. Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - K. C. Akdemir
- Genomic Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - L. Chin
- University of Texas System, Houston, TX USA
| | - A. Futreal
- Genomic Medicine, MD Anderson Cancer Center, Houston, TX USA
| | | | - S. Patterson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - C. Statz
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - S. Mockus
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - S. N. Nikolaev
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | - X. I. Bonilla
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | - L. Parmentier
- Department of Dermatology, Hospital of Valais, Sion, Switzerland
| | - B. King
- Department of Pathology, NYU School of Medicine, New York, NY USA
| | - F. Bezrukov
- Department of Physics, University of Connecticut, Connecticut, USA
| | - G. Kaya
- Department of Dermatology, University Hospitals of Geneva, Geneva, Switzerland
| | - V. Zoete
- Swiss Institute of Bioinformatics, Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - V. Seplyarskiy
- Institute of Information Transmission Problems, Russian Academy of Sciences, Moscow, Russian Federation
| | - H. Sharpe
- Department of Molecular Oncology, Genentech Inc, San Francisco, CA USA
| | - T. McKee
- Service of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - A. Letourneau
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - P. Ribaux
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - K. Popadin
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | | | - R. Ben Chaabene
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - F. Santoni
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - M. Andrianova
- Institute of Information Transmission Problems, Russian Academy of Sciences, Moscow, Russian Federation
| | - M. Guipponi
- Service of Genetic Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - M. Garieri
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - C. Verdan
- Service of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - K. Grosdemange
- Department of Dermatology, University Hospitals of Geneva, Geneva, Switzerland
| | - O. Sumara
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
| | - M. Eilers
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
| | - I. Aifantis
- Department of Pathology, NYU School of Medicine, New York, NY USA
| | - O. Michielin
- Swiss Institute of Bioinformatics, Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - F. de Sauvage
- Department of Molecular Oncology, Genentech Inc, San Francisco, CA USA
| | - S. Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | | | | | - A. Kurian
- Stanford Medical Center, Palo Alto, CA USA
| | - A. Desmond
- Massachusetts General Hospital, Boston, MA USA
| | - S. Yang
- Invitae, San Francisco, CA USA
| | | | - J. Ford
- Stanford Medical Center, San Francisco, CA USA
| | - L. Ellisen
- Massachusetts General Hospital, Boston, MA USA
| | - T. L. Peters
- Pathology & Immunology, Baylor College of Medicine, Houston, TX USA
| | - K. R. Alvarez
- Pathology, Texas Children’s Hospital, Houston, TX USA
| | | | - D. H. Lopez-Terrada
- Pathology & Immunology, Baylor College of Medicine, Houston, TX USA
- Pathology, Texas Children’s Hospital, Houston, TX USA
| | - A. Hastie
- BioNano Genomics, Inc, San Diego, CA USA
| | - Z. Dzakula
- BioNano Genomics, Inc, San Diego, CA USA
| | - A. W. Pang
- BioNano Genomics, Inc, San Diego, CA USA
| | - E. T. Lam
- BioNano Genomics, Inc, San Diego, CA USA
| | | | | | - H. Cao
- BioNano Genomics, Inc, San Diego, CA USA
| | | | - C. Gonzaga-Jauregui
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, NY USA
| | - L. Ma
- Department of Pediatrics, New York, NY USA
| | - A. King
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, NY USA
| | - E. Berman Rosenzweig
- Department of Pediatrics, New York, NY USA
- Department of Medicine, Columbia University Medical Center, New York, NY USA
| | | | - J. G. Reid
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, NY USA
| | - J. D. Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, NY USA
| | - F. Dewey
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York, NY USA
| | - W. K. Chung
- Department of Pediatrics, New York, NY USA
- Department of Medicine, Columbia University Medical Center, New York, NY USA
| | - K. Small
- Molecular Insight Research Foundation, Glendale, ᅟ
| | - A. DeLuca
- Ophthalmology, University of Iowa, Iowa City, IA USA
| | - F. Cremers
- Biology, Raboud University Medical Center, Nijmegen, Netherlands
| | - R. A. Lewis
- Ophthalmology, Baylor College of Medicine, Houston, TX USA
| | - V. Puech
- Service d’Exploration de la vision et Neuro-ophtalmologie CHRU, Service d’Exploration de la vision et Neuro-ophtalmologie CHRU, Lille, France
| | - B. Bakall
- Associated Retina Consultants, University of Arizona College of Medicine, Phoenix, TX USA
| | | | | | - M. Leys
- WVU Eye Institute, Morgantown, WV USA
| | - F. S. Shaya
- Molecular Insight Research Foundation, Glendale, ᅟ
| | - E. Stone
- University of Iowa, Iowa City, IA USA
| | - N. L. Sobreira
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | - H. Ling
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - E. Pugh
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - D. Witmer
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - K. Hetrick
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - P. Zhang
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - K. Doheny
- Center for Inherited Disease Research, JHUSOM, Baltimore, MD USA
| | - D. Valle
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - A. Hamosh
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - S. N. Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Z. Coban Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - M. N. Bainbridge
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - W. Charng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - W. Wiszniewski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - T. Gambin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - E. Karaca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Y. Bayram
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - M. K. Eldomery
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - J. Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - H. Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - V. R. Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - D. M. Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - E. A. Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - D. Valle
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - J. R. Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - R. A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | - W. Salerno
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - A. English
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | | | - A. Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, Quebec Canada
| | - B. M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Quebec Canada
| | | | - H. Takahashi
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - K. R. Nitta
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - A. Kozhuharova
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - A. M. Suzuki
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - H. Sharma
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - D. Cotella
- Dipartimento di Scienze della Salute, Universita’ del Piemonte Orientale, Novara, Italy
| | - C. Santoro
- Dipartimento di Scienze della Salute, Universita’ del Piemonte Orientale, Novara, Italy
| | - S. Zucchelli
- Area of Neuroscience, SISSA, International School for Advanced Studies, Trieste, Italy
| | - S. Gustincich
- Area of Neuroscience, SISSA, International School for Advanced Studies, Trieste, Italy
| | - P. Carninci
- Center for Life Science Technologies, Division of Genomic Technologies, RIKEN, Yokohama, Japan
| | - J. J. Mulvihill
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD USA
| | - G. Baynam
- Office of Population Health, Department of Health, Perth, Australia
| | - W. Gahl
- Undiagnosed Diseases Program, National Human Genome Research Institute, Bethesda, MD USA
| | - S. C. Groft
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - K. Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - P. Lasko
- Department of Biology, McGill University, Montreal, Quebec Canada
| | - B. Melegh
- Department of Medical Genetics, University of Pecs, Pecs, Hungary
| | - D. Taruscio
- National Center for Rare Diseases, Istituto Superiore di Sanita, Rome, Italy
| | - R. Ghosh
- Pediatrics-Oncology, Baylor College of Medicine, Houston, TX USA
| | - S. Plon
- Pediatrics-Oncology, Baylor College of Medicine, Houston, TX USA
| | - S. Scherer
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - X. Qin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Sanghvi
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - K. Walker
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - T. Chiang
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - D. Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - L. Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, NY USA
| | - J. Black
- Department of Psychiatry, Mayo Clinic, Rochester, NY USA
| | - E. Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | - R. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | | | | | - K. Wani
- MD Anderson Cancer Center, Houston, USA
| | - X. Yu
- MD Anderson Cancer Center, Houston, USA
| | - C. Creasy
- MD Anderson Cancer Center, Houston, USA
| | | | - M. Forget
- MD Anderson Cancer Center, Houston, USA
| | - V. Nanda
- MD Anderson Cancer Center, Houston, USA
| | - J. Roszik
- MD Anderson Cancer Center, Houston, USA
| | - J. Wargo
- MD Anderson Cancer Center, Houston, USA
| | - L. Haydu
- MD Anderson Cancer Center, Houston, USA
| | - X. Song
- MD Anderson Cancer Center, Houston, USA
| | - A. Lazar
- MD Anderson Cancer Center, Houston, USA
| | | | - M. Davies
- MD Anderson Cancer Center, Houston, USA
| | | | - J. Zhang
- MD Anderson Cancer Center, Houston, USA
| | | | | | | | | | | | | | | | | | - M. Xiong
- University of Texas School of Public Health, Houston, TX USA
| | - L. Ma
- University of Texas School of Public Health, Houston, TX USA
| | - N. Lin
- University of Texas School of Public Health, Houston, TX USA
| | - C. Amos
- Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - N. Lin
- Biostatistics, University of Texas Health Science Center at Houston, Houston, TX USA
| | - P. Wang
- Biostatistics, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Y. Zhu
- Tulane University, New Orleans, LO USA
| | - J. Zhao
- Tulane University, New Orleans, LO USA
| | - V. Calhoun
- University of New Mexico, Albuquerque, NM USA
| | - M. Xiong
- University of Texas Health Science Center at Houston, Houston, TX USA
| | | | - M. Egger
- EPS Software Corp, Spring, TX USA
| | | | - S. Sadedin
- Bioinformatics, Murdoch Childrens Research Institute, Parkville, Australia
| | - A. Oshlack
- Bioinformatics, Murdoch Childrens Research Institute, Parkville, Australia
| | | | - V. A. A. Antonio
- Computational Systems Biology Laboratory, Nara Institute of Science and Technology, Ikoma-cho, Japan
| | - N. Ono
- Computational Systems Biology Laboratory, Nara Institute of Science and Technology, Ikoma-cho, Japan
| | | | - Z. Ahmed
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - M. Bolisetty
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - S. Zeeshan
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - E. Anguiano
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - D. Ucar
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - A. Sarkar
- Laboratory of Genomics and Profiling Applications, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - M. R. Nandineni
- Laboratory of Genomics and Profiling Applications, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - C. Zeng
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - J. Shao
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - H. Cao
- BioNano Genomics, Inc, San Diego, CA USA
| | - A. Hastie
- BioNano Genomics, Inc, San Diego, CA USA
| | - A. W. Pang
- BioNano Genomics, Inc, San Diego, CA USA
| | - E. T. Lam
- BioNano Genomics, Inc, San Diego, CA USA
| | - T. Liang
- BioNano Genomics, Inc, San Diego, CA USA
| | - K. Pham
- BioNano Genomics, Inc, San Diego, CA USA
| | | | - Z. Dzakula
- BioNano Genomics, Inc, San Diego, CA USA
| | - Y. Chee-Wei
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - L. Dongsheng
- Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Shanghai, Shanghai, China
| | - W. Lai-Ping
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - D. Lian
- Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Shanghai, Shanghai, China
| | - R. O. Twee Hee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Y. Yunus
- Institute of Medical Molecular Biotechnology, Universiti Teknologi MARA, Sungai Buloh, ᅟ
| | - F. Aghakhanian
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Petaling Jaya, Malaysia
| | - S. S. Mokhtar
- Institute of Medical Molecular Biotechnology, Universiti Teknologi MARA, Sungai Buloh, ᅟ
| | - C. V. Lok-Yung
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - J. Bhak
- Personal Genomics Institute, Genome Research Foundation, Suwon, Republic Of Korea
| | - M. Phipps
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campu, Petaling Jaya, Malaysia
| | - X. Shuhua
- Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Shanghai, Shanghai, China
| | - T. Yik-Ying
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - V. Kumar
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - H. Boon-Peng
- UCSI University, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - I. Campbell
- Research Division, Peter Maccallum Cancer Centre, East Melbourne, Australia
| | - M. -A. Young
- Familial Cancer Centre, Peter Maccallum Cancer Centre, East Melbourne, Australia
| | - P. James
- Familial Cancer Centre, Peter Maccallum Cancer Centre, East Melbourne, Australia
| | | | - M. Rain
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - G. Mohammad
- Department of Medicine, Sonam Norbu Memorial Hospital, Leh, Ladakh India
| | - R. Kukreti
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Q. Pasha
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - A. R. Akilzhanova
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - C. Guelly
- Center of Medical Research, Medical University of Graz, Graz, Austria
| | - Z. Abilova
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - S. Rakhimova
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - A. Akhmetova
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - U. Kairov
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - S. Trajanoski
- Center of Medical Research, Medical University of Graz, Graz, Austria
| | - Z. Zhumadilov
- Nazarbayev University, National Laboratory Astana, Center for Life Sciences, Astana, Kazakhstan
| | - M. Bekbossynova
- National Scientific Cardiac Surgery Center, Astana, Kazakhstan
| | | | - S. Sandhu
- Swift Biosciences Inc, Ann Arbor, MI USA
| | - T. Harkins
- Swift Biosciences Inc, Ann Arbor, MI USA
| | - V. Makarov
- Swift Biosciences Inc, Ann Arbor, MI USA
| | - H. Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Glenn
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Z. Momin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - B. Dilrukshi
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - H. Chao
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Q. Meng
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - B. Gudenkauf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Kshitij
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Jayaseelan
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - C. Nessner
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - S. Lee
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - K. Blankenberg
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - L. Lewis
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Y. Han
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - H. Dinh
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - S. Jireh
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - K. Walker
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - E. Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - D. Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - K. Walker
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - C. Buhay
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - X. Liu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Q. Wang
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Sanghvi
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - H. Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Y. Ding
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - N. Veeraraghavan
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - Y. Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - E. Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX USA
| | - A. L. Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - C. M. Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - D. M. Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - K. C. C. Worley
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Y. Liu
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - D. S. T. Hughes
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - S. C. Murali
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - R. A. Harris
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - A. C. English
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - X. Qin
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - O. A. Hampton
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - P. Larsen
- Department of Biology, Duke University, Durham, NC USA
| | - C. Beck
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Y. Han
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - M. Wang
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - H. Doddapaneni
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - C. L. Kovar
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - W. J. Salerno
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - A. Yoder
- Department of Biology, Duke University, Durham, NC USA
| | - S. Richards
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - J. Rogers
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - J. R. Lupski
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - D. M. Muzny
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - R. A. Gibbs
- Human Genome Sequencing Center, Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Q. Meng
- HGSC, Baylor College of Medicine, Houston, TX USA
| | | | - M. Wang
- HGSC, Baylor College of Medicine, Houston, TX USA
| | | | - Y. Han
- HGSC, Baylor College of Medicine, Houston, TX USA
| | - D. Muzny
- HGSC, Baylor College of Medicine, Houston, TX USA
| | - R. Gibbs
- HGSC, Baylor College of Medicine, Houston, TX USA
| | - R. A. Harris
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - M. Raveenedran
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - C. Xue
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - M. Dahdouli
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - L. Cox
- Genetics, Southwest National Primate Research Center, San Antonio, TX USA
| | - G. Fan
- Human Genetics, Univeristy of California Los Angeles, Los Angeles, CA USA
| | - B. Ferguson
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR USA
| | - J. Hovarth
- Genomics & Microbiology Research Laboratory, NC Museum of Natural Sciences, Raleigh, NC USA
| | - Z. Johnson
- Yerkes Nonhuman Primate Genomics Core, Yerkes National Primate Research Center, Atlanta, GA USA
| | - S. Kanthaswamy
- Environmental Toxicology, California National Primate Research Center, Davis, CA USA
| | - M. Kubisch
- Physiology, Tulane National Primate Research Center, New Orleans, LO USA
| | - M. Platt
- Neuroscience, University of Pennsylvania, Philadelphia, PA USA
| | - D. Smith
- Anthropology, University of California Davis, Davis, CA USA
| | - E. Vallender
- Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS USA
| | - R. Wiseman
- Genetics, Wisconsin National Primate Research Center, Madison, WI USA
| | - X. Liu
- Epidemiology, Human Genetics & Environmental Sciences, ᅟ, ᅟ
| | - J. Below
- Epidemiology and Disease Control Human Genetics Center, University of Texas Health Science Center, Houston, TX USA
| | - D. Muzny
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - R. Gibbs
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - F. Yu
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Rogers
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX USA
| | - J. Lin
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - Y. Zhang
- Department of Statistics, University of Connecticut, Storrs, CT USA
| | - Z. Ouyang
- The Jackson Laboratory for Genomic Medicine, Farmington, CT USA
| | - A. Moore
- National Cancer Institute, Rockville, USA
| | - Z. Wang
- St. Jude Children’s Research Hospital, Memphis, USA
| | - J. Hofmann
- National Cancer Institute, NIH, DHHS, Rockville, USA
| | - M. Purdue
- National Cancer Institute, Rockville, USA
| | | | | | - D. Albanes
- National Cancer Institute, Rockville, USA
| | - C. S. Liu
- Changhua Christian Hospital, Changhua, Taiwan Province of China
| | - W. L. Cheng
- Changhua Christian Hospital, Changhua, Taiwan Province of China
| | - T. T. Lin
- Changhua Christian Hospital, Changhua, Taiwan Province of China
| | - Q. Lan
- National Cancer Institute, Rockville, USA
| | - N. Rothman
- National Cancer Institute, Rockville, USA
| | - S. Berndt
- National Cancer Institute, Rockville, USA
| | - E. S. Chen
- Biochemistry, National University of Singapore, Singapore, Singapore
| | - H. Bahrami
- Proteomics, Faraby Eye Hospital, Tehran, Iran Islamic Republic Of
- R & D, MIB Co., Tehran, Iran Islamic Republic Of
| | | | | | - H. Bahrami
- Proteomics, Faraby Eye Hospital, Tehran, Iran Islamic Republic Of
- R & D, MIB Co., Tehran, Iran Islamic Republic Of
| | | | | | - K. K. R. Alharbi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - M. Zhalbinova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - A. Akilzhanova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - S. Rakhimova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - M. Bekbosynova
- Cardiology, JSC “National Research Cardiac Surgery Center”, National medical holding, Astana, Kazakhstan
| | - S. Myrzakhmetova
- Cardiology, JSC “National Research Cardiac Surgery Center”, National medical holding, Astana, Kazakhstan
| | - M. Matar
- UAE Genetic Diseases Association, Dubai, United Arab Emirates
| | - N. Mili
- Research Center for Statistics, University of Geneva, Switzerland, Geneva Switzerland
| | - R. Molinari
- Research Center for Statistics, University of Geneva, Switzerland, Geneva Switzerland
| | - Y. Ma
- Department of Statistics, University of South Carolina, Columbia, USA
| | - S. Guerrier
- Department of Statistics, University of Illinois at Urbana Champaign, Champaign, USA
| | - N. Elhawary
- Department of Molecular Genetics, Medical Genetics Center, Ain Shams University, Cairo, Egypt
- Department of Medical Genetics, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - M. Tayeb
- Department of Medical Genetics, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - N. Bogari
- Department of Medical Genetics, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - N. Qotb
- Department of Psychology, Umm Al-Qura University, Faculty of Education, Mecca, Saudi Arabia
| | - S. A. McClymont
- Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - P. W. Hook
- Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - L. A. Goff
- Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - A. McCallion
- Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Y. Kong
- The Jackson Laboratory, Bar Harbor, USA
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, USA
| | | | | | | | - L. Zhao
- The Jackson Laboratory, Bar Harbor, USA
| | - P. M. Nishina
- The Jackson Laboratory, Bar Harbor, USA
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, USA
| | - B. M. Edrees
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - M. Athar
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - F. A. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - M. M. Taher
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - W. Khan
- Department of Basic Sciences, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A. Bouazzaoui
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - N. A. Harbi
- Department of Pediatric, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - R. Safar
- Department of Pediatric, Madinah Maternity and Children’s Hospital, Madinah, Saudi Arabia
| | - H. Al-Edressi
- Department of Pediatric, Madinah Maternity and Children’s Hospital, Madinah, Saudi Arabia
| | - A. Anazi
- Pediatric, King Fahad Medical City, Riyadh, Saudi Arabia
| | - N. Altayeb
- Molecular Diagnostics Unit, Department of Laboratory and Blood Bank, King Abdullah Medical City, Makkah, Saudi Arabia
| | - M. A. Ahmed
- Medical Genetics, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - K. Alansary
- Medical Genetics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Z. Abduljaleel
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - A. Kratz
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - P. Beguin
- Brain Science Institute (BSI), Launey Research Unit, RIKEN Wako, Wako, Japan
| | - S. Poulain
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - M. Kaneko
- Brain Science Institute (BSI), Launey Research Unit, RIKEN Wako, Wako, Japan
| | - C. Takahiko
- Brain Science Institute (BSI), Launey Research Unit, RIKEN Wako, Wako, Japan
| | - A. Matsunaga
- Brain Science Institute (BSI), Launey Research Unit, RIKEN Wako, Wako, Japan
| | - S. Kato
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - A. M. Suzuki
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - N. Bertin
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - T. Lassmann
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - R. Vigot
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - P. Carninci
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - C. Plessy
- Center for Life Science Technologies, RIKEN Yokohama, Yokohama City, Kanagawa Japan
| | - T. Launey
- Brain Science Institute (BSI), Launey Research Unit, RIKEN Wako, Wako, Japan
| | - D. Graur
- Biology and Biochemistry, University of Houston, Houston, USA
| | - D. Lee
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - A. Kapoor
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - A. Chakravarti
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - J. Friis-Nielsen
- Technical University of Denmark, Center for Biological Sequence Analysis, Lyngby, Denmark
| | - J. M. Izarzugaza
- Technical University of Denmark, Center for Biological Sequence Analysis, Lyngby, Denmark
| | - S. Brunak
- Technical University of Denmark, Center for Biological Sequence Analysis, Lyngby, Denmark
| | - A. Chakraborty
- Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - J. Basak
- Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - A. Mukhopadhyay
- Medical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | | | - D. Das
- National Institute of Biomedical Genomics, Kalyani, India
| | - N. Biswas
- National Institute of Biomedical Genomics, Kalyani, India
| | - S. Das
- National Institute of Biomedical Genomics, Kalyani, India
| | - S. Sarkar
- Chittaranjan National Cancer Institute, Kolkata, India
| | - A. Maitra
- National Institute of Biomedical Genomics, Kalyani, India
| | - C. Panda
- Chittaranjan National Cancer Institute, Kolkata, India
| | - P. Majumder
- National Institute of Biomedical Genomics, Kalyani, India
| | - H. Morsy
- Human Genetics, Faculty of Medicine, Alexandria, Egypt
| | - A. Gaballah
- Microbiology, Faculty of Medicine, Alexandria, Egypt
| | - M. Samir
- Clinical and Experimental Surgery, Faculty of Medicine, Alexandria, Egypt
| | - M. Shamseya
- Clinical and Experimental Internal Medicine, Medical Research Institute, Faculty of Medicine, Alexandria, Egypt
| | - H. Mahrous
- Human Genetics, Faculty of Medicine, Alexandria, Egypt
| | - A. Ghazal
- Microbiology, Faculty of Medicine, Alexandria, Egypt
| | - W. Arafat
- Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria, Egypt
| | - M. Hashish
- Human Genetics, Faculty of Medicine, Alexandria, Egypt
| | | | - N. Jaeger
- Genetics, Stanford University, Palo Alto, USA
| | - M. Snyder
- Genetics, Stanford University, Palo Alto, USA
| | | | | | - T. Davis
- New England Biolabs, Ipswich, USA
| | | | | | | | | | | | - K. Zhang
- Pathology, University of North Dakota, Grand Forks, USA
| | | | | | | | | | - N. Jäger
- Genetics, Stanford University, Palo Alto, USA
| | - J. Chen
- Genetics, Stanford University, Palo Alto, USA
| | - R. Haile
- Stanford Cancer Institute, Stanford University, Palo Alto, USA
| | - M. Hitchins
- Stanford Cancer Institute, Stanford University, Palo Alto, USA
| | | | - M. Snyder
- Genetics, Stanford University, Palo Alto, USA
| | - S. Jiménez-Morales
- Cancer Genomic Laboratory, National Institute of Genomic Medicine (INMEGEN), ᅟ, Mexico
| | - M. Ramírez
- Biología, FES -Iztacala, UNAM, ᅟ, Mexico
| | - J. Nuñez
- Hospital de Pediatría, CMN SXXI, IMSS, ᅟ, Mexico
| | - V. Bekker
- Investigación Médica en Inmunología, CMN La Raza, IMSS, ᅟ, Mexico
| | - Y. Leal
- Diagnóstico Molecular H1N1-Influenza , UMAE-IMSS, Mérida, Yucatán Mexico
| | - E. Jiménez
- Hematología Pediátrica, CMN La Raza, IMSS, ᅟ, Mexico
| | - A. Medina
- Hemato-Oncología, Hospital Infantil de México, ᅟ, Mexico
| | - A. Hidalgo
- Cancer Genomics Laboratory, INMEGEN, ᅟ, Mexico
| | - J. Mejía
- Coordinación de Investigación en Salud, IMSS, ᅟ, Mexico
| | - V. Halytskiy
- Molecular Immunology Department, Palladin Institute of Biochemistry of the National Academy of Sciences of Ukraine, Kiev, Ukraine
| | | | | | | | | | | | - K. Belhassa
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - K. Belhassan
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - L. Bouguenouch
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - I. Samri
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - H. Sayel
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - FZ. moufid
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - I. El Bouchikhi
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - S. Trhanint
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - H. Hamdaoui
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - I. Elotmani
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - I. Khtiri
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - O. Kettani
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - L. Quibibo
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - M. Ahagoud
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - M. Abbassi
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - K. Ouldim
- Department of Medical Genetics and Oncogene, Morocco; Medical Genetics, CHU Hassan II Fes, Fes, Morocco
| | - A. V. Marusin
- Evolutionary Genetics, Institute of Medical Genetics, ᅟ, Russian Federation
| | - A. N. Kornetov
- Siberian State Medical University, Tomsk, Russian Federation
| | - M. Swarovskaya
- Evolutionary Genetics, Institute of Medical Genetics, ᅟ, Russian Federation
| | - K. Vagaiceva
- Evolutionary Genetics, Institute of Medical Genetics, ᅟ, Russian Federation
| | - V. Stepanov
- Evolutionary Genetics, Institute of Medical Genetics, ᅟ, Russian Federation
| | - E. M. Cutiongco De La Paz
- National Institutes of Health, University of the Philippines, Manila, Philippines
- Philippine Genome Center, University of the Philippines, Quezon City, Philippines
| | - R. Sy
- College of Medicine, University of the Philippines, Manila, Philippines
| | - J. Nevado
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - P. Reganit
- College of Medicine, University of the Philippines, Manila, Philippines
| | - L. Santos
- College of Medicine, University of the Philippines, Manila, Philippines
| | - J. D. Magno
- College of Medicine, University of the Philippines, Manila, Philippines
| | - F. E. Punzalan
- College of Medicine, University of the Philippines, Manila, Philippines
| | - D. Ona
- College of Medicine, University of the Philippines, Manila, Philippines
| | - E. Llanes
- College of Medicine, University of the Philippines, Manila, Philippines
| | - R. L. Santos-Cortes
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX United States
| | - R. Tiongco
- College of Medicine, University of the Philippines, Manila, Philippines
| | - J. Aherrera
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - L. Abrahan
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - P. Pagauitan-Alan
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - K. H. Morelli
- The Jackson Laboratory, Bar Harbor, USA
- Graduate School of Biomedical Sciences & Engineering, The University of Maine, Orono, USA
| | - J. S. Domire
- Center For Gene Therapy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio USA
| | - N. Pyne
- Center For Gene Therapy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio USA
| | - S. Harper
- Center For Gene Therapy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio USA
| | - R. Burgess
- Graduate School of Biomedical Sciences & Engineering, The University of Maine, Orono, USA
| | - M. Zhalbinova
- Laboratory of Genomic and Personalized Medicine, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - A. Akilzhanova
- Laboratory of Genomic and Personalized Medicine, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - S. Rakhimova
- Laboratory of Genomic and Personalized Medicine, National Laboratory Astana, Nazarbayev University, ᅟ, Kazakhstan
| | - M. Bekbosynova
- Cardiology, JSC “National Research Cardiac Surgery Center”, National Medical Holding, Astana, Kazakhstan
| | - S. Myrzakhmetova
- Cardiology, JSC “National Research Cardiac Surgery Center”, National Medical Holding, Astana, Kazakhstan
| | - M. A. Gari
- Medical Laboratory Technology, ᅟ, Saudi Arabia
| | - A. Dallol
- Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - H. Alsehli
- Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A. Gari
- Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M. Gari
- Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A. Abuzenadah
- Center of Innovation in Personalized Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M. Thomas
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - M. Sukhai
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - S. Garg
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - M. Misyura
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - T. Zhang
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - A. Schuh
- Princess Margaret Cancer Centre, Toronto, Canada
| | - T. Stockley
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | - S. Kamel-Reid
- Advanced Molecular Diagnostics Laboratory, ᅟ, Canada
| | | | | | | | | | | | | | | | | | | | - C. Xiao
- National Institutes of Health, Bethesda, USA
| | | | - S. Sherry
- National Institutes of Health, Bethesda, USA
| | - C. Rangel-Escareño
- Computational Genomics, National Institute of Genomic Medicine, Mexico City, Mexico
| | - H. Rueda-Zarate
- Computational Genomics, National Institute of Genomic Medicine, Mexico City, Mexico
| | - I. A. Tayubi
- Computer Science, Faculty of Computing and Information Technology, King AbdulAziz University, Rabigh, Saudi Arabia
| | - R. Mohammed
- Computer Science, Faculty of Computing and Information Technology, King AbdulAziz University, Rabigh, Saudi Arabia
| | | | - I. Ahmed
- Computer Science, Faculty of Computing and Information Technology, King AbdulAziz University, Rabigh, Saudi Arabia
| | - T. Ahmed
- Computer Science, Faculty of Computing and Information Technology, King AbdulAziz University, Rabigh, Saudi Arabia
| | - S. Seth
- Institute of Applied Cancer Science, ᅟ, USA
| | - S. Amin
- Genomic Medicine, University of Texas, ᅟ, ᅟ
| | - X. Song
- Institute of Applied Cancer Science, ᅟ, USA
| | - X. Mao
- Genomic Medicine, University of Texas, ᅟ, ᅟ
| | - H. Sun
- MD Anderson Cancer Center, Houston, USA
| | | | - A. Futreal
- Genomic Medicine, University of Texas, ᅟ, ᅟ
| | - J. Zhang
- Institute of Applied Cancer Science, ᅟ, USA
| | - S. J. Whiite
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - T. Chiang
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - A. English
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - J. Farek
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - Z. Kahn
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - W. Salerno
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - N. Veeraraghavan
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - E. Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, USA
| | - R. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, ᅟ, USA
| | - T. Kasukawa
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - M. Lizio
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - J. Harshbarger
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - S. Hisashi
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
- Preventive Medicine and Diagnosis Innovation Program, RIKEN, Wako, Japan
| | - J. Severin
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - A. Imad
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - S. Sahin
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | - T. C. Freeman
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - K. Baillie
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - A. Sandelin
- Department of Biology & Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - P. Carninci
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
| | | | - H. Kawaji
- Center for Life Science Technologies, RIKEN, Yokohama, Japan
- Preventive Medicine and Diagnosis Innovation Program, RIKEN, Wako, Japan
- Advanced Center for Computing and Communication, RIKEN, Yokohama, Japan
| | | | - W. Salerno
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas USA
| | - A. English
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas USA
| | | | | | | | - E. Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas USA
- Human Genetics Center and Department of Epidemiology, UT School of Public Health, Houston, Texas USA
| | - R. A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas USA
| | - A. H. Salem
- Anatomy, Arabian Gulf University, Manama, Bahrain
| | - M. Ali
- Biochemistry, Arabian Gulf University, Manama, Bahrain
| | - A. Ibrahim
- Central Laboratory, Ministry of Science and Technology, ᅟ, Sudan
| | - M. Ibrahim
- College of Animal Production Science and Technology, Sudan University of Science and Technology, Khartoum, Sudan
| | - H. A. Barrera
- Bioquimica y Medicina Molecular, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - L. Garza
- Bioquimica y Medicina Molecular, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - J. A. Torres
- Bioquimica y Medicina Molecular, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - V. Barajas
- Bioquimica y Medicina Molecular, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - D. Kershenobich
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Shahroj Mortaji
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Pedro Guizar
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Eliezer Loera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Karen Moreno
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Adriana De León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Daniela Monsiváis
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Jackeline Gómez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | - Raquel Cardiel
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico
| | | | - V. Bonifaz-Peña
- Computational Genomics, Nacional de Medicina Genomica, Mexico City, Mexico
| | - C. Rangel-Escareño
- Computational Genomics, Nacional de Medicina Genomica, Mexico City, Mexico
| | - A. Hidalgo-Miranda
- Cancer Genomics Laboratory, Nacional de Medicina Genomica, Mexico City, Mexico
| | - A. V. Contreras
- Nutrigenetics and Nutrigenomics Laboratory, Instituto Nacional de Medicina Genomica, Mexico City, Mexico
| | - L. Polfus
- Human Genetics Center, University of Texas Health Science Center, Houston, USA
| | | | - X. Wang
- System Genetics, The Jackson Laboratory, Bar Harbor, USA
| | - V. Philip
- System Genetics, The Jackson Laboratory, Bar Harbor, USA
| | - G. Carter
- System Genetics, The Jackson Laboratory, Bar Harbor, USA
| | - A. A. Abuzenadah
- Center of Innovation in Personalized Medicine, Faculty of Applied Medical Sciences, King Abdulaziz University, ᅟ, Saudi Arabia
| | - M. Gari
- Center of Innovation in Personalized Medicine, Faculty of Applied Medical Sciences, King Abdulaziz University, ᅟ, Saudi Arabia
| | - R. Turki
- Ob/Gyn, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - A. Dallol
- Center of Innovation in Personalized Medicine, Faculty of Applied Medical Sciences, King Abdulaziz University, ᅟ, Saudi Arabia
| | - A. Uyar
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - A. Kaygun
- Department of Mathematical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - S. Zaman
- Department of Biomedical Engineering, University of Connecticut, Storrs, USA
| | - E. Marquez
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - J. George
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - D. Ucar
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | | | | | | | | | | | - T. Davis
- New England Biolabs, Ipswich, USA
| | | | | | - D. B. Starr
- Genetics, Stanford University, Stanford, USA
| | - M. Baird
- DNA Diagnostics Center, Fairfield, USA
| | | | - K. Sheets
- Vibrant Gene Consulting, Cambridge, USA
| | - R. Nitsche
- Agilent Technologies, Agilent Technologies, Waldbronn, Germany
| | - L. Prieto-Lafuente
- Agilent Technologies UK Ltd, Agilent Technologies UK Ltd., Edinburgh, UK
| | | | - J. Lee
- NIH/NLM/NCBI, Bethesda, USA
| | | | | | - P. K. R. Thavanati
- Institute of Human Genetics, Department of Molecular Biology & Genomics, Centre for Health Sciences, ᅟ, Mexico
| | - A. Escoto de Dios
- Institute of Human Genetics, Department of Molecular Biology & Genomics, Centre for Health Sciences, ᅟ, Mexico
| | | | | | - M. R. Ruiz Mejia
- Biochemistry, Centre for Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - K. R. R. Kanala
- Human Genetics Unit, Department Anthropology, Sri Venkateswara University, Tirupati, India
| | - Z. Abduljaleel
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - W. Khan
- Department of Basic Sciences, College of Science and Health Professions, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - F. A. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - M. Athar
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - M. M. Taher
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - N. Shahzad
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - A. Bouazzaoui
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
- Department of Medical Genetics, Umm Al Qura University, Mecca, Saudi Arabia
- Medical Clinic 3 – Hematology/Oncology, University Hospital Regensburg, Regensburg, Germany
| | - E. Huber
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - A. Dan
- IgNova GmbH, Oberursel, Germany
| | - F. A. Al-Allaf
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - W. Herr
- Medical Clinic 3 – Hematology/Oncology, University Hospital Regensburg, Regensburg, Germany
| | - G. Sprotte
- Department of Ansethesiologie, University of Würzburg Medical School, Würzburg, Germany
| | - J. Köstler
- Department of microbiology, University Hospital Regensburg, Regensburg, Germany
| | - A. Hiergeist
- Department of microbiology, University Hospital Regensburg, Regensburg, Germany
| | - A. Gessner
- Department of microbiology, University Hospital Regensburg, Regensburg, Germany
| | - R. Andreesen
- Medical Clinic 3 – Hematology/Oncology, University Hospital Regensburg, Regensburg, Germany
| | - E. Holler
- Medical Clinic 3 – Hematology/Oncology, University Hospital Regensburg, Regensburg, Germany
| | - F. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, ᅟ, Saudi Arabia
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
- Molecular Diagnostics Unit, Department of Laboratory and Blood Bank, King Abdullah Medical City, Makkah, Saudi Arabia
| | - A. Alashwal
- King Faisal Specialist Hospital and Research Centre, ᅟ, Saudi Arabia
| | - Z. Abduljaleel
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, ᅟ, Saudi Arabia
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - M. Taher
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, ᅟ, Saudi Arabia
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - A. Bouazzaoui
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, ᅟ, Saudi Arabia
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - H. Abalkhail
- King Faisal Specialist Hospital and Research Centre, ᅟ, Saudi Arabia
| | - A. Al-Allaf
- Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - R. Bamardadh
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - M. Athar
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, ᅟ, Saudi Arabia
- Science and Technology Unit, Umm Al-Qura University, ᅟ, Saudi Arabia
| | - O. Filiptsova
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - M. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - Y. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Burlaka
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Timoshyna
- Human Physiology and Anatomy, National University of Pharmacy, Kharkiv, Ukraine
| | - O. Filiptsova
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - M. N. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - Y. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Burlaka
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Timoshyna
- Human Physiology and Anatomy, National University of Pharmacy, Kharkiv, Ukraine
| | - O. Filiptsova
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - M. N. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - Y. Kobets
- Pharmaceutical Marketing and Management, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Burlaka
- Biology, National University of Pharmacy, Kharkiv, Ukraine
| | - I. Timoshyna
- Human Physiology and Anatomy, National University of Pharmacy, Kharkiv, Ukraine
| | - F. A. Al-allaf
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
- Molecular Diagnostics Unit Department of Laboratory Medicine and Blood Bank, King Abdullah Medical City, ᅟ, Saudi Arabia
| | - M. T. Mohiuddin
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
| | - A. Zainularifeen
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
| | - A. Mohammed
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
| | - H. Abalkhail
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - T. Owaidah
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A. Bouazzaoui
- Department of Medical Genetics Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, Mecca, Saudi Arabia
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