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Lüftner D, Schuetz F, Schneeweiss A, Hartkopf A, Bloch W, Decker T, Uleer C, Stötzer O, Foerster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Kreuzeder J, Guderian G, Fasching PA. Efficacy and safety of everolimus plus exemestane in patients with hormone receptor-positive, HER-2-negative advanced breast cancer: Results from the open-label, multicentre, non-interventional BRAWO study. Int J Cancer 2024. [PMID: 38447007 DOI: 10.1002/ijc.34912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
BRAWO, a real-world study, assessed the efficacy, quality of life (QoL) and safety of EVE + EXE in postmenopausal women with HR+/HER2- advanced breast cancer (ABC) in routine clinical practice. Postmenopausal women with HR+/HER2-ABC with recurrence or progression after a NSAI were included. Primary Observation parameters included the evaluation of the effectiveness of EVE + EXE. A multivariate-analysis using Cox proportional hazard model was built to identify predictors of progression. Overall, 2100 patients were enrolled (August 2012-December 2017); 2074 were evaluable for efficacy and safety analyses. Majority of patients (60.6%) received EVE + EXE as first (28.7%) or second-line (31.9%) therapy. Visceral metastases were present in 54.1% patients. Median progression-free survival (mPFS) reported as 6.6 months (95%CI: 6.3-7.0). Multivariate-analysis in a subset of patients (n = 1837) found higher body mass index (BMI) and non-visceral metastases to be independent predictors of favorable PFS. Patients with a BMI of 20 to <25 had a mPFS of 6.0 (95%CI: 5.4-6.4) and those with a BMI ≥30 had mPFS of 8.5 (95%CI: 6.9-9.9). 41.2% patients achieved stable disease and 7.3% partial response. No major changes were observed QoL; 86.4% patients received stomatitis prophylaxis and 41.4% experienced EVE related AEs of stomatitis, mainly low grade. AEs occurred in 91.2% of patients, of which stomatitis (42.6%) and fatigue (19.8%) were most frequent. The BRAWO study provides real-world evidence of efficacy and safety of EVE + EXE in patients with HR+, HER2- ABC. A high BMI and the absence of visceral metastases were independent predictors of PFS in this cohort of patients.
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Affiliation(s)
- Diana Lüftner
- Medical University of Brandenburg Theodor Fontane, Campus Rüdersdorf and Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | | | - Andreas Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Andreas Hartkopf
- Department of Women's Health, Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | | | | | | | | | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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2
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Graf J, Sickenberger N, Brusniak K, Matthies LM, Deutsch TM, Simoes E, Plappert C, Keilmann L, Hartkopf A, Walter CB, Hahn M, Engler T, Wallwiener S, Schuetz F, Fasching PA, Schneeweiss A, Brucker SY, Wallwiener M. Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial. J Med Internet Res 2022; 24:e16128. [PMID: 35133288 PMCID: PMC8864528 DOI: 10.2196/16128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2021] [Accepted: 09/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app’s evaluation parameters. Conclusions The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills.
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Affiliation(s)
- Joachim Graf
- Institute for Health Sciences, Section of Midwifery Science, University Hospital Tübingen, Tübingen, Germany
| | - Nina Sickenberger
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Brusniak
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lina Maria Matthies
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Thomas M Deutsch
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Elisabeth Simoes
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Claudia Plappert
- Institute for Health Sciences, Section of Midwifery Science, University Hospital Tübingen, Tübingen, Germany
| | - Lucia Keilmann
- Department of Obstetrics and Gynecology, University Hospital Ludwig-Maximilians-University Munich, München, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | | | - Markus Hahn
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Stephanie Wallwiener
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Schuetz
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany.,Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany.,University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Sara Yvonne Brucker
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
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3
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Hlevnjak M, Schulze M, Elgaafary S, Fremd C, Michel L, Beck K, Pfütze K, Richter D, Wolf S, Horak P, Kreutzfeldt S, Pixberg C, Hutter B, Ishaque N, Hirsch S, Gieldon L, Stenzinger A, Springfeld C, Smetanay K, Seitz J, Mavratzas A, Brors B, Kirsten R, Schuetz F, Fröhling S, Sinn HP, Jäger D, Thewes V, Zapatka M, Lichter P, Schneeweiss A. CATCH: A Prospective Precision Oncology Trial in Metastatic Breast Cancer. JCO Precis Oncol 2021; 5:PO.20.00248. [PMID: 34036222 PMCID: PMC8140780 DOI: 10.1200/po.20.00248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/25/2020] [Revised: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE CATCH (Comprehensive Assessment of clinical feaTures and biomarkers to identify patients with advanced or metastatic breast Cancer for marker driven trials in Humans) is a prospective precision oncology program that uses genomics and transcriptomics to guide therapeutic decisions in the clinical management of metastatic breast cancer. Herein, we report our single-center experience and results on the basis of the first 200 enrolled patients of an ongoing trial. METHODS From June 2017 to March 2019, 200 patients who had either primary metastatic or progressive disease, with any number of previous treatment lines and at least one metastatic site accessible to biopsy, were enrolled. DNA and RNA from tumor tissue and corresponding blood-derived nontumor DNA were profiled using whole-genome and transcriptome sequencing. Identified actionable alterations were brought into clinical context in a multidisciplinary molecular tumor board (MTB) with the aim of prioritizing personalized treatment recommendations. RESULTS Among the first 200 enrolled patients, 128 (64%) were discussed in the MTB, of which 64 (50%) were subsequently treated according to MTB recommendation. Of 53 evaluable patients, 21 (40%) achieved either stable disease (n = 13, 25%) or partial response (n = 8, 15%). Furthermore, 16 (30%) of those patients showed improvement in progression-free survival of at least 30% while on MTB-recommended treatment compared with the progression-free survival of the previous treatment line. CONCLUSION The initial phase of this study demonstrates that precision oncology on the basis of whole-genome and RNA sequencing is feasible when applied in the clinical management of patients with metastatic breast cancer and provides clinical benefit to a substantial proportion of patients.
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Affiliation(s)
- Mario Hlevnjak
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Markus Schulze
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Shaymaa Elgaafary
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carlo Fremd
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laura Michel
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Beck
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katrin Pfütze
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Daniela Richter
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephan Wolf
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Horak
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon Kreutzfeldt
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Pixberg
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Hutter
- Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Naveed Ishaque
- Heidelberg Center for Personalized Oncology (DKFZ-HIPO), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Hirsch
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Gieldon
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christoph Springfeld
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Smetanay
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Seitz
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Athanasios Mavratzas
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt Brors
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Romy Kirsten
- National Center for Tumor Diseases (NCT), Liquid Biobank, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Peter Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Verena Thewes
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Zapatka
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Center for Personalized Oncology (DKFZ-HIPO), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Schneeweiss
- Gynecologic Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Pfob A, Koelbel V, Schuetz F, Feißt M, Blumenstein M, Hennigs A, Golatta M, Heil J. Surgeon's preference of subcutaneous tissue resection: most important factor for short-term complications in subcutaneous implant placement after mastectomy-results of a cohort study. Arch Gynecol Obstet 2020; 301:1037-1045. [PMID: 32157414 PMCID: PMC7103012 DOI: 10.1007/s00404-020-05481-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
Purpose Little is known about the reason of high short-term complication rates after the subcutaneous placement of breast implants or expanders after mastectomy without biological matrices or synthetic meshes. This study aims to evaluate complications and their risk factors to develop guidelines for decreasing complication rates. Methods We included all cases of mastectomy followed by subcutaneous implant or expander placement between 06/2017 and 05/2018 (n = 92). Mean follow-up time was 12 months. Results Explantation occurred in 15 cases (16.3%). The surgeon’s preference for moderate vs. radical subcutaneous tissue resection had a significant influence on explantation rates (p = 0.026), impaired wound healing or infection (requiring surgery) (p = 0.029, p = 0.003 respectively) and major complications (p = 0.018). Multivariate analysis revealed significant influence on complication rates for radical subcutaneous tissue resection (p up to 0.003), higher implant volume (p up to 0.023), higher drain volume during the last 24 h (p = 0.049), higher resection weight (p = 0.035) and incision type (p = 0.011). Conclusion Based on the significant risk factors we suggest the following guidelines to decrease complication rates: favoring thicker skin envelopes after surgical preparation, using smaller implants, removing drains based on a low output volume during the last 24 h and no use of periareolar incision with extension medial or lateral. We should consider ADMs for subcutaneous one-stage reconstructions. The individual surgeon’s preference of subcutaneous tissue resection is of highest relevance for short-term complications—this has to be part of internal team discussions and should be considered in future trials for comparable results.
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Affiliation(s)
- André Pfob
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Vivian Koelbel
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Maria Blumenstein
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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5
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Heublein S, Egger M, Zhu J, Berger L, Mayr D, Schindlbeck C, Kuhn C, Hofmann SS, Schuetz F, Jeschke U, Ditsch N. Evaluation of the anti-Thomsen-Friedenreich antibodies Nemod-TF1 and Nemod-TF2 as prognostic markers in breast cancer. Breast Cancer Res Treat 2019; 179:643-652. [PMID: 31828591 DOI: 10.1007/s10549-019-05503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The TF (Thomsen-Friedenreich, CD176, Galβ1-3GalNAc) carbohydrate moiety is known as a specific oncofetal carbohydrate epitope present in fetal and neoplastic tissue as well as in stem cells. TF was demonstrated to mediate tumor-promoting features and to be highly immunogenic. The current study aimed to evaluate whether presence of the TF antigen is associated with clinico-pathological parameters and prognosis of early breast cancer (BC). METHODS Primary BC tissue (n = 226) was stained for TF using two monoclonal anti-TF antibodies (Nemod-TF1, Nemod-TF2). Staining results were correlated to clinical data including survival. RESULTS Nemod-TF1 staining was positively correlated to lymph node metastasis (p = 0.03) and the presence of tumor-associated MUC1 (TA-MUC1; p = 0.003). Further, the presence of the Nemod-TF1 epitope predicted worse prognosis in TA-MUC1 positive (overall survival: p = 0.026) as well as in triple negative (overall survival: p = 0.002; distant metastasis-free survival: p = 0.012) BC. CONCLUSIONS The data presented here further support a role of TF in BC tumor biology. Whether anti-TF directed treatment approaches may gain clinical relevance in those cases determined as triple negative or TA-MUC1 positive remains to be determined.
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Affiliation(s)
- Sabine Heublein
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany. .,Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Markus Egger
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany.,St. Anna Kinderspital, Vienna, Austria
| | - Junyan Zhu
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Luisa Berger
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doris Mayr
- Department of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Christina Kuhn
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Simone S Hofmann
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Florian Schuetz
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany.,Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Nina Ditsch
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany.,Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
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6
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Ge Y, Böhm HH, Rathinasamy A, Xydia M, Hu X, Pincha M, Umansky L, Breyer C, Hillier M, Bonertz A, Sevko A, Domschke C, Schuetz F, Frebel H, Dettling S, Herold-Mende C, Reissfelder C, Weitz J, Umansky V, Beckhove P. Tumor-Specific Regulatory T Cells from the Bone Marrow Orchestrate Antitumor Immunity in Breast Cancer. Cancer Immunol Res 2019; 7:1998-2012. [PMID: 31672785 DOI: 10.1158/2326-6066.cir-18-0763] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/04/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022]
Abstract
Endogenous antitumor effector T-cell responses and immune-suppressive regulatory T cells (Treg) critically influence the prognosis of patients with cancer, yet many of the mechanisms of how this occurs remain unresolved. On the basis of an analysis of the function, antigen specificity, and distribution of tumor antigen-reactive T cells and Tregs in patients with breast cancer and transgenic mouse tumor models, we showed that tumor-specific Tregs were selectively activated in the bone marrow (BM) and egressed into the peripheral blood. The BM was constantly depleted of tumor-specific Tregs and was instead a site of increased induction and activity of tumor-reactive effector/memory T cells. Treg egress from the BM was associated with activation-induced expression of peripheral homing receptors such as CCR2. Because breast cancer tissues express the CCR2 ligand CCL2, the activation and egress of tumor antigen-specific Tregs in the BM resulted in the accumulation of Tregs in breast tumor tissue. Such immune compartmentalization and redistribution of T-cell subpopulations between the BM and peripheral tissues were achieved by vaccination with adenoviral vector-encoded TRP-2 tumor antigen in a RET transgenic mouse model of spontaneous malignant melanoma. Thus, the BM simultaneously represented a source of tumor-infiltrating Tregs and a site for the induction of endogenous tumor-specific effector T-cell responses, suggesting that both antitumor immunity and local immune suppression are orchestrated in the BM.
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Affiliation(s)
- Yingzi Ge
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Hans-Henning Böhm
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anchana Rathinasamy
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Regensburg Center for Interventional Immunology, University Clinic Regensburg, Regensburg, Germany
| | - Maria Xydia
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Regensburg Center for Interventional Immunology, University Clinic Regensburg, Regensburg, Germany
| | - Xiaoying Hu
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls University of Heidelberg, Mannheim, Germany
| | - Mudita Pincha
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Ludmila Umansky
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Christopher Breyer
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Hillier
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andreas Bonertz
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Alexandra Sevko
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls University of Heidelberg, Mannheim, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, University Medical Center, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, University Medical Center, Heidelberg, Germany
| | - Helge Frebel
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Steffen Dettling
- Department of Neurosurgery, Division of Experimental Neurosurgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Division of Experimental Neurosurgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Viktor Umansky
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls University of Heidelberg, Mannheim, Germany
| | - Philipp Beckhove
- Translational Immunology Department, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany. .,Regensburg Center for Interventional Immunology, University Clinic Regensburg, Regensburg, Germany.,Hematology-Oncology Department, University Clinic Regensburg, Regensburg, Germany
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Cortés J, André F, Gonçalves A, Kümmel S, Martín M, Schmid P, Schuetz F, Swain SM, Easton V, Pollex E, Deurloo R, Dent R. IMpassion132 Phase III trial: atezolizumab and chemotherapy in early relapsing metastatic triple-negative breast cancer. Future Oncol 2019; 15:1951-1961. [PMID: 30977385 DOI: 10.2217/fon-2019-0059] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The PD-L1 inhibitor atezolizumab received US FDA accelerated approval as treatment for PD-L1-positive metastatic triple-negative breast cancer (TNBC). In IMpassion130, combining atezolizumab with first-line nab-paclitaxel for metastatic TNBC significantly improved progression-free survival and showed a clinically meaningful effect on overall survival in patients with PD-L1-positive tumors. The placebo-controlled randomized Phase III IMpassion132 (NCT03371017) trial is evaluating atezolizumab with first-line chemotherapy (capecitabine [mandatory in platinum-pretreated patients] or gemcitabine/carboplatin) for inoperable locally advanced/metastatic TNBC recurring ≤12 months after completing standard (neo)adjuvant anthracycline and taxane chemotherapy. Stratification factors are: visceral metastases, tumor immune cell PD-L1 status and selected chemotherapy. Patients are randomized to atezolizumab 1200 mg or placebo every 3 weeks with the chosen chemotherapy, continued until progression, unacceptable toxicity or withdrawal. The primary end point is overall survival.
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Affiliation(s)
- Javier Cortés
- IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona, & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Fabrice André
- Institut Gustave Roussy, Université Paris Sud, 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - Anthony Gonçalves
- Aix-Marseille University, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), & Institut Paoli-Calmettes, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), 232 Bvd Sainte-Marguerite, 13009 Marseille, France
| | - Sherko Kümmel
- Breast Unit Essen, Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Universidad Complutense, Madrid, Spain
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Florian Schuetz
- University Breast Unit, National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Sandra M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC 20057, USA
| | - Valerie Easton
- F Hoffmann-La Roche, Hochstrasse, CH 4070 Basel, Switzerland
| | - Erika Pollex
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Regula Deurloo
- F Hoffmann-La Roche, Building 1, Grenzacherstrasse, CH 4070 Basel, Switzerland
| | - Rebecca Dent
- Department of Medical Oncology, National Cancer Center, 11 Hospital Drive, Singapore, 169690, Singapore
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Stefanovic S, Wirtz R, Deutsch T, Hartkopf A, Sinn P, Varga Z, Sohn C, Schuetz F, Schneeweiss A, Wallwiener M. rt-qPCR versus protein-based analysis of receptor conversion from primary to metastatic breast cancer. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deutsch T, Feisst M, Nees J, Stefanovic S, Hartkopf A, Taran FA, Schuetz F, Brucker S, Sohn C, Schneeweiss A, Burwinkel B, Wallwiener M. Correlation of microRNA expression in matched-paired primary tumor, metastasis and plasma samples of metastatic breast cancer patients. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.379] [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: 11/30/2022]
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Hartkopf AD, Brucker SY, Taran FA, Harbeck N, von Au A, Naume B, Pierga JY, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta MH, Bittner AK, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard FC, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. Abstract GS5-07: International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
As early breast cancer might relapse even after complete removal of breast and lymphnodes, the disease must persist in secondary sites. The detection of disseminated tumor cells (DTC) in the bone marrow (BM) has been described as a surrogate of residual disease. Various trials showed an impaired prognosis of DTC positive early breast cancer (EBC) patients. The PADDY (Pooled Analysis of DTC Detection in Early Breast Cancer) study is a large international pooled analysis that aimed to assess the prognostic impact of DTC detection in patients with EBC.
Methods
A pre-specified protocol was followed, and centers known to practice BM sampling for DTC detection were contacted for individual patient data. Patients with EBC, with available follow-up data and BM sampling before any anti-cancer treatment were eligible. BM aspirates were collected at the time of primary surgery. DTC were identified by antibody (A45-B/B3, AE1/AE3, 2E11 and E29) staining against cytokeratin. The DTC status was compared to other prognostic factors using the chi-squared test. Univariate log-rank test and multivariate cox regression were used to compare survival of DTC positive versus DTC negative patients.
Results
Individual data from 10,320 patients (11 centers from Europe and USA) were included with a median follow-up of 91 months. Of all patients, 2,823 (27.4 %) were DTC positive. DTC detection was associated with higher tumor grade, higher T stage, nodal positivity, ER and PR negativity, and HER2 positivity (all p<0.001). In univariate analyses, overall, breast cancer specific, disease-free and distant disease-free survival (OS, BCSS, DFS, DDFS) were significantly shorter in DTC positive patients with p-values of <0.001. Multivariate analyses showed the DTC status to be an independent prognostic marker for OS, BCSS, DFS and DDFS with hazard ratios (HR) and 95%-confidence intervals (CI) of 1.23 (95%-CI: 1.06-1.42, p=0.007), 1.38 (95%-CI: 1.11-1.72, p=0.004), 1.29 (95%-CI: 1.10-1.50, p=0.001) and 1.32 (95%-CI: 1.10-1.58, p=0.003), respectively.
Conclusions
Detection of DTC in the bone marrow is an independent prognostic marker in patients with non-metastatic breast cancer. Further studies should investigate the impact of DTC on metastatic cancer progression and their role for clinical decision making.
Citation Format: Hartkopf AD, Brucker SY, Taran F-A, Harbeck N, von Au A, Naume B, Pierga J-Y, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta M-H, Bittner A-K, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard F-C, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study [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 GS5-07.
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Affiliation(s)
- AD Hartkopf
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - SY Brucker
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-A Taran
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A von Au
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Naume
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-Y Pierga
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - O Hoffmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - MW Beckmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Rydén
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Fehm
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Aft
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Montserrat
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Walter
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Rack
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Schuetz
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Borgen
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M-H Ta
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A-K Bittner
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Fasching
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Fernö
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Krawczyk
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Weilbaecher
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Margelí
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Hahn
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Jueckstock
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Domschke
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-C Bidard
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Kasimir-Bauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Schoenfisch
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AG Kurt
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Gebauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Janni
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lüftner D, Schuetz F, Schneeweiss A, Grischke EM, Bloch W, Decker T, Uleer C, Salat C, Förster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Guderian G, Hanson S, Fasching P. Abstract P6-18-08: Everolimus + exemestane for HR+ advanced breast cancer in routine clinical practice- Final results from the non-interventional trial, BRAWO. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-08] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the pivotal BOLERO-2 trial, everolimus (EVE) + exemestane (EXE) more than doubled the median progression-free survival (PFS) vs EXE alone in hormone receptor positive (HR+), human epidermal growth factor-receptor 2-negative (HER2-) advanced breast cancer (ABC) recurring/progressing on/after prior non-steroidal aromatase inhibitors (NSAIs). BRAWO is a German non-interventional study conducted in patients (pts) with HR+, HER2–ABC receiving EVE + EXE, according to Summary of Product Characteristics (SmPC), in routine clinical practice. Here we report the final PFS and safety results.
Methods: This multicenter study documented 2100 pts between October 2012 and December 2017 across 341 sites in Germany. Postmenopausal women with HR+, HER2– ABC with recurrence or progression after a NSAI were included. Primary observation parameters included the evaluation of the effectiveness of EVE + EXE used in routine care for the entire pt group.
Results: In the final analysis, out of the 2100 documented pts, 2074 were included in the full analysis set. The median time since the primary diagnosis was 7.1 years and the median time from first sign of relapse (local recurrence or distant metastases) was 2.1 years. At baseline, 54.1% of pts presented with visceral metastases and 50.1% had an ECOG performance status of 0. Approximately, 63% of pts started with EVE 10 mg (median duration of exposure: 5.1 months; 95% CI, 4.6-5.4), while 34.1% started with EVE 5 mg (median duration of exposure: 4.6 months; 95% CI, 4.1-5.2).
The distribution of treatment lines was as follows: first line, 28.7% (n=595); second line, 31.9% (n=662); third line, 18.1% (n=376); fourth line, 10.7% (n=221) and, fifth line and later, 10.6% (n=220). Treatment was discontinued by 55.7% of pts (n=1170) due to progressive disease and 26% of pts (n=546) due to adverse events. The Kaplan-Meier estimate of the median PFS was 6.6 months (95% CI, 6.2-7.0). The best overall responses, based on clinical routine, were complete response, 0.8% (n=17), partial response, 7.4% (n=150), and stable disease, 41.3% (n=842). The general safety profile was consistent with the previously reported safety findings. The most common adverse events were stomatitis (any grade: 42.6%, grade 3: 3.8%, grade 4: <0.1%) and fatigue (any grade: 19.8%, grade 3: 1.5%).
Conclusions: Data from BRAWO support EVE + EXE as a suitable treatment option with a reasonable safety profile for HR+, HER2− ABC recurring or progressing on/after prior NSAIs.
Citation Format: Lüftner D, Schuetz F, Schneeweiss A, Grischke E-M, Bloch W, Decker T, Uleer C, Salat C, Förster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Guderian G, Hanson S, Fasching P. Everolimus + exemestane for HR+ advanced breast cancer in routine clinical practice- Final results from the non-interventional trial, BRAWO [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 P6-18-08.
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Affiliation(s)
- D Lüftner
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - F Schuetz
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Schneeweiss
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - E-M Grischke
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - W Bloch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Decker
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Uleer
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Salat
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - F Förster
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - M Schmidt
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Mundhenke
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - H Tesch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Jackisch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fischer
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - G Guderian
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - S Hanson
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - P Fasching
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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12
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Matthies LM, Taran FA, Keilmann L, Schneeweiss A, Simoes E, Hartkopf AD, Sokolov AN, Walter CB, Sickenberger N, Wallwiener S, Feisst M, Gass P, Lux MP, Schuetz F, Fasching PA, Sohn C, Brucker SY, Graf J, Wallwiener M. An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study. J Med Internet Res 2019; 21:e10004. [PMID: 30668517 PMCID: PMC6362389 DOI: 10.2196/10004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 01/05/2023] Open
Abstract
Background The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far. Objective The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients. Methods Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ρ) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed. Results High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients’ response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score. Conclusions The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score.
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Affiliation(s)
- Lina Maria Matthies
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Lucia Keilmann
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Elisabeth Simoes
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Andreas D Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Alexander N Sokolov
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Christina B Walter
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Nina Sickenberger
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Florian Schuetz
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Christof Sohn
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Joachim Graf
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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13
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Riedel F, Riedel M, Freis A, Heil J, Golatta M, Schuetz F, Sohn C, Hennigs A. Exam preparatory course for the 2nd part of the German medical examination in obstetrics and gynecology - a potential tool for the recruitment of new residents during the occupational decision process before the practical year? BMC Med Educ 2019; 19:24. [PMID: 30654790 PMCID: PMC6335710 DOI: 10.1186/s12909-019-1457-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The "Second Stage of the Physician Exam" at the end of the 5th year of medical school in Germany is the final step before the "Practical Year." An exam preparatory class can cover the complete content of Obstetrics and Gynecology (OB/GYN) in two days. We raise the question of whether such training might promote students' interest in the given specialty during occupational decision making and whether it could even be used by hospitals as a recruitment tool. This investigation is even more important in the context of fierce competition among young professionals at clinics and in different specialties. METHODS We conducted a multimodal course evaluation for four exam preparatory courses (each of which lasted two days and involved 8.5 h of teaching), including pre- and post-course tests with 20 multiple-choice questions to quantify the level of skill gain. Additionally, a standardized evaluation of course satisfaction was performed, followed by a post-exam questionnaire that dealt with studying activities and individual professional objectives. RESULTS Overall, n = 197 students took part in four identical courses. Among them, n = 121 completed the pre-/post-course tests, n = 170 completed the evaluation, and n = 110 completed the post-exam questionnaire. An average improvement from 13.9 to 17.2 correct answers was observed (max. 20; pre-/post-difference 95%-CI: [2.77; 3.86], t-test: p < 0.0001). By trend, the students noted that course participation positively influenced their later choice of specialty training (m = 3.63; scale 1 = "strongly disagree," 5 = "strongly agree"). CONCLUSIONS In addition to self-studying, condensed classroom training is effective and reasonable and might also increase the attractivity of OB/GYN among students and have a positive effect on recruitment.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Freis
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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14
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Riedel F, Heil J, Golatta M, Schaefgen B, Hug S, Schott S, Rom J, Schuetz F, Sohn C, Hennigs A. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
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Affiliation(s)
- F Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - B Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Hug
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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15
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Dent R, Andre F, Goncalves A, Kummel S, Martin M, Schmid P, Schuetz F, Swain SM, Easton V, Pollex E, Cortés J. IMpassion132: A double-blind randomized phase 3 trial evaluating chemotherapy (CT) ± atezolizumab (atezo) for early progressing locally advanced/metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps1115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Fabrice Andre
- Institut Gustave-Roussy, Université Paris Sud, Villejuif, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, INSERM, and Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Florian Schuetz
- University Breast Unit, National Center for Tumor Diseases, Heidelberg, Germany
| | - Sandra M. Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | - Javier Cortés
- Ramon y Cajal University Hospital, Madrid, and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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16
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Riedel F, Hennigs A, Hug S, Schaefgen B, Sohn C, Schuetz F, Golatta M, Heil J. Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer? Breast Care (Basel) 2017; 12:385-390. [PMID: 29456470 PMCID: PMC5803719 DOI: 10.1159/000485737] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM To describe and discuss the evidence for oncological safety of different procedures in oncological breast surgery, i.e. breast-conserving treatment versus mastectomy. METHODS Literature review and discussion. RESULTS Oncological safety in breast cancer surgery has many dimensions. Breast-conserving treatment has been established as the standard surgical procedure for primary breast cancer and fits to the preferences of most breast cancer patients concerning oncological safety and aesthetic outcome. CONCLUSIONS Breast-conserving treatment is safe. Nonetheless, the preferences of the individual patients in their consideration of breast conservation versus mastectomy should be integrated into routine treatment decisions.
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Affiliation(s)
| | | | | | | | | | | | | | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
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17
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Dinkic C, Kruse A, Zygmunt M, Schuetz F, Brucker J, Rom J, Sohn C, Fluhr H. Influence of Paclitaxel and Heparin on Vitality, Proliferation and Cytokine Production of Endometrial Cancer Cells. Geburtshilfe Frauenheilkd 2017; 77:1104-1110. [PMID: 29093604 PMCID: PMC5658230 DOI: 10.1055/s-0043-119289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/26/2017] [Accepted: 09/05/2017] [Indexed: 01/03/2023] Open
Abstract
Background Cancer patients have a higher risk for thromboembolic events compared to healthy individuals and are often treated with heparins. A beneficial effect of heparins on tumor patients above and beyond the classic anticoagulation effect has been reported, leading to an increased focus on the use of heparins in anticancer treatment. In recent years, it has become apparent that microenvironments greatly affect tumor development and can be a major source of tumor-promoting factors. Cytokines play an important role in tumor microenvironments, inducing carcinogenesis and influencing tumor progression by promoting angiogenesis, metastatic potential and immunosuppression. The possible interaction of heparins and cytokines could also have an effect on cancer cells. Methods This study investigated the effect of paclitaxel (PTX) combined with heparins on the vitality of endometrial cancer cells using viability and cytotoxicity assays. The study also examined whether treatment with paclitaxel and heparin influences cytokine secretion or expression. Results Heparin treatment did not influence cell viability, and no influence of heparins in combination with paclitaxel was seen for the evaluated cancer cell lines HEC-1-A, KLE, RL 95-2 and AN3-CA compared to untreated cells. Secretion of the cytokines CCL5, CCL2 and IL-6 increased after paclitaxel treatment in several endometrial cancer cell lines, but no general effect on cytokine secretion was detected after heparin treatment. A significant decrease in CCL5 expression was only detected in KLE cells following treatment with heparin and paclitaxel, and an increase in the expression of CCL5 in RL 95-2 cells. Conclusion Further in-depth studies are needed to investigate the functions of cytokines CCL2, CCL5 and IL-6 in endometrial cancer cells treated with paclitaxel. Although no general effect on cytokine secretion was detected following heparin treatment, a selective modulatory impact could exist.
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Affiliation(s)
- Christine Dinkic
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Anja Kruse
- Department of Gynecology and Obstetrics, University Hospital Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Hospital Greifswald, Greifswald, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Janina Brucker
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Rom
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Herbert Fluhr
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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18
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Krause AL, Schuetz F, Boudewijns M, Pritsch M, Wallwiener M, Golatta M, Rom J, Heil J, Sohn C, Schneeweiss A, Beckhove P, Domschke C. Parity improves anti-tumor immunity in breast cancer patients. Oncotarget 2017; 8:104981-104991. [PMID: 29285226 PMCID: PMC5739613 DOI: 10.18632/oncotarget.20756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/08/2017] [Accepted: 08/04/2017] [Indexed: 12/27/2022] Open
Abstract
Compared to nulliparous women, parous women have an up to 50% lower lifetime risk of developing breast cancer. An endogenous mechanism to prevent the development of cancer is the destruction of tumor cells by T cells that recognize tumor-associated antigens (TAA). Since a number of TAA are also highly present in the breast and placenta of pregnant women, we investigated the induction and characteristics of spontaneous T cell responses against TAA during pregnancy. To this end, we collected peripheral blood from healthy nulliparous, primigravid and parous women, as well as from breast cancer patients. IFN-γ ELISpot assays were performed to measure the intensity and specificity of T cell responses against 11 different TAA. The impact of TAA-specific Treg cells on anti-TAA responses was assessed by performing the assay before and after depletion of CD4+CD25+ T cells. The antigenic specificities of these Treg cells were analyzed by the Treg specificity assay. Furthermore, we conducted flow cytometric analyses to determine the memory phenotype and cytokine secretion profile of TAA-specific T cells. Our results demonstrate that pregnancy induces functional and long-lived memory and effector T cells that react against multiple TAA. These persist for many decades in parous females, but are not found in age-matched females without children. We also detected TAA-specific Treg cells, which suppressed strong effector T cell responses after delivery. Nulliparous breast cancer patients displayed median TAA-specific effector T cell responses to be decreased threefold compared to parous patients, which could be restored in vitro after depletion of Treg cells.
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Affiliation(s)
- Anna-Lena Krause
- Translational Immunology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marc Boudewijns
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Maria Pritsch
- Translational Immunology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Joachim Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Philipp Beckhove
- Translational Immunology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Regensburg Center for Interventional Immunology (RCI) and University Medical Center of Regensburg, Regensburg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
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19
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Brecht L, Wallwiener M, Schott S, Domschke C, Dinkic C, Golatta M, Schuetz F, Fluhr H, Stenzinger A, Kirchner M, Sohn C, Rom J. Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- L Brecht
- St. Josef's Hospital, Department for internal medicine, Heidelberg
| | - M Wallwiener
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - S Schott
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - C Domschke
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - C Dinkic
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - M Golatta
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - F Schuetz
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - H Fluhr
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - A Stenzinger
- University of Heidelberg, Department of Pathology, Heidelberg
| | - M Kirchner
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg
| | - C Sohn
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - J Rom
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
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20
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Stefanovic S, Wirtz R, Deutsch TM, Hartkopf A, Sinn P, Varga Z, Sobottka B, Sotiris L, Taran FA, Domschke C, Hennigs A, Brucker SY, Sohn C, Schuetz F, Schneeweiss A, Wallwiener M. Tumor biomarker conversion between primary and metastatic breast cancer: mRNA assessment and its concordance with immunohistochemistry. Oncotarget 2017; 8:51416-51428. [PMID: 28881657 PMCID: PMC5584258 DOI: 10.18632/oncotarget.18006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/05/2017] [Indexed: 01/09/2023] Open
Abstract
Biomarker changes between primary (PT) and metastatic tumor (MT) site may be significant in individualizing treatment strategies and can result from actual clonal evolution, biomarker conversion, or technical limitations of diagnostic tests. This study explored biomarker conversion during breast cancer (BC) progression in 67 patients with different tumor subtypes and metastatic sites via mRNA quantification and subsequently analyzed the concordance between real-time qPCR and immunohistochemistry (IHC). Immunostaining for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 was performed on formalin-fixed, paraffin-embedded PT and MT tissue sections. RT-qPCR was performed using a multiplex RT-qPCR kit for ESR1, PGR, ERBB2, and MKI67 and the reference genes B2M and CALM2. Subsequent measurement of tumor biomarker mRNA expression to detect conversion revealed significant decreases in ESR1 and PGR mRNA and MKI67 upregulation (all p < 0.001) in MT compared to PT of all tumor subtypes and ERBB2 upregulation in MT from triple-negative PT patients (p = 0.023). Furthermore, ERBB2 mRNA was upregulated in MT brain biopsies, particularly those from triple-negative PTs (p = 0.023). High concordance between RT-qPCR and IHC was observed for ER/ESR1 (81%(κ 0.51) in PT and 84%(κ 0.34) in MT, PR/PGR (70%(κ 0.10) in PT and 78% (κ -0.32) in MT), and for HER2/ERBB2 (100% in PT and 89% in MT). Discordance between mRNA biomarker assessments of PT and MT resulting from receptor conversion calls for dynamic monitoring of BC tumor biomarkers. Overall, RT-qPCR assessment of BC target genes and their mRNA expression is highly concordant with IHC protein analysis in both primary and metastatic tumor.
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Affiliation(s)
- Stefan Stefanovic
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Ralph Wirtz
- Stratifyer Molecular Pathology GmbH, 50935 Cologne, Germany
| | - Thomas M. Deutsch
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Peter Sinn
- Department of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Zsuzsanna Varga
- Institute of Surgical Pathology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Bettina Sobottka
- Institute of Surgical Pathology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Lakis Sotiris
- Stratifyer Molecular Pathology GmbH, 50935 Cologne, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Andre Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Sara Y. Brucker
- Research Institute for Women's Health, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, 69120 Heidelberg, Germany
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21
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Maier A, Heil J, Lauer A, Harcos A, Schaefgen B, von Au A, Spratte J, Riedel F, Rauch G, Hennigs A, Domschke C, Schott S, Rom J, Schuetz F, Sohn C, Golatta M. Inter-rater reliability and double reading analysis of an automated three-dimensional breast ultrasound system: comparison of two independent examiners. Arch Gynecol Obstet 2017; 296:571-582. [PMID: 28748340 DOI: 10.1007/s00404-017-4473-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/08/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Breast ultrasound could be a valuable tool complementary to mammography in breast cancer screening. Automated 3D breast ultrasound (ABUS) addresses challenges of hand-held ultrasound and could allow double reading analysis of ultrasound images. This trial assesses the inter-rater reliability and double reading analysis of an ABUS system. METHODS To assess the reproducibility and diagnostic validity of the ABUS system, SomoV™, a blinded double reading analysis, was performed in 1019 patients (2038 breasts) by two examiners (examiner A/B) and compared to single reading results, as well as to the reference standard regarding its diagnostic validity. Cohen's kappa coefficients were calculated to measure the inter-rater reliability and agreement of the different diagnostic modalities. Patient comfort and time consumption for image acquisition and reading were analyzed descriptively as secondary objectives. RESULTS Analysis of inter-rater reliability yielded agreement in 81.6% (κ = 0.37; p < 0.0001) showing fair agreement. Single reading analysis of SomoV™ exams (examiner A/examiner B) compared to reference standard showed good specificity (examiner A: 88.3%/examiner B: 84.5%), fair inter-rater agreement (examiner A: κ = 0.31/examiner B: κ = 0.31), and adequate sensitivity (examiner A: 53.1%/examiner B: 64.2%). Double reading analysis yielded good sensitivity and specificity (73.7 and 77.7%). Mammography (n = 1911) alone detected 160 of 176 carcinomas (sensitivity 90.1%). Adding SomoV™ to mammography would have detected 12 additional carcinomas, resulting in a higher sensitivity of 97.7%. CONCLUSION SomoV™ is a promising technique with good sensitivity, high patient comfort, and fair inter-examiner reliability. It allows double reading analysis that, in combination with mammography, could increase detection rates in breast cancer screening.
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Affiliation(s)
- Anna Maier
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Anna Lauer
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Aba Harcos
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Benedikt Schaefgen
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Alexandra von Au
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Julia Spratte
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hennigs
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sarah Schott
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joachim Rom
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Florian Schuetz
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- University Breast Unit, Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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22
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Jackisch C, Fasching PA, Grischke EM, Schuetz F, Decker T, Uleer C, Salat C, Foerster F, Schmidt M, Mundhenke C, Tesch H, Wimberger P, Aktas B, Zahn MO, Tome O, Bloch W, Hanson S, Schubert J, Lueftner D. Median progression free survival (PFS) for patients treated with everolimus (EVE) + exemestane (EXE) for HR+ mBC in routine clinical practice: Results of the 3rd interim analysis of the non-interventional trial BRAWO. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12547] [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
e12547 Background: BRAWO is a non-interventional study, which enrolled more than 2400 patients (pts) with advanced/metastatic, hormone-receptor-positive and HER2-negative breast cancer treated with EVE and EXE. Main objectives are a) the impact of physical activity on efficacy and quality of life, b) prophylaxis and management of stomatitis in clinical routine, and c) the sequence of therapy when EVE is used in daily clinical practice. We report updated data of the 3rd interim analysis, including PFS. Methods: This updated analysis (data cut-off 18 Oct 2016) covers data of the first 1345 documented pts with at least one follow up under therapy. Here we describe the baseline characteristics, safety and PFS as well as response rates. PFS was estimated using Kaplan-Meier estimator. Results: At the time point of this data cut-off 1289 pts (93.9%) had discontinued the documentation. The median time for pts since primary diagnosis was 7.1 yrs and 2.2 yrs, since first sign of relapse (local recurrence or metastases). At baseline, 54.1% presented with visceral metastases. 49.2% had an ECOG performance status of 0 and 74.8% of pts started with 10mg EVE, while 24.5% started with 5mg EVE. According to treatment lines we found 27% 1L (359 pts), 32% 2L (426 pts), 19% 3L (253 pts), 11% 4L (153 pts) and 11% 5L (154 pts) in our cohort Additional baseline and safety data will be presented. The Kaplan Meier estimate of the overall PFS is 6.9 months (95%CI 6.3-7.4). 2.2% (18 pts) of the pts experienced a complete and 17.8% (147 pts) a partial remission, while 57.4% (475 pts) remained stable as their best overall responses during the documentation period. 52.3% (718 pts) discontinued the treatment due to a progressive disease and 25.5% (350 pts) due to adverse events. 67.1% (902 pts) continued the antineoplastic treatment with a subsequent therapy. Conclusions: Here we report the PFS of pts treated with EVE + EXE in a real world scenario. The PFS of 6.9 months observed in our series matches somewhat perfect with the PFS of 7.8 months from the randomized Bolero-2 trial suggesting that these findings might be valid and useful for everyday routine. Clinical trial information: EUPAS9462.
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Affiliation(s)
| | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | - Sven Hanson
- Novartis Pharmaceuticals GmbH, Goettingen, Germany
| | | | - Diana Lueftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
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23
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Fasching PA, Grischke EM, Schuetz F, Decker T, Uleer C, Salat C, Foerster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Wimberger P, Aktas B, Zahn MO, Tome O, Bloch W, Hanson S, Fischer T, Schubert J, Lueftner D. Analysis of everolimus starting dose as prognostic marker in HR+ mBC patients treated with everolimus (EVE) + exemestane (EXE): Results of the 3rd interim analysis of the non-interventional trial BRAWO. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1061] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
1061 Background: BRAWO is a German non-interventional study, which enrolled more than 2400 patients (pts) with advanced/metastatic, hormone-receptor-positive and HER2-negative breast cancer treated with EVE and EXE. Main objectives are a) the impact of physical activity on efficacy and quality of life, b) prophylaxis and management of stomatitis in clinical routine, and c) the sequence of therapy when EVE is used in daily clinical practice. Methods: In this update on the results of the 3rd interim analysis (data cut-off 18-Oct-2016) we analyzed under real world conditions the first 1.078 patients followed up until disease progression for their progression-free survival (PFS) events. A two-stage process based on a Cox regression model was used to check the relevance of the start dose on PFS. In the first step potentially relevant covariates defined by medical experts were evaluated for relevance. In the second step start dose and all covariates showing a p-value of at most 0.1 in first step including all two-interaction of start dose with these parameters were included into the model. Results: Our multivariate analysis support the evidence that predictive factors, such as body mass index (BMI, p-value: < 0.001), therapeutic line (1st vs. 2nd+3rd vs. ≥4th; p-value: 0.013), presence of visceral metastases (p-value: < 0.001) and ECOG (Eastern Cooperative Oncology Group, p-value: < 0.001) status at the beginning of the therapy correlated significantly with the PFS. 283 patients started with 5mg and 795 Patients started with 10 mg. Starting dose had no significant impact on the PFS (neither as main effect nor within interactions, p-value: 0.44-0.88). Conclusions: Even though the approved and recommended starting dose for treatment with EVE is 10 mg, physicians sometimes start EVE-treatment with a lower starting dose, trying subsequently to increase the dose to the recommended dose of 10mg to allow the patient’s organism to adapt to the therapeutic. As the study was not powered to detect possible differences in PFS by starting dose, the result of showing no detrimental effect of a lower start dose may be the result of limited power. Clinical trial information: EUPAS9462.
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Affiliation(s)
| | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | - Sven Hanson
- Novartis Pharmaceuticals GmbH, Goettingen, Germany
| | | | | | - Diana Lueftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
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24
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Fremd C, Hack CC, Schneeweiss A, Rauch G, Wallwiener D, Brucker SY, Taran FA, Hartkopf A, Overkamp F, Tesch H, Fehm T, Hadji P, Janni W, Lüftner D, Lux MP, Müller V, Ettl J, Belleville E, Sohn C, Schuetz F, Beckmann MM, Fasching PA, Wallwiener M. Use of complementary and integrative medicine among German breast cancer patients: predictors and implications for patient care within the PRAEGNANT study network. Arch Gynecol Obstet 2017; 295:1239-1245. [DOI: 10.1007/s00404-017-4348-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022]
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25
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Rathinasamy A, Domschke C, Ge Y, Böhm HH, Dettling S, Jansen D, Lasitschka F, Umansky L, Gräler MH, Hartmann J, Herold-Mende C, Schuetz F, Beckhove P. Tumor specific regulatory T cells in the bone marrow of breast cancer patients selectively upregulate the emigration receptor S1P1. Cancer Immunol Immunother 2017; 66:593-603. [PMID: 28224210 PMCID: PMC5406429 DOI: 10.1007/s00262-017-1964-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 01/27/2017] [Indexed: 10/25/2022]
Abstract
Regulatory T cells (Treg) hamper anti-tumor T-cell responses resulting in reduced survival and failure of cancer immunotherapy. Among lymphoid organs, the bone marrow (BM) is a major site of Treg residence and recirculation. However, the process governing the emigration of Treg from BM into the circulation remains elusive. We here show that breast cancer patients harbour reduced Treg frequencies in the BM as compared to healthy individuals or the blood. This was particularly the case for tumor antigen-specific Treg which were quantified by MHCII tumor peptide loaded tetramers. We further demonstrate that decreased Treg distribution in the BM correlated with increased Treg redistribution to tumor tissue, suggesting that TCR triggering induces a translocation of Treg from the BM into tumor tissue. Sphingosine-1-phosphate receptor 1 (S1P1)-which is known to mediate exit of immune cells from lymphoid organs was selectively expressed by tumor antigen-specific BM Treg. S1P1 expression could be induced in Treg by BM-resident antigen-presenting cells (BMAPCs) in conjunction with TCR stimulation, but not by TCR stimulation or BMAPCs alone and triggered the migration of Treg but not conventional T cells (Tcon) to its ligand Sphingosine-1-phosphate (S1P). Interestingly, we detected marked S1P gradients between PB and BM in breast cancer patients but not in healthy individuals. Taken together, our data suggest a role for S1P1 in mediating the selective mobilization of tumor specific Treg from the BM of breast cancer patients and their translocation into tumor tissue.
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Affiliation(s)
- Anchana Rathinasamy
- Division of Translational Immunology, National Center for Tumor Diseases (NCT), DKFZ, Heidelberg, Germany.,Regensburg Center for Interventional Immunology and University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Yingzi Ge
- Division of Translational Immunology, National Center for Tumor Diseases (NCT), DKFZ, Heidelberg, Germany
| | - Hans-Henning Böhm
- Division of Translational Immunology, National Center for Tumor Diseases (NCT), DKFZ, Heidelberg, Germany
| | - Steffen Dettling
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - David Jansen
- Institute of Pathology, Heidelberg University Hospital Center, Heidelberg, Germany.,Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Felix Lasitschka
- Institute of Pathology, Heidelberg University Hospital Center, Heidelberg, Germany
| | - Ludmila Umansky
- Division of Translational Immunology, National Center for Tumor Diseases (NCT), DKFZ, Heidelberg, Germany
| | - Markus H Gräler
- Department of Anesthesiology and Intensive Care Medicine, Center for Sepsis Control and Care (CSCC), and Center for Molecular Biomedicine (CMB), University Hospital Jena, Jena, Germany
| | - Jennifer Hartmann
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Beckhove
- Division of Translational Immunology, National Center for Tumor Diseases (NCT), DKFZ, Heidelberg, Germany. .,Regensburg Center for Interventional Immunology and University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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26
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von Au A, Klotzbuecher M, Uhlmann L, Boudewijns M, Michel L, Wallwiener M, Heil J, Golatta M, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Impact of reproductive factors on breast cancer subtypes in postmenopausal women: a retrospective single-center study. Arch Gynecol Obstet 2017; 295:971-978. [DOI: 10.1007/s00404-017-4298-8] [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] [Received: 06/17/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
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27
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Heil J, Schaefgen B, Sinn P, Richter H, Harcos A, Gomez C, Stieber A, Hennigs A, Rauch G, Schuetz F, Sohn C, Schneeweiss A, Golatta M. Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy? Eur J Cancer 2016; 69:142-150. [DOI: 10.1016/j.ejca.2016.09.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/23/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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28
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Stefanovic S, Wallwiener M, Karic U, Domschke C, Katic L, Taran FA, Pesic A, Hartkopf A, Hadji P, Teufel M, Schuetz F, Sohn C, Fasching P, Schneeweiss A, Brucker S. Patient-reported outcomes (PRO) focused on adverse events (PRO-AEs) in adjuvant and metastatic breast cancer: clinical and translational implications. Support Care Cancer 2016; 25:549-558. [PMID: 27747478 DOI: 10.1007/s00520-016-3437-2] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The capture of adequate treatment outcomes and quality of life (QOL) of advanced breast cancer patients in clinical routine represents a great challenge. Patient-reported outcomes (PROs) are data elements directly reported by patients about experiences with care, including symptoms, functional status, or quality of life. There is growing interest in the medical community for the evaluation and implementation of PROs of adverse events (PRO-AEs). Recent interest in PROs in health care has evolved in the context of patient centeredness. Our primary objective was to identify trials that had implemented PRO-AEs in the breast cancer treatment setting, thereby demonstrating its feasibility. We aimed to identify published studies that used patient reports to assess AEs during and after breast cancer treatment, to identify clinician underreported and modifiable AEs that are important to patients, and to analyze the feasibility and usefulness of PRO instrument implementation in everyday oncological practice with special attention given to electronic-based PRO instruments. METHODS We conducted a systematic search of PubMed for studies that used PRO instruments to assess AEs of breast cancer treatment in the metastatic and adjuvant settings. Two authors independently reviewed the search results and decided which studies fully met the predefined inclusion criteria. RESULTS The search yielded 606 publications. The two reviewers found that 9 studies met the inclusion criteria. Three AEs were identified as important to patients but inadequately reported by health care providers, namely hot flushes, vaginal dryness, and weight gain. CONCLUSIONS PROs and PRO-AEs are the consequence of contemporary concepts of patient-centered medicine and the growing feasibility, utility, and implications of collecting data using modern technology. Furthermore, the willingness of patients to utilize innovative applications for their own health has been increasing in parallel to the enhanced impact of the World Wide Web. Especially, the coverage of the metastatic situation promises numerous findings on the structure and quality of health care, enabling implementation of individually tailored interventions. Remote electronic self-reporting (i.e., home reporting) is feasible and is associated with high compliance levels.
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Affiliation(s)
- Stefan Stefanovic
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Uros Karic
- IMDI Science Center, International Medical Diplomacy Institute, Vodovodska 27a, Belgrade, 11000, Serbia
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Luka Katic
- IMDI Science Center, International Medical Diplomacy Institute, Vodovodska 27a, Belgrade, 11000, Serbia
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Aleksandra Pesic
- IMDI Science Center, International Medical Diplomacy Institute, Vodovodska 27a, Belgrade, 11000, Serbia
| | - Andreas Hartkopf
- Department of Women's Health, University Hospital Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Peyman Hadji
- Department of Bone Oncology, Gynecological Endocrinology and Reproductive Medicine, Philipps-University of Marburg-Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy/Psycho-Oncology, Tuebingen University Hospital, Osianderstr. 5, 72076, Tuebingen, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Peter Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Sara Brucker
- Department of Women's Health, Research Institute for Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tuebingen, Germany
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Hennigs A, Riedel F, Marmé F, Sinn P, Lindel K, Gondos A, Smetanay K, Golatta M, Sohn C, Schuetz F, Heil J, Schneeweiss A. Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat 2016; 160:491-499. [PMID: 27744486 PMCID: PMC5090013 DOI: 10.1007/s10549-016-4016-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 10/07/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022]
Abstract
Background During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units. Patients and methods This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014. Results Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %. Conclusions The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-4016-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Marmé
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany
| | - P Sinn
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - K Lindel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - A Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Smetanay
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
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Heil J, Schaefgen B, Sinn P, Richter H, Harcos A, Gomez C, Stieber A, Hennigs A, Rauch G, Schneeweiss A, Schuetz F, Sohn C, Golatta M. Kann eine pathologische Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebspatientinnen mithilfe einer minimal invasiven Biopsie diagnostiziert werden? Ergebnisse einer prospektiven Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592805] [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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Au AV, Klotzbücher M, Wallwiener M, Schneeweiss A, Sohn C, Schuetz F, Domschke C. Impact of reproductive factors on breast cancer subtypes in postmenopausal women: a retrospective monocentric study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593139] [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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Heil J, Kneser U, Hennigs A, Bieber C, Gschwendtner K, Mueller N, Rauch G, Schuetz F, Sohn C, Kremer T. Do Contralateral Prophylactic Mastectomies Help Patients? J Clin Oncol 2016; 34:4191. [PMID: 27621389 DOI: 10.1200/jco.2016.68.2997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Joerg Heil
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Andre Hennigs
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Christiane Bieber
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Kathrin Gschwendtner
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Nicole Mueller
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Geraldine Rauch
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Florian Schuetz
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Christof Sohn
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
| | - Thomas Kremer
- Joerg Heil, University Hospital Heidelberg, Heidelberg, Germany; Ulrich Kneser, University of Heidelberg, Ludwigshafen, Germany; Andre Hennigs, Christiane Bieber, Kathrin Gschwendtner, Nicole Mueller, Geraldine Rauch, Florian Schuetz, and Christof Sohn, University Hospital Heidelberg, Heidelberg, Germany; and Thomas Kremer, University of Heidelberg, Ludwigshafen, Germany
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von Au A, Milloth E, Diel I, Stefanovic S, Hennigs A, Wallwiener M, Heil J, Golatta M, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Intravenous pamidronate versus oral and intravenous clodronate in bone metastatic breast cancer: a randomized, open-label, non-inferiority Phase III trial. Onco Targets Ther 2016; 9:4173-80. [PMID: 27468239 PMCID: PMC4944913 DOI: 10.2147/ott.s103130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose Patients with metastasized breast cancer often suffer from discomfort caused by metastatic bone disease. Thus, osteoprotection is an important part of therapy in breast cancer metastasized to bone, and bisphosphonates (BPs) are a major therapeutic option. In this study, our objectives were to compare the side effects of oral versus intravenous BP treatment and to assess their clinical effectiveness. Patients and methods In this prospective randomized, open-label, non-inferiority trial, we enrolled breast cancer patients with at least one bone metastasis and an Eastern Cooperative Oncology Group performance status of 0–2. Patients were randomly assigned to one of the three treatment groups: A, 60 mg pamidronate intravenously q3w; B-iv, 900 mg clodronate intravenously q3w; and B-o, 2,400 mg oral clodronate daily. Assessments were performed at baseline and every 3 months thereafter. Results Between 1995 and 1999, 321 patients with confirmed bone metastases from breast cancer were included in the study. At first follow-up, gastrointestinal (GI) tract side effects were most common, and adverse effects on the GI tract were more frequent in the oral treatment group (P=0.002 and P<0.001, respectively). There were no statistically significant differences among the treatment cohorts for other documented side effects (skin, serum electrolytes, urinary tract, immune system, and others). No significant differences in clinical effectiveness of BP treatment, as assessed by pain score, were detected among the groups; however, pathologic fractures were more effectively prevented by intravenous than oral BP administration (P=0.03). Noncompliance rates were similar among the study cohorts. Conclusion We conclude that oral BP treatment is significantly associated with higher rates of adverse GI side effects. Additionally, our data indicate that intravenous BP administration is more effective than oral treatment in prevention of pathologic fractures; hence, oral administration should be considered with caution.
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Affiliation(s)
- Alexandra von Au
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Eva Milloth
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Ingo Diel
- CGG Clinic - Centrum für ganzheitliche Gynäkologie Mannheim, Mannheim, Germany
| | - Stefan Stefanovic
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Andre Hennigs
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Markus Wallwiener
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Joerg Heil
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Michael Golatta
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Joachim Rom
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Christof Sohn
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Andreas Schneeweiss
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Florian Schuetz
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
| | - Christoph Domschke
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg
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Domschke C, Schneeweiss A, Stefanovic S, Wallwiener M, Heil J, Rom J, Sohn C, Beckhove P, Schuetz F. Cellular Immune Responses and Immune Escape Mechanisms in Breast Cancer: Determinants of Immunotherapy. Breast Care (Basel) 2016; 11:102-7. [PMID: 27239171 DOI: 10.1159/000446061] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
More recently, immunotherapy has emerged as a novel potentially effective therapeutic option also for solid malignancies such as breast cancer (BC). Relevant approaches, however, are determined by the 2 main elements of cancer immunoediting - the elimination of nascent transformed cells by immunosurveillance on the one hand and tumor immune escape on the other hand. Correspondingly, we here review the role of the various cellular immune players within the host-protective system and dissect the mechanisms of immune evasion leading to tumor progression. If the immune balance of disseminated BC cell dormancy (equilibrium phase) is lost, distant metastatic relapse may occur. The relevant cellular antitumor responses and translational immunotherapeutic options will also be discussed in terms of clinical benefit and future directions in BC management.
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Affiliation(s)
- Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Stefan Stefanovic
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Joachim Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology (RCI) and University Medical Center of Regensburg, Regensburg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
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Hennigs A, Fuchs V, Sinn HP, Riedel F, Rauch G, Smetanay K, Golatta M, Domschke C, Schuetz F, Schneeweiss A, Sohn C, Heil J. Do Patients After Reexcision Due to Involved or Close Margins Have the Same Risk of Local Recurrence as Those After One-Step Breast-Conserving Surgery? Ann Surg Oncol 2016; 23:1831-7. [PMID: 26732272 DOI: 10.1245/s10434-015-5067-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore whether patients after a reexcision due to involved or close margins have the same risk of local recurrence (LR) than those after a one-step breast-conserving surgery (BCS); to learn whether the presence of residual cancer in the reexcision specimen influences the probability of LR. METHODS We reviewed demographic, clinical, radiologic, and pathologic records of a cohort of women diagnosed with invasive cancer or carcinoma-in situ who underwent BCS surgery as final surgical treatment between January 1, 2003, and December 31, 2011. Univariable and multivariable Cox regression analyses were used to evaluate influencing factors of LR. RESULTS A total of 2657 patients were eligible for inclusion onto this study. LR was observed in 67 patients (2.5 %) after a median follow-up of 52 months. Reexcision surgery was performed in 486 patients (18.3 %). The 5-year LR-free survival rate was 94.5 % in the reexcision group and 98.0 % in the group with one-step BCS surgery (p < 0.001). In multivariable Cox regression analyses including different covariates patients with a reexcision had a two to eightfold higher risk of LR. Residual cancer in the reexcision specimen did not influence the LR rate (hazard ratio 1.1, p = 0.779). CONCLUSIONS This study suggests the importance of a complete tumor resection ideally within one surgical procedure. Therefore, rigorous preoperative planning, multidisciplinary decision making, and additional intraoperative techniques (e.g., ultrasound, specimen radiography, and/or cavity shaved margin) should be used to avoid the need for reexcision.
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Affiliation(s)
- André Hennigs
- Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Valerie Fuchs
- Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Fabian Riedel
- Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor Diseases, Heidelberg University, Heidelberg, Germany
| | | | | | | | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University, Heidelberg, Germany
| | - Christof Sohn
- Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Joerg Heil
- Breast Unit, Heidelberg University, Heidelberg, Germany.
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von Au A, Weiler U, Stefanovic S, Wallwiener M, Heil J, Golatta M, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Breast cancer presentation and therapy in migrant versus native German patients: contrasting and convergent data of a retrospective monocentric study. Arch Gynecol Obstet 2015; 294:145-52. [DOI: 10.1007/s00404-015-3938-0] [Citation(s) in RCA: 3] [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] [Received: 09/03/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Schaefgen B, Mati M, Sinn HP, Golatta M, Stieber A, Rauch G, Hennigs A, Richter H, Domschke C, Schuetz F, Sohn C, Schneeweiss A, Heil J. Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response? Ann Surg Oncol 2015; 23:789-95. [PMID: 26467456 DOI: 10.1245/s10434-015-4918-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT. METHODS This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2-/HR+) cancers, respectively. RESULTS In 46 cases (31%), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61% for near-cCR in MRI and lowest with 44% for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25% according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94%; FNR 5%). The lowest FPR was 10 % in MRI, and the highest FPR was 44% in US. CONCLUSION Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
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Affiliation(s)
- B Schaefgen
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - M Mati
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H P Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Stieber
- Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H Richter
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Domschke
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.,National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.
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Stefanovic S, Diel I, Sinn P, Englert S, Hennigs A, Mayer C, Schott S, Wallwiener M, Blumenstein M, Golatta M, Heil J, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Disseminated Tumor Cells in the Bone Marrow of Patients with Operable Primary Breast Cancer: Prognostic Impact in Immunophenotypic Subgroups and Clinical Implication for Bisphosphonate Treatment. Ann Surg Oncol 2015; 23:757-66. [DOI: 10.1245/s10434-015-4895-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Indexed: 11/18/2022]
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Lüftner D, Grischke E, Fasching P, Decker T, Schneeweiss A, Uleer C, Foerster F, Wimberger P, Kluth-Pepper B, Schubert J, Bloch W, Tesch H, Schuetz F, Jackisch C. 1869 Disease characteristics of subgroup patients treated with everolimus + exemestane for <12 months, ≥12 to <18months, and ≥18 months - Results of the 3rd interim analysis of the non-interventional trial BRAWO. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30819-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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Rauh C, Schuetz F, Rack B, Stickeler E, Klar M, Orlowska-Volk M, Windfuhr-Blum M, Heil J, Rom J, Sohn C, Andergassen U, Jueckstock J, Fehm T, Loehberg CR, Hein A, Schulz-Wendtland R, Hartmann A, Beckmann MW, Janni W, Fasching PA, Häberle L. Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients. Geburtshilfe Frauenheilkd 2015; 75:588-596. [PMID: 26166840 DOI: 10.1055/s-0035-1546149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/02/2015] [Accepted: 05/19/2015] [Indexed: 12/23/2022] Open
Abstract
Introduction: Use of hormone therapy (HT) has declined dramatically in recent years. Some studies have reported that HT use before a diagnosis of breast cancer (BC) may be a prognostic factor in postmenopausal patients. This study aimed to examine the prognostic relevance of HT use before BC diagnosis. Methods: Four BC cohort studies in Germany were pooled, and 4492 postmenopausal patients with HT use data were identified. Patient data and tumor characteristics were compared between users and nonusers, along with overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS). Cox proportional hazards models were stratified by study center and adjusted for age at diagnosis, tumor stage, grading, nodal status, and hormone receptors. Results: Women with HT use before the diagnosis of BC were more likely to have a lower tumor stage, to be estrogen receptor-negative, and to have a lower grading. With regard to prognosis there were effects seen for OS, DMFS and LRFS, specifically in the subgroup of women with a positive hormone receptor. In these subgroups, BC patients had a better prognosis with previous HT use. Conclusions: HT use before a diagnosis of BC is associated with a more favorable prognosis in women with a positive hormone receptor status. It may be recommended that the prognostic factor HT should be documented and analyzed as a confounder for prognosis in studies of postmenopausal hormone-responsive breast cancers.
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Affiliation(s)
- C Rauh
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - F Schuetz
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - B Rack
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - E Stickeler
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Klar
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Orlowska-Volk
- Institute of Pathology, Freiburg University Medical Center, Freiburg
| | - M Windfuhr-Blum
- Department of Radiology, Freiburg University Medical Center, Freiburg
| | - J Heil
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - J Rom
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - C Sohn
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - U Andergassen
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - J Jueckstock
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - T Fehm
- Department of Gynecology and Obstetrics, Duesseldorf University Hospital, Düsseldorf
| | - C R Loehberg
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hein
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hartmann
- Institute of Pathology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - M W Beckmann
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - W Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - P A Fasching
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, USA
| | - L Häberle
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
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Fremd C, Stefanovic S, Beckhove P, Pritsch M, Lim H, Wallwiener M, Heil J, Golatta M, Rom J, Sohn C, Schneeweiss A, Schuetz F, Domschke C. Mucin 1-specific B cell immune responses and their impact on overall survival in breast cancer patients. Oncoimmunology 2015; 5:e1057387. [PMID: 26942066 DOI: 10.1080/2162402x.2015.1057387] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 02/07/2023] Open
Abstract
Considering the diverse functions of B cells, responses to tumor-associated antigens (TAA) have been thought to be the main source of B cell-mediated antitumor immunity. Polymorphic epithelial mucin (MUC1) is considered one of the most specific TAA in patients with breast cancer. The present study aims to dissect the level and subclasses of naturally occurring anti-MUC1 antibodies in regard to tumor biologic parameters, clinical characteristics and overall survival. In 288 primary, non-metastatic breast cancer patients, pretreatment serum levels of anti-MUC1 immunoglobulin G (IgG) and its subclasses G1-4 as well as immunoglobulin M (IgM) were analyzed via ELISA. With respect to overall survival (Kaplan-Meier analysis), tumor biologic parameters as hormone receptor status, human epidermal growth factor receptor 2 (Her2), Ki-67 expression and tumor grading have been correlated as well as clinical characteristics as nodal involvement, tumor stage and patients' age at the time of diagnosis. Median follow-up time was 148 mo (IQR: 73.1-158.5 mo). A significant increase in IgG antibody titers was correlated highly significantly with an improved overall survival of patients. In multivariate analysis, total IgG proved to be an independent prognostic marker for overall survival (p = 0.002). IgG subclass analysis did not reveal any correlation of IgG1, IgG3 and IgG4 levels with overall survival, while increased immunoglobulin G2 (IgG2) values, although statistically not significant, tended to correlate with prolonged patient survival. MUC1-specific IgM antibodies were shown not to be predictive of overall survival. Altogether, humoral immune responses appear to play a crucial part in the tumor immunity of breast cancer patients. The present data confirms the positive impact of tumor-specific IgG on prolonged overall survival in breast cancer patients. MUC1-antibody testing might be a useful tool to identify high-risk patients who may need adjuvant therapy and potentially might benefit from MUC1-directed immunotherapy.
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Affiliation(s)
- Carlo Fremd
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Stefan Stefanovic
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Philipp Beckhove
- Division of Translational Immunology; Tumor Immunology Program; German Cancer Research Center ; Heidelberg, Germany
| | - Maria Pritsch
- Division of Translational Immunology; Tumor Immunology Program; German Cancer Research Center ; Heidelberg, Germany
| | - Hendry Lim
- Division of Translational Immunology; Tumor Immunology Program; German Cancer Research Center ; Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Joachim Rom
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics; National Center for Tumor Diseases; Heidelberg University Hospital ; Heidelberg, Germany
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Abstract
In up to 75% of cases, advanced breast cancer patients eventually develop bone metastases with often debilitating skeletal-related events (SREs). Osteoclast inhibitors are commonly used as therapeutic mainstay with clinical studies showing superiority of denosumab over bisphosphonates (e.g., zoledronate) for the prevention of SREs. The present review discusses the adverse event profile of these agents, and addresses the prevention and management of untoward side effects. Adverse events associated with osteoclast inhibitors comprise osteonecrosis of the jaw and hypocalcemia. Hypocalcemia is more common with denosumab, particularly in severe renal dysfunction. During therapy, the appropriate prevention of these adverse events includes close attention to dental health, avoidance of invasive dental procedures, supplementation with calcium and vitamin D unless patients are hypercalcemic, and regular monitoring of relevant serum values. Relating to the risk of nephrotoxicity, bisphosphonates but not denosumab have been incriminated. Therefore, serum creatinine levels should be checked prior to each dose of zoledronate, and in severe renal dysfunction (creatinine clearance < 30 ml/min) zoledronate is contraindicated anyway. Acute-phase reactions are particularly linked to bisphosphonates. Consequently, if these adverse events predominate, switching to denosumab is recommended.
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Affiliation(s)
- Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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43
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Schneeweiss A, Seitz J, Smetanay K, Schuetz F, Jaeger D, Bachinger A, Zorn M, Sinn HP, Marmé F. Efficacy of nab-paclitaxel does not seem to be associated with SPARC expression in metastatic breast cancer. Anticancer Res 2014; 34:6609-6615. [PMID: 25368265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the predictive value of the expression of the secreted protein acidic and rich in cysteine (SPARC) for nab-paclitaxel in metastatic breast cancer (MBC). PATIENTS AND METHODS Forty-four patients with progressive MBC were prospectively treated with nab-paclitaxel. Expression of SPARC in tumor cells was assessed by an immunoreactive score, integrating staining intensity and percentage of positive tumor cells; expression in stroma based on staining intensity. SPARC serum levels were determined before 1st and 2nd cycle of nab-paclitaxel and at progression. By applying several cut-offs the association between SPARC expression or serum levels and clinical end-points was analyzed. RESULTS No clear association between expression of SPARC in primary or metastatic tumor tissue or in serum and any clinical end-point could be detected regardless of the various cut-offs applied. CONCLUSION Efficacy of nab-paclitaxel in MBC does not seem to be associated with expression of SPARC in tumor tissues or serum.
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Schuetz
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jaeger
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Markus Zorn
- Central Laboratory, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Marmé
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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Fremd C, Schuetz F, Sohn C, Beckhove P, Domschke C. B cell-regulated immune responses in tumor models and cancer patients. Oncoimmunology 2014; 2:e25443. [PMID: 24073382 PMCID: PMC3782133 DOI: 10.4161/onci.25443] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 12/20/2022] Open
Abstract
The essential role played by T cells in anticancer immunity is widely accepted. The immunosuppressive functions of regulatory T cells are central for tumor progression and have been endowed with a robust predictive value. Increasing evidence indicates that also B cells have a crucial part in the regulation of T-cell responses against tumors. Although experiments reporting the production of natural antitumor antibodies and the induction of cytotoxic immune responses have revealed a tumor-protective function for B cells, other findings suggest that B cells may also exert tumor-promoting functions, resulting in a controversial picture. Here, we review recent evidence on the interactions between B and T cells in murine models and cancer patients and their implications for cancer immunology.
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Affiliation(s)
- Carlo Fremd
- Department of Gynecology and Obstetrics; University Hospital of Heidelberg; Heidelberg, Germany
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45
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Stefanovic S, Diel I, Sinn P, Sohn C, Schuetz F, Domschke C. Disseminated tumor cells in the bone marrow of patients with operable primary breast cancer: prognostic value and tumor phenotype. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tedla M, Golatta M, Stieber A, Rauch G, Marmé F, Schulz S, Harcos A, Schott S, Domschke C, Kauczor HU, Schneeweiss A, Schuetz F, Sohn C, Sinn P, Heil J. Prädiktion einer pathologischen Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebs mithilfe bildgebender und pathologischer Befunde. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Foersterling E, Golatta M, Hennigs A, Schulz S, Rauch G, Schott S, Domschke C, Schuetz F, Sohn C, Heil J. Predictors of early poor aesthetic outcome after breast-conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a single institution. J Surg Oncol 2014; 110:801-6. [PMID: 25132148 DOI: 10.1002/jso.23733] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to explore features of patients reporting early poor aesthetic outcome after simple breast-conserving surgery. METHODS We prospectively evaluated 709 patients shortly after breast-conserving surgery. Aesthetic outcome was measured by aesthetic status scores of the Breast Cancer Treatment Outcome Scale. Clinical, surgical, and pathologic variables were assessed to identify predictors of poor aesthetic outcome. RESULTS Poor aesthetic outcome was reported by 46 (6.5%) patients, and 209 (29%) patients reported an intermediate aesthetic outcome. A single factor analysis of variance showed a negative impact of higher specimen weight (P < 0.001). Univariate logistic regression analysis revealed the following significant risk factors for poor aesthetic outcome: 12 o'clock positioning of tumor localization, a tumor behind the nipple areolar complex (NAC), fishmouth-shaped incision with resection of the NAC, quadrantectomy, central segmental resection, and pT stages 3 and 4. Multivariate logistic regression analysis indicated statistically independent associations between poor aesthetic outcome and tumor position in the inner half of the breast or behind the NAC, quadrantectomy, and pT stages 3 and 4. CONCLUSION Poor aesthetic outcome is relatively rare shortly after breast-conserving surgery, but predictable in specific situations.
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Affiliation(s)
- Eva Foersterling
- Breast Unit, University Hospital of Heidelberg, Heidelberg, Germany
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48
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Lueftner D, Schuetz F, Grischke EM, Fasching PA, Wimberger P, Foerster FG, Decker T, Uleer C, Muth M, Kreuzeder J, Bloch W, Tesch H, Jackisch C. Breast cancer treatment with everolimus and exemestane for ER+ women: Results of the first interim analysis of the noninterventional trial BRAWO. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.578] [Citation(s) in RCA: 2] [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)
- Diana Lueftner
- Department of Hematology, Oncology, and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, University Hospital, Heidelberg, Germany
| | | | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technical University of Dresden, Dresden, Germany
| | - Frank Gerhard Foerster
- Schwerpunktpraxis fuer Gynaekologische Onkologie und Palliativmedizin, Chemnitz, Germany
| | | | | | | | | | | | - Hans Tesch
- Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt/Main, Germany
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Schneeweiss A, Aigner J, Smetanay K, Schuetz F, Sohn C, Kriegsmann M, Jaeger D, Zorn M, Bachinger A, Sinn HP, Marme F. Expression of SPARC and response to nab-paclitaxel (nab-p) in patients (pts) with metastatic breast cancer (MBC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e12009] [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)
- Andreas Schneeweiss
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Julia Aigner
- Department of Gynecolgy and Obstetrics, Universitiy Hospital, Heidelberg, Germany
| | - Katherina Smetanay
- Department of Gynecology and Obstetrics, University Hospital, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, University Hospital, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, University Hospital, Heidelberg, Germany
| | - Dirk Jaeger
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Frederik Marme
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
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50
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Aigner J, Marmé F, Smetanay K, Schuetz F, Jaeger D, Schneeweiss A. Nab-Paclitaxel monotherapy as a treatment of patients with metastatic breast cancer in routine clinical practice. Anticancer Res 2013; 33:3407-3413. [PMID: 23898112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To compare treatment results with use of nab-paclitaxel in routine clinical practice with data obtained from clinical trials. PATIENTS AND METHODS A retrospective chart review of all 36 patients with metastatic breast cancer treated with nab-paclitaxel was performed. Nab-paclitaxel was given weekly and usually started at 150 mg/m(2). RESULTS Thirteen (36.1%) patients received nab-paclitaxel as first-line, seven (19.4%) as second-line and 16 as third- or further line treatment. Overall, the response rate was 9.7%, disease control rate 64.5%, median progression-free survival 7.5 months and median overall survival 14.2 months. The most frequent non-hematological toxicities of grade 3 or more were fatigue (27.8%), dyspnea, rash and arthalgia (all 5.6%). Six (16.7%) patients developed peripheral neuropathy of grade 2 or more. Incidence of neutropenia grade 3 or more was 41.7% with no case of febrile neutropenia. CONCLUSION According to our experience, weekly nab-paclitaxel is effective and tolerable, with results at least comparable to those from the prospective clinical trials.
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Affiliation(s)
- Julia Aigner
- National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany.
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