1
|
Wimmer K, Hlauschek D, Balic M, Pfeiler G, Strobl-Kacerovsky S, Greil R, Singer C, Halper S, Steger G, Suppan C, Gampenrieder S, Helfgott R, Egle D, Filipits M, Jakesz R, Sölkner L, Fesl C, Gnant M, Fitzal F. P270 Is the CTS5 a helpful decision-making tool in the extended adjuvant therapy setting? Breast 2023. [DOI: 10.1016/s0960-9776(23)00388-0] [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: 03/16/2023] Open
|
2
|
Harbeck N, Rastogi P, Martin M, Tolaney SM, Shao ZM, Fasching PA, Huang CS, Jaliffe GG, Tryakin A, Goetz MP, Rugo HS, Senkus E, Testa L, Andersson M, Tamura K, Del Mastro L, Steger GG, Kreipe H, Hegg R, Sohn J, Guarneri V, Cortés J, Hamilton E, André V, Wei R, Barriga S, Sherwood S, Forrester T, Munoz M, Shahir A, San Antonio B, Nabinger SC, Toi M, Johnston SRD, O'Shaughnessy J. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 2021; 32:1571-1581. [PMID: 34656740 DOI: 10.1016/j.annonc.2021.09.015] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [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: 07/15/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adjuvant abemaciclib combined with endocrine therapy (ET) previously demonstrated clinically meaningful improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer at the second interim analysis, however follow-up was limited. Here, we present results of the prespecified primary outcome analysis and an additional follow-up analysis. PATIENTS AND METHODS This global, phase III, open-label trial randomized (1 : 1) 5637 patients to adjuvant ET for ≥5 years ± abemaciclib for 2 years. Cohort 1 enrolled patients with ≥4 positive axillary lymph nodes (ALNs), or 1-3 positive ALNs and either grade 3 disease or tumor ≥5 cm. Cohort 2 enrolled patients with 1-3 positive ALNs and centrally determined high Ki-67 index (≥20%). The primary endpoint was IDFS in the intent-to-treat population (cohorts 1 and 2). Secondary endpoints were IDFS in patients with high Ki-67, DRFS, overall survival, and safety. RESULTS At the primary outcome analysis, with 19 months median follow-up time, abemaciclib + ET resulted in a 29% reduction in the risk of developing an IDFS event [hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.58-0.87; nominal P = 0.0009]. At the additional follow-up analysis, with 27 months median follow-up and 90% of patients off treatment, IDFS (HR = 0.70, 95% CI 0.59-0.82; nominal P < 0.0001) and DRFS (HR = 0.69, 95% CI 0.57-0.83; nominal P < 0.0001) benefit was maintained. The absolute improvements in 3-year IDFS and DRFS rates were 5.4% and 4.2%, respectively. Whereas Ki-67 index was prognostic, abemaciclib benefit was consistent regardless of Ki-67 index. Safety data were consistent with the known abemaciclib risk profile. CONCLUSION Abemaciclib + ET significantly improved IDFS in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer, with an acceptable safety profile. Ki-67 index was prognostic, but abemaciclib benefit was observed regardless of Ki-67 index. Overall, the robust treatment benefit of abemaciclib extended beyond the 2-year treatment period.
Collapse
Affiliation(s)
- N Harbeck
- Breast Center, Department of OB & GYN and CCC Munich, LMU University Hospital, Munich, Germany.
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - M Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | - Z M Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - P A Fasching
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C S Huang
- National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - G G Jaliffe
- Grupo Medico Camino S.C., Mexico City, Mexico
| | - A Tryakin
- N.N.Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, San Francisco, USA
| | - E Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - L Testa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
| | | | - K Tamura
- National Cancer Center Hospital, Tokyo, Japan
| | - L Del Mastro
- IRCSS Ospedale Policlinico San Martino, UO Breast Unit, Genoa, Italy; Università di Genova, Department of Internal Medicine and Medical Specialties (DIM), Genoa, Italy
| | - G G Steger
- Medical University of Vienna, Vienna, Austria
| | - H Kreipe
- Medizinische Hochschule Hannover, Hannover, Germany
| | - R Hegg
- Clin. Pesq. e Centro São Paulo, São Paulo, Brazil
| | - J Sohn
- Yonsei Cancer Center, Seoul, Korea
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - J Cortés
- International Breast Cancer Center (IBCC), Madrid & Barcelona, and Vall d'Hebron Institute of Oncology, Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, USA
| | - V André
- Eli Lilly and Company, Indianapolis, USA
| | - R Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Barriga
- Eli Lilly and Company, Indianapolis, USA
| | - S Sherwood
- Eli Lilly and Company, Indianapolis, USA
| | | | - M Munoz
- Eli Lilly and Company, Indianapolis, USA
| | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | | | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, USA
| | | |
Collapse
|
3
|
Bjelic-Radisic V, Fitzal F, Knauer M, Steger G, Egle D, Greil R, Schrenk P, Balic M, Singer C, Exner R, Soelkner L, Gnant M. Primary surgery versus no surgery in synchronous metastatic breast cancer: patient-reported quality-of-life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial. BMC Cancer 2020; 20:392. [PMID: 32375735 PMCID: PMC7204290 DOI: 10.1186/s12885-020-06894-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The ABCSG-28 trial compared primary surgery followed by systemic therapy versus primary systemic therapy without surgery in patients with de novo stage IV BC. The present report describes QoL results of this trial. METHODS Ninety patients with primary operable MBC were randomised to surgery of the primary tumor followed by systemic therapy or to primary systemic therapy without surgery. QoL analyses covering the results at baseline, 6,12,18 and 24 months follow up of 79 (88%) patients, was assessed with the EORTC QLQ-C30 and QLQ-BR23 questionnaires. RESULTS There were no statistically significant differences in any of the scales of the QLQ-C30 and QLQ-BR23 questionnaires between the two groups over the time. Baseline global health status and physical functioning were predictors for OS (patients with a higher score lived longer (p=0.0250, p=0.0225; p=0.0355, p=0.0355)). Global health status, social functioning scale, breast symptoms and future perspective were predictors for longer TTPd (p=0.0244; p=0.0140, p=0.020; p=0.0438, p=0.0123). Patients in both arms reported significant improvement on the emotional functioning scale. Cognitive functioning decreased over time in both groups. Younger women had clinically relevant better physical and sexual functioning scores (p=0.039 and 0.024). CONCLUSION Primary surgery does not improve nor alter QoL of patients with de novo stage IV BC. Global health status and physical functioning were predictors for OS and could be use as additional marker for prediction of OS and TTTd in patients with de novo stage IV BC. TRIAL REGISTRATION The trial is registered on clinicaltrial.gov (NCT01015625, date of registration:18/11/2009).
Collapse
Affiliation(s)
- V Bjelic-Radisic
- Breast Unit, University Hospital Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany. .,Department of Gynecology and Obstetrics, Medical University Graz, Graz, Austria.
| | - F Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Knauer
- Breast Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - G Steger
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - D Egle
- Department of Gynecology and Obstetrics, Medical University Innsbruck, Inssbruck, Austria
| | - R Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular cancer Reseasrch, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - P Schrenk
- Department of Surgery, Medical University Linz, Linz, Austria
| | - M Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University Graz, Graz, Austria
| | - Ch Singer
- Department of Gynecology and Obstetrics, Medical University Vienna, Vienna, Austria
| | - R Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - L Soelkner
- Statistics Department, Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
4
|
Matikas A, Foukakis T, Moebus V, Greil R, Bengtsson NO, Steger GG, Untch M, Johansson H, Hellström M, Malmström P, Gnant M, Loibl S, Bergh J. Dose tailoring of adjuvant chemotherapy for breast cancer based on hematologic toxicities: further results from the prospective PANTHER study with focus on obese patients. Ann Oncol 2020; 30:109-114. [PMID: 30357310 DOI: 10.1093/annonc/mdy475] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Adjuvant chemotherapy (ACT) for breast cancer improves relapse-free survival (BCRFS) and overall survival. Differences in terms of efficacy and toxicity could partly be explained by the significant interpatient variability in pharmacokinetics which cannot be captured by dosing according to body surface area. Consequently, tailored dosing was prospectively evaluated in the PANTHER trial. Patients and methods PANTHER is a multicenter, open-label, randomized phase III trial which compared tailored, dose-dense (DD) epirubicin/cyclophosphamide (E/C) and tailored docetaxel (D) (tDD) with standard interval 5-fluorouracil/E/C and D. The primary end point was BCRFS and the primary efficacy analysis has been previously published. In this secondary analysis, we aimed to retrospectively explore the concept of dose tailoring. Our two hypotheses were that BCRFS would not vary depending on the cumulative administered epirubicin dose; and that dose tailoring would lead to appropriate dosing and improved outcomes for obese patients, who are known to have worse prognosis and increased toxicity after DD ACT. Results Patients treated with tDD had similar BCRFS regardless of the cumulative epirubicin dose (P = 0.495), while obese patients in this group [body mass index (BMI) ≥30] had improved BCRFS compared with nonobese ones (BMI <30) [hazard ratio (HR) = 0.51, 95% confidence interval (CI) 0.30-0.89, P = 0.02]. Moreover, tDD was associated with improved BCRFS compared with standard treatment only in obese patients (HR = 0.49, 95% CI 0.26-0.90, P = 0.022) but not in nonobese ones (HR = 0.79, 95% CI 0.60-1.04, P = 0.089). The differences were not formally statistically significant (P for interaction 0.175). There were no differences in terms of toxicity across the epirubicin dose levels or the BMI groups. Conclusions Dose tailoring is a feasible strategy that can potentially improve outcomes in obese patients without increasing toxicity and should be pursued in further clinical studies. ClinicalTrials.gov identifier NCT00798070.
Collapse
Affiliation(s)
- A Matikas
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Karolinska University Hospital, Stockholm, Sweden.
| | - T Foukakis
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - V Moebus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Academic Hospital Goethe University, Frankfurt, Germany
| | - R Greil
- IIIrd Medical Department, Paracelcus Medical University Salzburg, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
| | | | - G G Steger
- Medical Oncology, Medical University, Vienna; Gaston H. Glock Research Center, Medical University, Vienna, Austria
| | - M Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - H Johansson
- Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - M Hellström
- Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - P Malmström
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - M Gnant
- Gaston H. Glock Research Center, Medical University, Vienna, Austria; Department of Surgery, Medical University Vienna, Vienna, Austria
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - J Bergh
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
Wimmer K, Bolliger M, Bago-Horvath Z, Steger G, Kauer-Dorner D, Helfgott R, Gruber C, Moinfar F, Mittlböck M, Fitzal F. Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival. Ann Surg Oncol 2019; 27:1700-1707. [PMID: 31873929 PMCID: PMC7138765 DOI: 10.1245/s10434-019-08089-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Indexed: 12/27/2022]
Abstract
Background While “no tumour on ink” is an accepted margin width for R0 resection in primary surgery, it’s unclear if it’s oncologically safe after neoadjuvant chemotherapy (NAC). Only limited data demonstrate that surgery within new margins in cases of a pathological complete response (pCR) is safe. We therefore investigated the influence of different margins and pCR on local recurrence and survival rates after NAC. Methods We retrospectively analysed data of 406 women with invasive breast cancer, treated with NAC and breast-conserving therapy between 1994 and 2014 in two certified Austrian breast health centres. We compared R ≤ 1 mm, R > 1 mm and RX (pCR) for local recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS). Results After a median follow-up of 84.3 months, the 5-year LRFS (R ≤ 1 mm: 94.2%, R > 1 mm: 90.6%, RX: 95.0%; p = 0.940), the 5-year DFS (R ≤ 1 mm: 71.9%, R > 1 mm: 74.1%, RX: 87.2%; p = 0.245) and the 5-year OS (R ≤ 1 mm: 85.1%, R > 1 mm: 88.0%, RX: 96.4%; p = 0.236) did not differ significantly between narrow, wide, nor RX resections. Regarding DFS and OS, a negative nodal status reduced the hazard ratio significantly. Conclusion There is no significant difference in LRFS, DFS and OS comparing close, wide or unknown margins after pCR. We suggest that resection in new margins after NAC is safe according to “no tumour on ink”. Resection of the clipped area in cases of pCR is emphasized.
Collapse
Affiliation(s)
- K Wimmer
- Department of Surgery, Medical University of Vienna, Vienna, Austria.,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - M Bolliger
- Department of Surgery, Medical University of Vienna, Vienna, Austria.,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - G Steger
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Oncology Medical, University of Vienna, Vienna, Austria
| | - D Kauer-Dorner
- Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Radio-oncology, Medical University of Vienna, Vienna, Austria
| | - R Helfgott
- Department of Surgery, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - C Gruber
- Department of Pathology, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - F Moinfar
- Department of Pathology, Ordensklinikum Linz/Hospital of the Sisters of Charity, Linz, Austria
| | - M Mittlböck
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Breast Health Centre, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
6
|
Papakonstantinou A, Matikas A, Hellström M, Johansson H, Steger G, Greil R, Loibl S, Gnant M, Moebus V, Untch M, Foukakis T, Bergh J. Impact of menopause status on breast cancer outcomes and amenorrhea incidence during adjuvant tailored dose dense chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.082] [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: 11/12/2022] Open
|
7
|
Ionce LR, Christ A, Aretin B, Sagaster V, Marhold M, Steger G. Single center outcome analysis of dual anti-Her2 blockade using trastuzumab and pertuzumab in early and advanced Her2-overexpressing breast cancer. Breast 2019. [DOI: 10.1016/s0960-9776(19)30461-8] [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] Open
|
8
|
Devyatko Y, Filipits M, Greil R, Balic M, Bago-Horvath Z, Singer C, Fitzal F, Steger G, Gray B, Ferree S, Fesl C, Soelkner L, von Minckwitz G, Gnant M. Abstract P1-17-05: The impact of clinical risk assessment versus PAM-50 ROR score on prognosis and therapeutic decision making in patients with hormone-receptor positive early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Therapeutic recommendations for adjuvant treatment of hormone-receptor positive breast cancer patients depend on the individual recurrence risk. A number of genomic assays introduced to achieve this goal, but it's still questioned if they actually offer superior risk assessment compared to traditional risk evaluation by experienced clinicians. This study was designed to compare the prognostic accuracy of PAM-50 to clinical judgment.
Methods: Based on the real data of a large adjuvant trial cohort (ABCSG-8, postmenopausal HR positive breast cancer patients), we created online-questionnaires including demographic, histological, and local-therapy details, with and without results of PAM50 ROR score. Out of 14 international breast cancer experts asked for individual patient's risk evaluation (low, intermediate, high) and therapy recommendations, 9 completed the questionnaire.
Patient data were described by Kaplan-Meier estimates of distant disease free survival (DDFS) stratified by risk group. Cox regression models were compared using the Akaike Information Criterion (AIC).
Results: 10 years DDFS and hazard ratios for distant recurrences stratified by risk-group as estimated giving in Table 1:
10 years DDFS and hazard ratios for distant recurrences stratified by risk-group as estimated Low riskIntermediate riskHigh risk n (%)10y DDFS,%(95%CI)n (%)10y DDFS,%(95%CI)n (%)10y DDFS, %(95%CI) HR(95% CI) HR(95% CI) HR(95% CI)Clinical only: AIC 817.6269 (43)93.0(89.8-96.2)289 (46)89.7(85.9-93.5)73 (11)76.6(66.1-87.1) 0.68(0.39,1.20) 1 2.57(1.41,4.65)PAM50 ROR: AIC 804.8241 (34)96.5(93.1-99.1)210 (33)89.2(84.7-93.7)207 (33)82.5(76.9-88.2) 0.27(0.11,0.62) 1 1.66(0.99,2.78)Combined: AIC 813.4232 (37)95.7(93.0-98.5)282 (45)87.8(83.7-92.0)117 (18)81.7(74.2-89.2) 0.42(0.22,0.84) 1 1.90(1.11,3.24)
Adding genomic information to clinical risk factors leads to escalation of therapeutic recommendations (i.e. additional chemotherapy, extended adjuvant endocrine) in 20% of patients, and de-escalation in 13% of patients.
Conclusions: Clinical judgment accurately identified the patients at high risk of relapse, but was clearly inferior to multi-genomic testing using the PAM-50 ROR score in differentiating low from intermediate risk. Particularly when avoiding unnecessary escalated therapy is the strategic goal, the addition of PAM-50 testing to clinical judgment offers improved accuracy in predicting low vs. intermediate risk of breast cancer recurrence.
Citation Format: Devyatko Y, Filipits M, Greil R, Balic M, Bago-Horvath Z, Singer C, Fitzal F, Steger G, Gray B, Ferree S, Fesl C, Soelkner L, von Minckwitz G, Gnant M. The impact of clinical risk assessment versus PAM-50 ROR score on prognosis and therapeutic decision making in patients with hormone-receptor positive early stage breast cancer [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 P1-17-05.
Collapse
Affiliation(s)
- Y Devyatko
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Filipits
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - R Greil
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Balic
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - Z Bago-Horvath
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - C Singer
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - F Fitzal
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - G Steger
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - B Gray
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - S Ferree
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - C Fesl
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - L Soelkner
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - G von Minckwitz
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Gnant
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| |
Collapse
|
9
|
Minichsdorfer C, Bergen E, Steger GG, Pfeiler G, Frantal S, Greil R, Fohler H, Egle D, Balic M, Fitzal F, Wette V, Exner R, Bartsch RA, Gnant M. Abstract P6-21-02: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Minichsdorfer C, Bergen E, Steger GG, Pfeiler G, Frantal S, Greil R, Fohler H, Egle D, Balic M, Fitzal F, Wette V, Exner R, Bartsch RA, Gnant M. Withdrawn [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 P6-21-02.
Collapse
Affiliation(s)
- C Minichsdorfer
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - E Bergen
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - GG Steger
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - G Pfeiler
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - S Frantal
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Greil
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - H Fohler
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - D Egle
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - M Balic
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - F Fitzal
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - V Wette
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Exner
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - RA Bartsch
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| |
Collapse
|
10
|
Cazzaniga ME, Ciruelos E, Fabi A, Garcia-Saenz J, Lindman H, Mavroudis D, Schem C, Steger G, Timotheadou E, Zaman K, Torri V. Metastatic or locally advanced breast cancer patients: towards an expert consensus on nab-paclitaxel treatment in HER2-negative tumours-the MACBETH project. Cancer Chemother Pharmacol 2018; 83:301-318. [PMID: 30460489 DOI: 10.1007/s00280-018-3717-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the large use of nab-paclitaxel as a treatment option in metastatic breast cancer (MBC) across different countries, no definitive data are available in particular clinical situations. AREAS COVERED Efficacy, safety and schedule issues concerning available literature on nab-paclitaxel in advanced breast cancer and in specific subgroups of patients have been discussed and voted during an International Expert Meeting. Ten expert specialists in oncology, with extensive clinical experience on Nab-P and publications in the field of MBC have been identified. Six scientific areas of interest have been covered, generating 13 specific Statements for Nab-P, after literature review. For efficacy issues, a summary of research quality was performed adopting the GRADE algorithm for evidence scoring. The panel members were invited to express their opinion on the statements, in case of disagreement all the controversial opinions and the relative motivations have been made public. EXPERT OPINION Consensus was reached in 30.8% of the Nab-P statements, mainly those regarding safety issues, whereas ones regarding efficacy and schedule still remain controversial areas, requiring further data originated by the literature.
Collapse
Affiliation(s)
- Marina E Cazzaniga
- Phase 1 Trials Research Unit and Oncology Unit, ASST Monza and Milano Bicocca School of Medicine, Via GB Pergolesi 33, 20900, Monza, MB, Italy. .,Oncology Unit, ASST Monza, Monza, Italy.
| | - E Ciruelos
- Unidad de Cáncer de Mama del Centro Integral Oncológico Clara Campal HM CIOCC, Madrid, Spain
| | - A Fabi
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - J Garcia-Saenz
- Department of Medical Oncology, IdISSC. CIBERONC-ISCIII, Hospital Clínico San Carlos, Madrid, Spain
| | - H Lindman
- Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden
| | - D Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - C Schem
- Mammazentrum, Hamburg, Germany
| | - G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - E Timotheadou
- Aristotle University of Thessaloniki School of Medicine, Papageorgiou Gen. Hospital, Thessaloníki, Greece
| | - K Zaman
- Breast Center, Department of Oncology, University Hospital CHUV, Lausanne, Switzerland
| | - V Torri
- Istituto IRCCS Istituto Mario Negri, Milan, Italy
| | | |
Collapse
|
11
|
Mokwa NF, Domröse C, Kaiser R, Steger G, Berthold G, Mallmann P. Akute maternale Maserninfektion unter Geburt. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- NF Mokwa
- Universitätsklinikum Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Deutschland
| | - C Domröse
- Universitätsklinikum Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Deutschland
| | - R Kaiser
- Universitätsklinikum Köln, Institut für Virologie, Köln, Deutschland
| | - G Steger
- Universitätsklinikum Köln, Institut für Virologie, Köln, Deutschland
| | - G Berthold
- Universitätsklinikum Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Deutschland
| | - P Mallmann
- Universitätsklinikum Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Deutschland
| |
Collapse
|
12
|
Steger G, Pichler P, Airoldi M, Mazza P, Fontaine C, Timmer Bonte J, Walewski J, Katolicka J, Mikulova M, Gasparic M. Use of lipegfilgrastim for the prophylaxis of chemotherapy-induced neutropenia: Pan-European non-interventional study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Pereyra D, Bee A, Duerr C, Lamm C, Brostjan C, Spittler A, Starlinger P, Steger G, Balic M, Gnant M, Fitzal F. Pro-angiogenic profile after resection of primary tumour might be responsible for reduced outcome in patients with primary metastasized breast cancer. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30635-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: 11/24/2022]
|
14
|
Steger G, Petru E, Haslbauer F, Marth C, Egle D, Galid A, Sliwa T, Lang A, Kuehr T, Petzer A, Ruckser R, Greil R, Mlineritsch B, Singer C, Seifert M, Andel J, Kwasny W, Pichler P, Tinchon C, Bartsch R. Real-World multicenter Austrian analysis of the safety and effectiveness of nab-paclitaxel in young and elderly patients with metastatic breast cancer. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Derfler K, Swoboda K, Hirschl M, Gottsauner-Wolf M, Steger G, Sunder-Plassmann G, Widhalm K. Comparison of Plasma Separation and Immunospecific LDL-Elimination in Severe Hypercholesterolemia. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- K. Derfler
- Medical Clinic III; Department of Nephrology
| | - K. Swoboda
- Medical Clinic III; Department of Nephrology
| | | | - M. Gottsauner-Wolf
- Medical Clinic II; Department of Cardiology University of Vienna - Austria
| | - G. Steger
- Medical Clinic III; Department of Nephrology
| | | | - K. Widhalm
- Clinic of Pediatrics, Laboratory for Lipid Research
| |
Collapse
|
16
|
Brandberg Y, Loibl S, Foukakis T, Johansson H, Gnant M, Singer C, von Minckwitz G, Bengtsson NO, Karlsson E, Mlineritsch B, Hellström M, Steger G, Carlsson L, Egle D, Greil R, Bergh J. CTCA toxicity scoring and EORTC quality of life questionnaire: A comparison of physicians’ and patients’ scoring of toxicity in the “Panther trial”. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Matoušek J, Siglová K, Jakše J, Radišek S, Brass JRJ, Tsushima T, Guček T, Duraisamy GS, Sano T, Steger G. Propagation and some physiological effects of Citrus bark cracking viroid and Apple fruit crinkle viroid in multiple infected hop (Humulus lupulus L.). J Plant Physiol 2017; 213:166-177. [PMID: 28395198 DOI: 10.1016/j.jplph.2017.02.014] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
The hop metabolome important for the brewing industry and for medical purposes is endangered worldwide due to multiple viroid infections affecting hop physiology. Combinatorial biolistic hop inoculation with Citrus bark cracking viroid (CBCVd), Apple fruit crinkle viroid (AFCVd), Hop latent viroid, and Hop stunt viroid (HSVd) showed a low CBCVd compatibility with HSVd, while all other viroid combinations were highly compatible. Unlike to other viroids, single CBCVd propagation showed a significant excess of (-) over (+) strands in hop, tomato, and Nicotiana benthamiana, but not in citruses. Inoculation of hop with all viroids led to multiple infections with unstable viroid levels in individual plants in the pre- and post-dormancy periods, and to high plant mortality and morphological disorders. Hop isolates of CBCVd and AFCVd were highly stable, only minor quasispecies were detected. CBCVd caused a strong suppression of some crucial mRNAs related to the hop prenylflavonoid biosynthesis pathway, while AFCVd-caused effects were moderate. According to mRNA degradome analysis, this suppression was not caused by a direct viroid-specific small RNA-mediated degradation. CBCVd infection led to a strong induction of two hop transcription factors from WRKY family and to a disbalance of WRKY/WDR1 complexes important for activation of lupulin genes.
Collapse
Affiliation(s)
- J Matoušek
- Biology Centre ASCR v.v.i, Institute of Plant Molecular Biology, Branišovská 31, České Budějovice 370 05, Czech Republic
| | - K Siglová
- Biology Centre ASCR v.v.i, Institute of Plant Molecular Biology, Branišovská 31, České Budějovice 370 05, Czech Republic; University of South Bohemia, Faculty of Science, Branišovská 31, 370 05 České Budějovice, Czech Republic
| | - J Jakše
- University of Ljubljana, Biotechnical Faculty, Department of Agronomy, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - S Radišek
- Slovenian Institute of Hop Research and Brewing, Cesta Žalskega tabora 2, SI-3310 Žalec, Slovenia
| | - Joseph R J Brass
- Institute of Physical Biology, Heinrich-Heine-Universität Düsseldorf, D-40204 Düsseldorf, Germany
| | - T Tsushima
- Faculty of Agriculture and Life Science, Hirosaki University, Bubkyo-cho, Hirosaki 036-8561, Japan
| | - T Guček
- Slovenian Institute of Hop Research and Brewing, Cesta Žalskega tabora 2, SI-3310 Žalec, Slovenia
| | - G S Duraisamy
- Biology Centre ASCR v.v.i, Institute of Plant Molecular Biology, Branišovská 31, České Budějovice 370 05, Czech Republic
| | - T Sano
- Faculty of Agriculture and Life Science, Hirosaki University, Bubkyo-cho, Hirosaki 036-8561, Japan
| | - G Steger
- Institute of Physical Biology, Heinrich-Heine-Universität Düsseldorf, D-40204 Düsseldorf, Germany.
| |
Collapse
|
18
|
Bell R, Brown J, Parmar M, Toi M, Suter T, Steger GG, Pivot X, Mackey J, Jackisch C, Dent R, Hall P, Xu N, Morales L, Provencher L, Hegg R, Vanlemmens L, Kirsch A, Schneeweiss A, Masuda N, Overkamp F, Cameron D. Final efficacy and updated safety results of the randomized phase III BEATRICE trial evaluating adjuvant bevacizumab-containing therapy in triple-negative early breast cancer. Ann Oncol 2017; 28:754-760. [PMID: 27993816 DOI: 10.1093/annonc/mdw665] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this analysis was to assess the long-term impact of adding bevacizumab to adjuvant chemotherapy for early triple-negative breast cancer (TNBC). Methods Patients eligible for the open-label randomized phase III BEATRICE trial had centrally confirmed triple-negative operable primary invasive breast cancer (pT1a-pT3). Investigators selected anthracycline- and/or taxane-based chemotherapy for each patient. After definitive surgery, patients were randomized 1:1 to receive ≥4 cycles of chemotherapy alone or with 1 year of bevacizumab (5 mg/kg/week equivalent). Stratification factors were nodal status, selected chemotherapy, hormone receptor status, and type of surgery. The primary end point was invasive disease-free survival (IDFS; previously reported). Secondary outcome measures included overall survival (OS) and safety. Results After 56 months' median follow-up, 293 of 2591 randomized patients had died. There was no statistically significant difference in OS between treatment arms in either the total population (hazard ratio 0.93, 95% confidence interval [CI] 0.74-1.17; P = 0.52) or pre-specified subgroups. The 5-year OS rate was 88% (95% CI 86-90%) in both treatment arms. Updated IDFS results were consistent with the primary IDFS analysis. Five-year IDFS rates were 77% (95% CI 75-79%) with chemotherapy alone versus 80% (95% CI 77-82%) with bevacizumab. From 18 months after first study dose to study end, new grade ≥3 adverse events occurred in 4.6% and 4.5% of patients in the two arms, respectively. Conclusion Final OS results showed no significant benefit from bevacizumab therapy for early TNBC. Late-onset toxicities were rare in both groups. Five-year OS and IDFS rates suggest that the prognosis for patients with TNBC is better than previously thought. ClinicalTrials.gov NCT00528567.
Collapse
Affiliation(s)
- R Bell
- Faculty of Medicine, Deakin University, Geelong, Australia
| | - J Brown
- Clinical Trials Research Unit, University of Leeds, Leeds
| | - M Parmar
- Medical Research Council Clinical Trials Unit, London, UK
| | - M Toi
- Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - T Suter
- Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - G G Steger
- Department of Internal Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - X Pivot
- Medical Oncology Service, University Hospital Jean Minjoz, Besançon, France
| | - J Mackey
- Medical Oncology, Cross Center Institute, Edmonton, Canada
| | - C Jackisch
- Department of Obstetrics and Gynecology and Breast Cancer Center, Sana Klinikum Offenbach, Offenbach, Germany
| | - R Dent
- Department of Medical Oncology, National Cancer Center, Singapore, Singapore, and Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - P Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - N Xu
- Product Development Oncology, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - L Morales
- Product Development Oncology, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - L Provencher
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Hôpital du Saint-Sacrement, Ville de Québec, Québec, Canada
| | - R Hegg
- Oncology Department, Perola Byington Hospital/FMUSP, São Paulo, Brazil
| | - L Vanlemmens
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - A Kirsch
- Onkologischer Schwerpunktam Oskar-Helene-Heim, Berlin, Germany
| | - A Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital, Heidelberg, Germany
| | - N Masuda
- Department of Surgery, Breast Oncology NHO Osaka National Hospital, Osaka, Japan
| | | | - D Cameron
- Edinburgh University Cancer Research Centre, University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, UK
| |
Collapse
|
19
|
Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Gruber C, Bartsch R, Fridrik M, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M. Abstract P1-09-10: Pathological complete response to neoadjuvant trastuzumab is dependent on HER2/CEP17 ratio in HER2-amplified early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose To evaluate whether pathological complete response to neoadjuvant trastuzumab is dependent on the level of HER2 amplification.
Patients and Methods 114 women with HER2-overexpressing early breast cancer who had received neo-adjuvant trastuzumab in the prospective ABCSG-24 and ABCSG-32 trials, and for whom the HER2/CEP17 ratio was available, were included in this analysis. The ratio was correlated with tumor response as measured by the three most commonly used definitions of pathological complete response: ypT0 ypN0, ypT0/is ypN0, and ypT0/is.
Results In trastuzumab-treated patients, ypT0 pN0 was achieved in 69.0% of patients with a HER2/CEP17 ratio of >6, but only in 30.4% of tumors with a ratio of ≤6 (p=0.001, Chi Square test). When pCR was defined by ypT0/is pN0 or by ypTis, 75.9% and 82.8% of tumors with a high ratio had a complete remission, while only 39.1%, and 38.3% with a low ratio achieved a pCR (p=0.002 and p<0.001, respectively). Logistic regression revealed that tumors with a higher HER2/CEP17 ratio had a significantly higher probability to achieve ypT0 ypN0 (OR: 5.08, 95% CI 1.86-13.90; p=0.002) than tumors with a low ratio, while none of the other clinicopathological parameters was predictive of pCR. The association between high HER2 amplification and pCR was almost exclusively confined to HR positive tumors (62.5% vs. 24.0%, 75.0% vs. 28.0%, and 87.5% vs. 28.0%, for ypT0 ypN0, ypT0/is ypN0, and ypT0/is; p=0.014, p=0.005, and p<0.001), and was largely absent in HR negative tumors.
Conclusion A HER2/CEP17 ratio of >6 in the pre-therapeutic tumor biopsy is associated with a significantly higher pCR rate particularly in HER2 / HR co-positive tumors, and can be used to predict outcome before neoadjuvant trastuzumab is initiated.
Citation Format: Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Gruber C, Bartsch R, Fridrik M, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M, For the Austrian Breast and Colorectal Cancer Study Group. Pathological complete response to neoadjuvant trastuzumab is dependent on HER2/CEP17 ratio in HER2-amplified early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-10.
Collapse
Affiliation(s)
- CF Singer
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - YY Tan
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - GG Steger
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - D Egle
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - A Reiner
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - C Gruber
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Fridrik
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Seifert
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - R Exner
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Balic
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Filipits
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
20
|
Steger G, Petru E, Haslbauer F, Egle D, Galid A, Sliwa T, Lang A, Kühr T, Petzer A, Ruckser R, Mlineritsch B, Greil R, Seifert M, Singer C, Andel J, Kwasny W, Marth C, Pichler P, Tinchon C, Bartsch R. Safety and effectiveness of nab-paclitaxel in young and elderly patients with metastatic breast cancer: a prospective, multicenter non-interventional study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Pivot X, Poole C, Martín M, Gligorov J, Barrios C, Vrdoljak E, Gianni L, Ten Tije A, Machackova Z, Truman M, Steger G. An open-label, multinational, multicentre, phase IIIB umbrella study of subcutaneous trastuzumab with or without chemotherapy or pertuzumab in patients with HER2-positive early or metastatic breast cancer (UmbHER1): Interim safety results from early breast cancer studies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Body JJ, von Moos R, Lipton A, Martin M, Diel I, Steger G, Tonkin K, de Boer R, Radcliffe HS, Niepel D, Stopeck A. Denosumab for the prevention of symptomatic skeletal events (SSEs) in patients with bone-metastatic breast cancer: A comparison with skeletal-related events (SREs). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Exner R, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. Breast Cancer Res Treat 2016; 157:91-9. [PMID: 27107570 PMCID: PMC4866984 DOI: 10.1007/s10549-016-3787-y] [Citation(s) in RCA: 13] [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: 01/09/2016] [Accepted: 04/05/2016] [Indexed: 01/29/2023]
Abstract
We aimed to analyse the impact of breast cancer (BC) subtypes on the clinical course of disease with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly BC population. A total number of 706 patients ≥65 years receiving treatment for BC from 2007 to 2011 were identified from a BC database. 62 patients diagnosed with DCIS and 73 patients with incomplete datasets were excluded, leaving 571 patients for this analysis. Patient characteristics, biological tumour subtypes, and clinical outcome including overall survival (OS) were obtained by retrospective chart review. 380/571 (66, 5 %) patients aged 65–74 years were grouped among the young-old, 182/571 (31.9 %) patients aged 75–84 years among the old–old, and 29/571 (5.1 %) patients aged ≥85 years among the oldest-old. 392/571 (68.8 %) patients presented with luminal BC, 119/571 (20.8 %) with HER2-positive, and 59/571 (10.3 %) with triple-negative BC (TNBC). At 38 months median follow-up, 115/571 (20.1 %) patients presented with distant recurrence. A higher recurrence rate was observed in the HER2-positive subtype (43/119 (36.1 %)), as compared to TNBC (15/59 (25.4 %)) and luminal BC (57/392 (14.5 %); p < 0.001). BM were detected at a significantly higher rate in HER2-positive BC patients (9/119 (7.6 %)), as compared to TNBC (2/59 (3.4 %)) and luminal BC patients (6/392 (1.5 %); p = 0.003). Diagnosis of metastatic disease (HR 7.7; 95 % CI 5.2–11.4; p < 0.001) as well as development of BM (HR 3.5; 95 % CI 1.9–6.4; p < 0.001) had a significantly negative impact on OS in a time-dependent covariate cox regression model. In contrast to younger BC patients, outcome in this large cohort of elderly patients suggests that HER2-positive disease—not TNBC—featured the most aggressive clinical course with the highest rates of metastatic spread and BM. In-depth analysis regarding a potentially distinct biology of TNBC in elderly is therefore warranted.
Collapse
Affiliation(s)
- E S Bergen
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
| | - C Tichy
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - R M Mader
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Exner
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - G G Steger
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
24
|
Molinero L, Yu J, Li C, Deurloo R, Dent RA, Bell R, Brown J, Parmar M, Toi M, Suter T, Steger G, Pivot X, Mackey J, Jackisch C, Hall P, Hegde P, Bais C, Cameron D. Abstract S1-01: Analysis of molecular prognostic factors associated with tumor immune and stromal microenvironment in BEATRICE, an open-label phase 3 trial in early triple-negative breast cancer (eTNBC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s1-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: TNBC is a mutationally complex heterogeneous breast cancer subtype. In BEATRICE, adding bevacizumab to standard adjuvant chemotherapy for eTNBC improved neither invasive disease-free survival (IDFS; primary endpoint) nor overall survival (OS) [Cameron 2013; Bell SABCS 2014]. We explored prognostic effects of tumor-associated immune and stromal gene signatures.
Methods: Gene expression (RNA) was assessed in pretreatment archival tumor tissue using an 800-gene nanostring platform. Given the low event rates and lack of bevacizumab effect in BEATRICE, treatment arms were pooled. The biomarker-evaluable population (BEP; all patients with an evaluable biomarker sample and ≥1 postbaseline efficacy assessment) was dichotomized using median gene expression level as the cutoff. Prognostic associations between IDFS/OS and prespecified candidate gene sets/de novo identified clusters were assessed using univariate Cox proportional hazards models.
Results: Baseline characteristics and efficacy were similar in the BEP (988/2591 randomized pts; 38%) and the overall study population. In hierarchical cluster analysis based exclusively on immune gene expression, immune genes were enriched in 33% of samples, intermediate in 38%, and weak in 28%. Further characterization suggested differential prognostic value of distinct immune and stromal cell gene sets (Table). A significant prognostic effect for IDFS and OS was seen for CD8 effector T cell (Teff) and regulatory T cell (Treg) gene signatures, but not for the Teff:Treg ratio. A less pronounced positive prognostic effect was seen for other gene sets representing immune cells, including macrophages, CD4 T cells, and B cells (data not shown). Activated T helper (Th)-1 cell-derived chemokines and negative immune modulators of T cell activity (eg PD-L1) were highly prognostic for IDFS and OS. Both the cytokine IL-8 and ESM1 (target of VEGF-A pathway activation) were associated with worse IDFS and OS. No association was seen between outcome and markers for classic microvasculature (CD31, CD34), cancer-associated fibroblasts (FAP, BGN, DCN), VEGF-A, or VEGF-C.
IDFSOSGene signatureHR (95% CI)Interaction p-valueHR (95% CI)Interaction p-valueTeff0.40 (0.28-0.57)7.2x10-70.29 (0.17-0.49)4.2x10-6Treg0.38 (0.26-0.54)1.6x10-70.23 (0.13-0.40)2.9x10-7Teff:Treg ratio0.80 (0.58-1.12)0.20.89 (0.57-1.39)0.6Th10.45 (0.31-0.64)8.1x10-60.43 (0.27-0.70)5.8x10-4PD-L10.42 (0.29-0.60)1.8x10-60.24 (0.14-0.41)3.4x10-7IL-81.48 (1.06-2.08)0.0221.89 (1.18-3.01)0.0076ESM11.73 (1.23-2.43)0.00172.22 (1.38-3.58)0.001
Conclusions: These molecular gene signature analyses in eTNBC confirm that markers of cytotoxic CD8 T cells are associated with good prognosis. This is the first report of a positive prognostic effect of regulatory T cell markers, immune checkpoint modulators, and macrophage-associated markers in the adjuvant TNBC setting. High VEGF-A activity, but not its expression, was associated with worse prognosis. The strong prognostic effect of immune checkpoint modulators suggests equilibrium between cytotoxic T cells and their inhibitors in eTNBC, supporting further exploration of immune checkpoint inhibitors in this therapeutic context.
Citation Format: Molinero L, Yu J, Li C, Deurloo R, Dent RA, Bell R, Brown J, Parmar M, Toi M, Suter T, Steger G, Pivot X, Mackey J, Jackisch C, Hall P, Hegde P, Bais C, Cameron D. Analysis of molecular prognostic factors associated with tumor immune and stromal microenvironment in BEATRICE, an open-label phase 3 trial in early triple-negative breast cancer (eTNBC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S1-01.
Collapse
Affiliation(s)
- L Molinero
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Yu
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Li
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - R Deurloo
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - RA Dent
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - R Bell
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Brown
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - M Parmar
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - M Toi
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - T Suter
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - G Steger
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - X Pivot
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Mackey
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Jackisch
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - P Hall
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - P Hegde
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Bais
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - D Cameron
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| |
Collapse
|
25
|
Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Gnant M, Dieckmann K, Zielinski CC, Steger GG, Preusser M, Bartsch R. Abstract P2-08-17: Prognostic impact of breast cancer subtypes in elderly patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
We aimed to analyze the impact of BC subtypes on the clinical course with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly breast cancer population.
Patients and Methods
571 patients ≥65 years receiving treatment for BC from 2007-2011 were identified from a BC database. BC subtypes and clinical characteristics including overall survival (OS) were obtained by chart review. Statistical analysis was performed using the Chi Square test, the log rank test and time depended covariate cox regression model as appropriate.
Results
Three-hundred-eighty/571 (63%) were grouped among the young-old (65-74 years), 182/571 (31.9%) among the old-old (75-84 years), and 29/571 (5,1%) among the oldest-old (≥85 years). 392/571 (68.8%) patients presented with luminal BC, 119/571 (20.8%) with HER2 positive and 59/571 (10.3%) with triple negative BC. After a median follow up of 38 months (range 0-204), 115/571 (20.1%) patients presented with metastatic recurrence. Highest recurrence rate was observed in HER2 positive BC patients (43/119 (36.1%)), followed by triple negative (15/59 (25.4%) and luminal BC (57/392 (14.5%); p<0.001; Chi Square test). BM occurred significantly more frequently in HER2 positive BC patients (9/119 (7.6%) compared to triple negative (2/59 (3.4%) and luminal BC patients (6/392 (1.5%); p=0.003; Chi Square test). Occurrence of metastases (HR 7.7; 95% CI 5.2-11.4; p<0.001) as well as development of BM (HR 3.5; 95% CI 1.9-6.4; p<0.001) had a significant impact on OS prognosis as entered in a time depended covariate cox regression model.
Conclusions
In contrast to younger BC patients, HER2 positive BC subtype and not triple negative BC subtype was linked to the most aggressive clinical course including the development of metastatic disease and BM in our elderly cohort.
Citation Format: Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Gnant M, Dieckmann K, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-17.
Collapse
Affiliation(s)
- ES Bergen
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - C Tichy
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - AS Berghoff
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - RM Mader
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - CC Zielinski
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - GG Steger
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| |
Collapse
|
26
|
Exner R, Arnold T, Liang Y, Michlmair A, Zinn-Zinnenburg M, Pluschnig U, Bartsch R, Steger G, Gnant M, Bergmann M, Bachleitner-Hofmann T, Oehler R. 268 Eprirubicin/docetacel induced immunogenic cell death correlates with response to therapy and with extended disease-free survival. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30153-8] [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]
|
27
|
Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Knauer M, Moik M, Jakesz R, Seifert M, Taucher S, Bjelic-Radisic V, Balic M, Eidtmann H, Eiermann W, Steger G, Kwasny W, Dubsky P, Selim U, Fitzal F, Hochreiner G, Wette V, Sevelda P, Ploner F, Bartsch R, Fesl C, Greil R. Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozol plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian Breast and Colorectal Cancer Study Group Trial 12. Ann Oncol 2014; 26:313-20. [PMID: 25403582 DOI: 10.1093/annonc/mdu544] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Zoledronic acid (ZOL) plus adjuvant endocrine therapy significantly improved disease-free survival (DFS) at 48- and 62-month follow-up in the ABCSG-12 trial. We present efficacy results of a final additional analysis after 94.4 months. PATIENTS AND METHODS Patients were premenopausal women who had undergone primary surgery for stage I/II estrogen-receptor-positive and/or progesterone-receptor-positive breast cancer with <10 positive lymph nodes, and were scheduled for standard goserelin therapy. All 1803 patients received goserelin (3.6 mg every 28 days) and were randomized to tamoxifen (20 mg/days) or anastrozole (1 mg/days), both with or without ZOL (4 mg every 6 months) for 3 years. The primary end point was DFS; recurrence-free survival and overall survival (OS) were secondary end points. RESULTS After 94.4-month median follow-up (range, 0-114 months), relative risks of disease progression [hazard ratio (HR) = 0.77; 95% confidence interval (CI) 0.60-0.99; P = 0.042] and of death (HR = 0.66; 95% CI 0.43-1.02; P = 0.064) are still reduced by ZOL although no longer significant at the predefined significance level. Overall, 251 DFS events and 86 deaths were reported. Absolute risk reductions with ZOL were 3.4% for DFS and 2.2% for OS. There was no DFS difference between tamoxifen alone versus anastrozole alone, but there was a pronounced higher risk of death for anastrozole-treated patients (HR = 1.63; 95% CI 1.05-1.45; P = 0.030). Treatments were generally well tolerated, with no reports of renal failure or osteonecrosis of the jaw. CONCLUSION These final results from ABCSG 12 suggest that twice-yearly ZOL enhances the efficacy of adjuvant endocrine treatment, and this benefit is maintained long-term. CLINICALTRIALSGOV NCT00295646 (http://www.clinicaltrials.gov/ct2/results?term=00295646).
Collapse
Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - B Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | - H Stoeger
- Clinical Department of Oncology, Medical University of Graz, Graz
| | | | - M Knauer
- Department of General and Visceral Surgery, Hospital of the Sisters of Charity, Linz
| | - M Moik
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | - R Jakesz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - M Seifert
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - S Taucher
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - V Bjelic-Radisic
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - M Balic
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - H Eidtmann
- Gynecology and Obstetrics Clinic, University of Schleswig-Holstein, Kiel
| | - W Eiermann
- Gynecology and Gynecological Oncology, IOZ-München, Munich, Germany
| | - G Steger
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - W Kwasny
- Department of Surgery, Wiener Neustadt Hospital, Wiener Neustadt
| | - P Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - U Selim
- Department of Surgery, Hanusch Hospital, Vienna
| | - F Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - G Hochreiner
- Center of Hematology and Medical Oncology, General Hospital Linz, Linz
| | - V Wette
- Department of Surgery, Practice of Dr Wette, Sankt Veit an der Glan
| | | | - F Ploner
- Clinical Department of Oncology, Medical University of Graz, Graz
| | - R Bartsch
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - C Fesl
- Department of Statistics, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | | |
Collapse
|
28
|
Suppan C, Steger G, Balic M, Dandachi N, Lang A, Mlineritsch B, Fesl C, Samonigg H, Gnant M, Bauernhofer T. Evaluation of Soluble E-Cadherin as a Predictive Marker for Response to Preoperative Systemic Chemotherapy in Early Breast Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu066.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Steger GG, Greil R, Lang A, Rudas M, Fitzal F, Mlineritsch B, Hartmann BL, Bartsch R, Melbinger E, Hubalek M, Stoeger H, Dubsky P, Ressler S, Petzer AL, Singer CF, Muss C, Jakesz R, Gampenrieder SP, Zielinski CC, Fesl C, Gnant M. Epirubicin and docetaxel with or without capecitabine as neoadjuvant treatment for early breast cancer: final results of a randomized phase III study (ABCSG-24). Ann Oncol 2013; 25:366-71. [PMID: 24347519 DOI: 10.1093/annonc/mdt508] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This randomized phase III trial compared pathologic complete response (pCR) rates of early breast cancer (EBC) following neoadjuvant epirubicin-docetaxel (ED)±capecitabine (C), and evaluated the addition of trastuzumab in HER2-positive tumors. PATIENTS AND METHODS Patients with invasive breast cancer (except T4d) were randomly assigned to receive six 3-weekly cycles of ED (both 75 mg/m2)±C (1000 mg/m2, twice daily, days 1-14). Patients with HER2-positive disease were further randomized to receive trastuzumab (8 mg/kg, then 6 mg/kg every 3 weeks) or not. Primary end point: pCR rate at the time of surgery. RESULTS Five hundred thirty-six patients were randomized to ED (n=266) or EDC (n=270); 93 patients were further randomized to trastuzumab (n=44) or not (n=49). pCR rate was significantly increased with EDC (23.0% versus 15.4% ED, P=0.027), and nonsignificantly further increased with trastuzumab (38.6% EDC versus 26.5% ED, P=0.212). Rates of axillary node involvement at surgery and breast conservation were improved with EDC versus ED, but not significantly; the addition of trastuzumab had no further impact. Hormone receptor status, tumor size, grade, and C (all P≤0.035) were independent prognostic factors for pCR. Trastuzumab added to ED±C significantly increased the number of serious adverse events (35 versus 18; P=0.020), mainly due to infusion-related reactions. CONCLUSION These findings show that the integration of C into a neoadjuvant taxane-/anthracycline-based regimen is a feasible, safe, and effective treatment option, with incorporation of trastuzumab in HER2-positive disease. CLINICAL TRIAL NUMBER NCT00309556, www.clinicaltrials.gov.
Collapse
Affiliation(s)
- G G Steger
- Department of Internal Medicine I, Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Gnant M, Filipits M, Greil R, Stoeger H, Rudas M, Bago-Horvath Z, Mlineritsch B, Kwasny W, Knauer M, Singer C, Jakesz R, Dubsky P, Fitzal F, Bartsch R, Steger G, Balic M, Ressler S, Cowens JW, Storhoff J, Ferree S, Schaper C, Liu S, Fesl C, Nielsen TO. Predicting distant recurrence in receptor-positive breast cancer patients with limited clinicopathological risk: using the PAM50 Risk of Recurrence score in 1478 postmenopausal patients of the ABCSG-8 trial treated with adjuvant endocrine therapy alone. Ann Oncol 2013; 25:339-45. [PMID: 24347518 DOI: 10.1093/annonc/mdt494] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND PAM50 is a 50-gene test that is designed to identify intrinsic breast cancer subtypes and generate a Risk of Recurrence (ROR) score. It has been developed to be carried out in qualified routine hospital pathology laboratories. PATIENTS AND METHODS One thousand four hundred seventy-eight postmenopausal women with estrogen receptor (ER)+ early breast cancer (EBC) treated with tamoxifen or tamoxifen followed by anastrozole from the prospective randomized ABCSG-8 trial were entered into this study. Patients did not receive adjuvant chemotherapy. RNA was extracted from paraffin blocks and analyzed using the PAM50 test. Both intrinsic subtype (luminal A/B, HER2-enriched, basal-like) and ROR score were calculated. The primary analysis was designed to test whether the continuous ROR score adds prognostic value in predicting distant recurrence (DR) over and above standard clinical variables. RESULTS In all tested subgroups, ROR score significantly adds prognostic information to the clinical predictor (P<0.0001). PAM50 assigns an intrinsic subtype to all cases, and the luminal A cohort had a significantly lower ROR at 10 years compared with Luminal B (P<0.0001). Significant and clinically relevant discrimination between low- and high-risk groups occurred also within all tested subgroups. CONCLUSION(S) The results of the primary analysis, in combination with recently published results from the ATAC trial, constitute Level 1 evidence for clinical validity of the PAM50 test for predicting the risk of DR in postmenopausal women with ER+ EBC. A 10-year metastasis risk of <3.5% in the ROR low category makes it unlikely that additional chemotherapy would improve this outcome-this finding could help to avoid unwarranted overtreatment. CLINICAL TRIAL NUMBER ABCSG 8: NCT00291759.
Collapse
Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Foedermayr M, Sebesta M, Rudas M, Berghoff AS, Promberger R, Preusser M, Dubsky P, Fitzal F, Gnant M, Steger GG, Weltermann A, Zielinski CC, Zach O, Bartsch R. Abstract P1-08-40: BRCA-1 promotor methylation and p53 mutation in triple-negative breast cancer patients refrectory to taxane-based neoadjuvant chemotherapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Triple-negative breast cancer (TNBC) without pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with high risk of disease recurrence. In ABCSG trials 14 and 24, concomitant epirubicin plus docetaxel (+/- capecitabine) was used as NAC regimen; patients (pts) without pCR routinely received another 4-8 cycles of adjuvant CMF.
Tumours harbouring BRCA-1 germline mutations are apparently less responsive to taxane-based chemotherapy, while sensitivity to DNA-damaging agents is retained. In sporadic TNBC, BRCA-1 promotor methylation is frequently observed; this may also result in an impaired activity of genetic repair mechanisms. Therefore, we investigated the effect of adjuvant CMF as salvage therapy in pts with or without BRCA-1 promotor methylation who did not achieve pCR to taxane-based (cyclophosphamide-free) NAC. Moreover, the predictive role of TP53 mutations was investigated in these tumours.
Methods
All pts with TNBC refractory to taxane-based NAC who received adjuvant CMF were included.
DNA was extracted from formalin-fixed paraffin-embedded tissue samples with the Qiagen DNA FFPE Tissue Kit® and purified. For determining BRCA1 promoter methylation status, DNA was bisulfite-treated; the TaqMan® assay was used in order to perform a quantitative methylation-specific PCR. DNA quantity was normalized using Actin-b.
For the investigation of TP53 mutations in exons 4-9, purified DNA was PCR amplified, sequenced by Sanger sequencing and results were analyzed with SeqScape® software version 2.7. Mutations were validated using the IARC p53 database.
Results
Twenty-four pts, median age 47 years, were available for this analysis. In 10/24 pts (41.7%), a BRCA-1 promotor methylation was detected; TP53 mutations were observed in 16/24 pts (66.7%). At a median follow-up of 27.5 months, 2/10 pts (20%) with BRCA-1 promotor metyhlation had a disease-free survival (DFS) event, as compared to 9/14 (64.3%) in the non-methylated group (p = 0.0472; Fisher's exact test). Kaplan Meier estimation of disease-free survival (DFS) in the non-methylated group was 16 months (95% CI 0.0-41.73) and was not reached in the methylated group (n.s.). TP53 mutation was neither associated with increased risk of disease recurrence nor with DFS. No correlation was observed between BRCA-1 promotor methylation and TP53 mutation; still, all methylated samples were exclusively affected be missense and nonsense mutations.
Conclusions
Adjuvant CMF is of limited activity in TNBC refractory to taxane-based NAC. Still, in breast cancer harbouring BRCA-1 promotor methylation, a significant decrease of DFS events was observed. TP53 mutation status on the other hand, was not associated with outcome; while no correlation was found between BRCA-1 promotor methylation and TP53 mutation status, we only observed missense and non-sense mutations in methylated samples.
In conclusion, tumours harbouring BRCA-1 promotor methylation are apparently sensitive to DNA damage caused by cyclophosphamide. Further clinical validation of this concept is warranted.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-40.
Collapse
Affiliation(s)
- M Foedermayr
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Sebesta
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - AS Berghoff
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Promberger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - GG Steger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - A Weltermann
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - CC Zielinski
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - O Zach
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| |
Collapse
|
32
|
Gnant M, Pfeiler G, Stöger H, Mlineritsch B, Fitzal F, Balic M, Kwasny W, Seifert M, Stierer M, Dubsky P, Greil R, Steger G, Samonigg H, Fesl C, Jakesz R. The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial. Br J Cancer 2013; 109:589-96. [PMID: 23868011 PMCID: PMC3738117 DOI: 10.1038/bjc.2013.367] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/10/2013] [Accepted: 06/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We investigated whether body mass index (BMI) can be used as a predictive parameter indicating patients who benefit from extended aromatase inhibitor (AI) treatment. METHODS The ABCSG-6a trial re-randomised event-free postmenopausal hormone receptor-positive patients from the ABCSG-6 trial to receive either 3 additional years of endocrine therapy using anastrozole vs nil. In this retrospective analysis, we investigated the prognostic and predictive impact of BMI on disease outcome and safety. RESULTS In all, 634 patients (177 normal weight, 307 overweight, and 150 obese) patients were included in this analysis. Normal weight patients with additional 3 years of anastrozole halved their risk of disease recurrence (disease-free survival (DFS) HR 0.48; P=0.02) and death (HR 0.45; P=0.06) and had only a fifth of the risk of distant metastases (HR 0.22; P=0.05) compared with normal weight patients without any further treatment. In contrast, overweight+obese patients derived no benefit from additional 3 years of anastrozole (DFS HR 0.93; P=0.68; distant recurrence-free survival HR 0.91; P=0.78; and OS HR 0.9; P=0.68). The possible predictive impact of BMI on extended endocrine treatment could be strengthened by a Cox regression interaction model between BMI and treatment (P=0.07). CONCLUSION Body mass index may be used to predict outcome benefit of extended AI treatment in patients with receptor-positive breast cancer.
Collapse
Affiliation(s)
- M Gnant
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Zagouri F, Sergentanis TN, Chrysikos D, Zografos E, Rudas M, Steger G, Zografos G, Bartsch R. Fulvestrant and male breast cancer: a case series. Ann Oncol 2013; 24:265-6. [PMID: 23251011 DOI: 10.1093/annonc/mds597] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Berghoff AS, Bago-Horvath Z, Ilhan-Mutlu A, Magerle M, Dieckmann K, Marosi C, Birner P, Widhalm G, Steger GG, Zielinski CC, Bartsch R, Preusser M. Brain-only metastatic breast cancer is a distinct clinical entity characterised by favourable median overall survival time and a high rate of long-term survivors. Br J Cancer 2012; 107:1454-8. [PMID: 23047551 PMCID: PMC3493775 DOI: 10.1038/bjc.2012.440] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The clinical course of breast cancer patients with brain metastases (BM) as only metastatic site (brain-only metastatic breast cancer (BO-MBC)) has been insufficiently explored. METHODS All breast cancer patients with BM treated at our institution between 1990 and 2011 were identified. For each patient, full information on follow-up and administered therapies was mandatory for inclusion. Oestrogen receptor, progesterone receptor and Her2 status were determined according to standard protocols. Statistical analyses including computation of survival probabilities was performed. RESULTS In total, 222 female patients (26% luminal; 47% Her2; 27% triple negative) with BM of MBC were included in this study. In all, 38/222 (17%) BM patients did not develop extracranial metastases (ECM) during their disease course and were classified as BO-MBC. Brain-only-MBC was not associated with breast cancer subtype or number of BM. The median overall survival of BO-MBC patients was 11 months (range 0-69) and was significantly longer than in patients with BM and ECM (6 months, range 0-104; P=0.007). In all, 7/38 (18%) BO-MBC patients had long-term survival of >3 years after diagnosis of BM and long-term survival was significantly more common in BO-MBC patients as compared with BM patients with ECM (P<0.001). CONCLUSIONS Brain-only metastatic behaviour occurs in around 17% of breast cancer with BM and is not associated with breast cancer subtype. Exploitation of all multimodal treatment options is warranted in BO-MBC patients, as these patients have favourable prognosis and long-term survival is not uncommon.
Collapse
Affiliation(s)
- A S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Zielinski C, Lang I, Inbar M, Kahan Z, Greil R, Beslija S, Stemmer S, Kaufman B, Zvirbule Z, Steger G, Melichar B, Pienkowski T, Sirbu D, Petruzelka L, Eniu A, Nisenbaum B, Dank M, Anghel R, Messinger D, Brodowicz T. First Efficacy Results From the Turandot Phase III Trial Comparing Two Bevacizumab (BEV)-Containing Regimens as First-Line Therapy for HER2-Negative Metastatic Breast Cancer (MBC). Ann Oncol 2012. [DOI: 10.1093/annonc/mds393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Schmidt M, Rüttinger D, Sebastian M, Hanusch CA, Marschner N, Baeuerle PA, Wolf A, Göppel G, Oruzio D, Schlimok G, Steger GG, Wolf C, Eiermann W, Lang A, Schuler M. Phase IB study of the EpCAM antibody adecatumumab combined with docetaxel in patients with EpCAM-positive relapsed or refractory advanced-stage breast cancer. Ann Oncol 2012; 23:2306-2313. [PMID: 22357251 DOI: 10.1093/annonc/mdr625] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Targeted therapy options in HER2-negative breast cancer are limited. This open-label, multicenter phase IB dose-escalation trial was conducted to determine safety, tolerability, and antitumor activity of a combination of docetaxel (Taxotere) and increasing doses of adecatumumab, a human IgG1 antibody targeting epithelial cell adhesion molecule (EpCAM), in EpCAM-positive relapsed or primary refractory advanced-stage breast cancer. PATIENTS AND METHODS Patients pretreated with up to four prior chemotherapy regimens received increasing adecatumumab doses either every 3 weeks (q3w) or weekly (qw) combined with docetaxel (100 mg/m(2) q3w). Primary end points were safety and tolerability. Antitumor activity was evaluated according to RECIST. Clinical benefit was defined as complete or partial response or stable disease for ≥24 weeks. RESULTS Thirty-one evaluable patients were treated. Most adverse events were mild to moderate in severity. Neutropenia, leukocytopenia, lymphopenia, and diarrhea (dose-limiting) were the most frequent toxic effects. Maximum tolerated doses of adecatumumab given in combination with docetaxel were 550 mg/m(2) q3w and 360 mg/m(2) qw. Clinical benefit was observed in 44% of patients treated with q3w adecatumumab and docetaxel, increasing to 63% in patients with high EpCAM-expressing tumors. CONCLUSION Combination therapy of adecatumumab and docetaxel is safe, feasible, and potentially active in heavily pretreated advanced-stage breast cancer.
Collapse
Affiliation(s)
- M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - D Rüttinger
- Micromet, Inc., Bethesda, USA; Micromet AG, Munich
| | - M Sebastian
- Department of Internal Medicine III, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | | | - N Marschner
- Practice for Oncology and Hematology, Freiburg
| | - P A Baeuerle
- Micromet, Inc., Bethesda, USA; Micromet AG, Munich
| | - A Wolf
- Micromet, Inc., Bethesda, USA; Micromet AG, Munich
| | - G Göppel
- Micromet, Inc., Bethesda, USA; Micromet AG, Munich
| | - D Oruzio
- Hospital Augsburg, II. Medical Center, Augsburg, Germany
| | - G Schlimok
- Hospital Augsburg, II. Medical Center, Augsburg, Germany
| | - G G Steger
- Medical University Vienna, Department of Oncology, Vienna, Austria
| | - C Wolf
- Cooperative Breast Center, Ulm, Germany
| | - W Eiermann
- Gynecological Hospital Red Cross, Munich
| | - A Lang
- State Hospital Feldkirch at State Hospital Rankweil, Rankweil, Austria
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
37
|
Lang I, Inbar MJ, Kahán Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Zvirbule Z, Steger GG, Messinger D, Brodowicz T, Zielinski C. Safety results from a phase III study (TURANDOT trial by CECOG) of first-line bevacizumab in combination with capecitabine or paclitaxel for HER-2-negative locally recurrent or metastatic breast cancer. Eur J Cancer 2012; 48:3140-9. [PMID: 22640829 DOI: 10.1016/j.ejca.2012.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/30/2012] [Accepted: 04/28/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND We report safety data from a randomised, phase III study (CECOG/BC.1.3.005) evaluating first-line bevacizumab plus paclitaxel or capecitabine for locally recurrent or metastatic breast cancer. PATIENTS AND METHODS Patients aged ≥18 years with human epidermal growth factor receptor-2-negative breast adenocarcinoma were randomised to Arm A: bevacizumab 10 mg/kg days 1 and 15; paclitaxel 90 mg/m(2) days 1, 8, and 15, every 4 weeks; or Arm B: bevacizumab 15 mg/kg day 1; capecitabine 1000 mg/m(2) b.i.d., days 1-14, every 3 weeks, until disease progression, unacceptable toxicity or consent withdrawal. RESULTS A post hoc interim safety analysis included 561 patients (Arm A: 284, Arm B: 277). The regimens demonstrated similar frequencies of all-grade and serious adverse events (SAEs), but different safety profiles. Treatment-related events occurred in 85.2% (Arm A) and 78.0% (Arm B) of patients. Fatigue was most common in Arm A (30.6% versus 23.5% Arm B), and hand-foot syndrome (HFS) most common in Arm B (49.5% versus 2.5% Arm A). Diarrhoea (Arm A: 0.4%, Arm B: 1.4%) and pulmonary embolism (Arm A: 0.7%, Arm B: 1.1%) were the most frequently reported SAEs. CONCLUSION These findings are in-line with safety data for bevacizumab plus paclitaxel or capecitabine, reported in previous phase III trials.
Collapse
Affiliation(s)
- I Lang
- National Institute of Oncology, Oncology Department, Budapest, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Berghoff A, Bago-Horvath Z, De Vries C, Dubsky P, Pluschnig U, Rudas M, Rottenfusser A, Knauer M, Eiter H, Fitzal F, Dieckmann K, Mader RM, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Brain metastases free survival differs between breast cancer subtypes. Br J Cancer 2012; 106:440-6. [PMID: 22233926 PMCID: PMC3273356 DOI: 10.1038/bjc.2011.597] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/07/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Brain metastases (BM) are frequently diagnosed in patients with HER-2-positive metastatic breast cancer; in addition, an increasing incidence was reported for triple-negative tumours. We aimed to compare brain metastases free survival (BMFS) of breast cancer subtypes in patients treated between 1996 until 2010. METHODS Brain metastases free survival was measured as the interval from diagnosis of extracranial breast cancer metastases until diagnosis of BM. HER-2 status was analysed by immunohistochemistry and reanalysed by fluorescent in situ hybridisation if a score of 2+ was gained. Oestrogen-receptor (ER) and progesterone-receptor (PgR) status was analysed by immunohistochemistry. Brain metastases free survival curves were estimated with the Kaplan-Meier method and compared with the log-rank test. RESULTS Data of 213 patients (46 luminal/124 HER-2/43 triple-negative subtype) with BM from breast cancer were available for the analysis. Brain metastases free survival differed significantly between breast cancer subtypes. Median BMFS in triple-negative tumours was 14 months (95% CI: 11.34-16.66) compared with 18 months (95% CI: 14.46-21.54) in HER-2-positive tumours (P=0.001) and 34 months (95% CI: 23.71-44.29) in luminal tumours (P=0.001), respectively. In HER-2-positive patients, co-positivity for ER and HER-2 prolonged BMFS (26 vs 15 m; P=0.033); in luminal tumours, co-expression of ER and PgR was not significantly associated with BMFS. Brain metastases free survival in patients with lung metastases was significantly shorter (17 vs 21 months; P=0.014). CONCLUSION Brain metastases free survival in triple-negative breast cancer, as well as in HER-2-positive/ER-negative, is significantly shorter compared with HER-2/ER co-positive or luminal tumours, mirroring the aggressiveness of these breast cancer subtypes.
Collapse
Affiliation(s)
- A Berghoff
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - C De Vries
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - U Pluschnig
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - A Rottenfusser
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - M Knauer
- Department of Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - H Eiter
- Department of Radiotherapy, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - F Fitzal
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - R M Mader
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - G G Steger
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| |
Collapse
|
39
|
Bartsch R, Berghoff A, Bago-Horvath Z, DeVries C, Dubsky P, Pluschnig U, Rudas M, Rottenfusser A, Fitzal F, Dieckmann K, Mader RM, Gnant M, Zielinski CC, Steger GG. P4-17-05: Brain Metastasis Free Survival (BMFS) Differs between Breast Cancer Subtypes. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-17-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND Brain metastases (BM) are frequently diagnosed in patients (pts) with Her2-positive metastatic breast cancer (BC); a rising incidence was also reported in triple-negative disease. We hypothesized that pts with triple-negative or Her2-positive tumours had shorter BMFS as compared to other BC subtypes.
Therefore, we aimed to compare BMFS in pts with Her2-positive, estrogen receptor (ER) positive and triple-negative BC treated at the Medical University of Vienna from 1999–2009. In Her2-positive tumours, we further investigated the influence of ER co-expression on BMFS, as Her2-positive / ER-positive tumours were reported to express less aggressive biological properties.
METHODS BMFS was defined as primary study endpoint and measured as the interval from diagnosis of metastatic BC until diagnosis of BM. A total of 168 pts were identified from a breast cancer database. 34 pts were excluded from this analysis as brain was the first site of disease progression; hence complete datasets from 134 pts were available (69 Her2-positive; 33 triple-negative; 32 ER-positive).
Her2 status was analyzed by immunohistochemistry (IHC) and reanalyzed by FISH if a score of 2+ was gained. ER was analyzed by IHC; ER negative tumours were defined by a cut-off value of <10% positively stained tumour cells. BMFS was estimated with the Kaplan-Meier product limit method and compared with the log-rank test; factors significantly associated with BMFS in the univariate analysis were included into a Cox proportional hazard model.
RESULTS Median BMFS in triple-negative pts was 14 months (m) (95% CI 12.17−15.83), as compared to 25 m (95% CI 13.37−36.62) in Her2-positive (p=0.001) and 35 m (95% CI 19.79−50.22) in ER-positive pts (p<0.001), respectively.
In Her2-positive pts, prior trastuzumab treatment for metastatic disease prolonged median BMFS (29 vs. 11 m; p<0.001); BMFS was further improved by trastuzumab in multiple lines (p=0.045) and co-positivity for ER and Her2 (30 vs. 15 m; p<0.001).
ER-expression (HR 2.03; 95%CI 1.22−3.36; p<0.05) and prior trastuzumab (HR 2.72; 95%CI 1.20−6.17; p=0.017) remained independent predictors of longer BMFS in the Cox regression model. In ER-positive, triple-negative as well as Her2-positive pts, no correlation was found between BMFS and factors such as grading, histological subtype, stage IV disease at primary diagnosis, disease-free interval <24 months from primary treatment to diagnosis of metastatic disease, presence of visceral metastases, presence of lung metastases, and prior capecitabine exposure.
CONCLUSIONS BMFS in triple-negative disease is significantly shorter as compared to Her2-positive or ER-positive tumours, mirroring the aggressiveness of this breast cancer subtype. Probably due to improved systemic disease control, trastuzumab significantly prolonged BMFS in Her2-positive pts. Longer BMFS in ER/Her2 co-positive disease reflects a less aggressive subtype of Her2-positive breast cancer which is less likely to benefit from strategies of BM screening or prevention.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-05.
Collapse
Affiliation(s)
- R Bartsch
- 1Medical University of Vienna, Vienna, Austria
| | - A Berghoff
- 1Medical University of Vienna, Vienna, Austria
| | | | - C DeVries
- 1Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- 1Medical University of Vienna, Vienna, Austria
| | - U Pluschnig
- 1Medical University of Vienna, Vienna, Austria
| | - M Rudas
- 1Medical University of Vienna, Vienna, Austria
| | | | - F Fitzal
- 1Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- 1Medical University of Vienna, Vienna, Austria
| | - RM Mader
- 1Medical University of Vienna, Vienna, Austria
| | - M Gnant
- 1Medical University of Vienna, Vienna, Austria
| | | | - GG Steger
- 1Medical University of Vienna, Vienna, Austria
| |
Collapse
|
40
|
Beslija S, Brodowicz T, Greil R, Inbar MJ, Kahán Z, Kaufman B, Lang I, Steger GG, Stemmer SM, Zielinski C, Zvirbule Z. OT2-01-02: First-Line Bevacizumab in Combination with Capecitabine or Paclitaxel for HER2−Negative Locally Recurrent or Metastatic Breast Cancer (LR/MBC): A Randomized Phase III Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot2-01-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
A number of phase III studies have shown significant progression-free survival (PFS) benefits with the combination of bevacizumab (Bev) and either first-line capecitabine (X) or taxane therapy in LR/MBC. The ongoing open-label, randomized, phase III CECOG-sponsored TURANDOT study (CECOG/BC.1.3.005) is investigating the efficacy and safety of first-line Bev plus paclitaxel (P) versus Bev plus X in this setting.
Materials and methods: Eligible patients (pts) are aged ≥18 years with HER2−negative, chemonaïve LR/MBC, an ECOG performance status of 0–2 and a life expectancy >12 weeks. Prior chemotherapy and concomitant hormonal therapy for LR/MBC are not permitted, but prior (neo)adjuvant chemotherapy is allowed if completed ≥6 months before randomization or ≥12 months if taxane based. Pts are randomized to receive Bev 10mg/kg days 1, 15 plus P 90mg/m2 days 1, 8, 15, q28d (Arm A) or Bev 15mg/kg day 1 plus X 1,000mg/m2 bid days 1–14, q21d (Arm B) until disease progression, unacceptable toxicity or withdrawal of consent. The primary objective is to demonstrate non-inferiority in overall survival (OS) with Bev plus P versus Bev plus X (upper limit ≤1.33 for the two-sided confidence interval for hazard ratio [HR]). Secondary objectives are: comparison of overall response rate (RECIST criteria); PFS; time to response; duration of response; time to treatment failure; safety (CTCAE version 3); and quality of life (EORTC QLQ-30). The recruitment target is 560 pts. A sample size of 490 pts in the per-protocol population will be required to provide 80% power to reject the null hypothesis of inferiority at a one-sided significance level of 0.025, assuming a 24-month median OS with Bev plus P and an alternative hypothesis of HR=1. Data cut-off for adverse event reports was 12 Apr 2010. Interim and final efficacy analyses will be triggered after 175 and 389 events, respectively.
Results: Recruitment to the study began in Sep 2008 and was completed in Aug 2010, with 561 pts randomized. Follow-up is ongoing.
Conclusions: TURANDOT is the first study to examine the efficacy and safety of Bev plus P versus Bev plus X as first-line treatment for pts with LR/MBC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-01-02.
Collapse
Affiliation(s)
- S Beslija
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - T Brodowicz
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - R Greil
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - MJ Inbar
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Z Kahán
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - B Kaufman
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - I Lang
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - GG Steger
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - SM Stemmer
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - C Zielinski
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Z Zvirbule
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| |
Collapse
|
41
|
Fitzal F, Mittlböck M, Steger G, Bartsch R, Rudas M, Dubsky P, Riedl O, Jakesz R, Gnant M. P305 Neoadjuvant chemotherapy should also be considered for lobular breast cancer. Breast 2011. [DOI: 10.1016/s0960-9776(11)70245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
42
|
Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Heck D, Steger G, Jakesz R, Singer C, Dubsky P, Greil R. P286 Preplanned subgroup analysis of ABCSG-12 suggests that benefits of adjuvant zoledronic acid (ZOL) are most pronounced in lowest estrogen environment. Breast 2011. [DOI: 10.1016/s0960-9776(11)70228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
43
|
Mader RM, Wieser M, Berger W, Kalipciyan M, Hackl M, Steger GG, Grillari J. Relevance of microRNA modulation in chemoresistant colon cancer in vitro. Int J Clin Pharmacol Ther 2011; 49:67-68. [PMID: 21176732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- R M Mader
- Dept. of Medicine 1, Medical University of Vienna, Department of Clinical Oncology, Währinger Gürtel 18 – 20, 1090 Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
44
|
Mader RM, Kalipciyan M, Ohana P, Hochberg A, Steger GG. Suicide activation in a 5-fluorouracil resistant colon cancer model in vitro. Int J Clin Pharmacol Ther 2011; 49:69-70. [PMID: 21176733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- R M Mader
- Dept.of medicine 1, Medical University of Vienna, Department of Clinical Oncology, Währinger Gürtel 18 – 20, 1090 Vienna, Austria.
| | | | | | | | | |
Collapse
|
45
|
Ratzenboeck IE, Bartl B, Forstner B, Kalipciyan M, Steger GG, Mader RM. Cross-resistance of 5-fluorouracil-resistant colon carcinoma in vitro. Int J Clin Pharmacol Ther 2011; 49:81-82. [PMID: 21176738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- I E Ratzenboeck
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
46
|
Gnant M, Mlineritsch B, Stoeger H, Luschin-Ebengreuth G, Heck D, Steger G, Jakesz R, Singer C, Eidtmann H, Greil R. Abstract P5-11-02: The Carry-Over Effect of Adjuvant Zoledronic Acid: Comparison of 48- and 62-Month Analyses of ABCSG-12 Suggests That the Benefits of Combining Zoledronic Acid with Adjuvant Endocrine Therapy Persist Long after Completion of Therapy. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-11-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ABCSG-12 examined the efficacy of ovarian suppression using goserelin combined with tamoxifen (TAM) or anastrozole (ANA) ± zoledronic acid (ZOL) in premenopausal patients with endocrine-responsive early breast cancer. Results at 48 months and at 62 months show that adding ZOL significantly improved disease-free survival (DFS) and reduced disease recurrence.
Methods: Premenopausal patients with endocrine-responsive early breast cancer (N = 1,803) were randomized to goserelin (3.6 mg q28d) and TAM (20 mg/d) or ANA (1 mg/d) ± ZOL (4 mg q6mo) for 3 years. Endpoints included DFS and overall survival, both analyzed using log-rank test and Cox models.
Results: At 48 months’ median follow-up, ZOL significantly reduced the risk of DFS events by 36% versus no-ZOL (hazard ratio [HR] = 0.64; P = .01); this was maintained at 62 months’ follow-up (HR = 0.68; P = .009). In addition, the trend toward reduced risk of death with ZOL was maintained at both 48 months (HR = 0.60; P = .11) and 62 months (HR = 0.66; P = .10) compared with no-ZOL. Patients receiving ZOL also had fewer distant recurrences compared with no-ZOL: 29 versus 41 events at 48 months, and 44 versus 56 events at 62 months. No significant renal adverse events or confirmed cases of osteonecrosis of the jaw (ONJ) have been reported.
Conclusions: Comparisons of 48- and 62-month data suggest a possible carry-over of the ZOL anticancer benefit 2 years after treatment completion. Additional analyses will be presented, including disease outcomes during therapy and after treatment, as well as overall survival analyses.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-02.
Collapse
Affiliation(s)
- M Gnant
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - B Mlineritsch
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - H Stoeger
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - G Luschin-Ebengreuth
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - D Heck
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - G Steger
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - R Jakesz
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - C Singer
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - H Eidtmann
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| | - R. Greil
- Medical University of Vienna, Wien, Austria; Paracelsus Medical University Salzburg, Austria; Medical University of Graz, Austria; Hospital of the Sisters of Mercy, Linz, Austria; University of Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
47
|
Abstract
Abstract
Background: Patients with triple-negative breast cancer (TNBC) have a high unmet therapeutic need with a generally poor prognosis. Initial data from two randomised, phase III trials of capecitabine (C) in early breast cancer (EBC), ABCSG-24 and FinXX, are promising. ABCSG-24 demonstrated significant improvements in pathological complete response (pCR) rate with the incorporation of C into a neoadjuvant regimen of epirubicin (E) plus docetaxel (D) (24.3% vs 16.0%; p=0.02) [Steger G, et al. ECCO-ESMO 2009; Abst 4BA]. FinXX revealed significant improvements in 3-year recurrence-free survival (RFS) with the addition of C to a sequential taxane-anthracycline adjuvant regimen (92.5% vs 88.9% control; hazard ratio [HR] 0.66, 95% CI 0.47-0.94; p=0.020) [Joensuu H, et al. Lancet Oncol 2009]. We review subgroup analyses from these two studies in patients with TNBC to assess the potential benefit of C in this patient subgroup.
Methods: Patients with operable breast cancer except T4d, ± nodal involvement were randomised in the ABCSG-24 study to 6x ED every 21 days (dl: E 75mg/m2 and D 75mg/m2, d2: pegfilgrastim 6mg) ± C (1,000mg/m2 b.i.d., d1-14). Patients with medium-to high risk EBC were randomised in the FinXX study to 3x D≥3x CycEF (D 80mg/m2 d1→cyclophosphamide [Cyc] 600mg/m2 d1, E 75mg/m2 d1, F 600mg/m2 d1, every 21 days) or 3x CD≥3x CycEC (C 900mg/m2 bid d1-15 + D 60mg/m2 d1→Cyc 600mg/m2 d1, E 75mg/m2 d1, C 900mg/m2 b.i.d., d1-15, every 21 days).
Results: Patients with TNBC in the ABCSG-24 study (n=122) had a significantly greater chance of achieving a pCR than non-TNBC (n=348) (odds ratio [OR] 5.29, 95% CI: 3.22-8.68, P<0.0001), irrespective of the regimen. In the total study population, the highest pCR rates were achieved in patients with TNBC receiving EDC therapy (47.5% vs 31.2% with ED; p=NS). Patients with TNBC in the FinXX study (n=202) had significantly shorter RFS than patients without TNBC (n=1,294) (81.7% vs 92.2%, HR 0.43, 95% CI 0.29-0.63; P<0.001). Within the TNBC subgroup, 3-year RFS was significantly longer in the C-containing arm (n=93) than in the control arm (n=109) (87.7% vs 76.6%, respectively; HR 0.43, 95% CI 0.21-0.90; p=0.024). RFS did not differ significantly in the C arm among patients with TNBC or non-TNBC (HR 0.74, 95% CI: 0.38-1.41; p=0.357). Conclusions: Initial data for C in EBC are promising with the ABCSG-24 and FinXX randomised, phase III trials demonstrating significant improvements in pCR and RFS, respectively, with the addition of C to standard (neo)adjuvant regimens. Exploratory subgroup analyses from these studies show additional benefit of C therapy in patients with TNBC, who are typically recognised as a group with poorer prognosis. An ongoing randomised, phase III study conducted by the CIBOMA collaborative group is prospectively investigating C maintenance therapy after adjuvant anthracycline/taxane in patients with TNBC. This is the first study of C to specifically target patients with early TNBC and interim safety data are expected in 2010.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD01-03.
Collapse
Affiliation(s)
- GG Steger
- Medical University of Vienna, Austria; Hospital Sao Lucas da PUCRS, Oncology, Porto Alegre, Brazil; US Oncology, Dallas, TX; Hospital Universitario San Carlos, Madrid, Spain
| | - C Barrios
- Medical University of Vienna, Austria; Hospital Sao Lucas da PUCRS, Oncology, Porto Alegre, Brazil; US Oncology, Dallas, TX; Hospital Universitario San Carlos, Madrid, Spain
| | - J O'Shaughnessy
- Medical University of Vienna, Austria; Hospital Sao Lucas da PUCRS, Oncology, Porto Alegre, Brazil; US Oncology, Dallas, TX; Hospital Universitario San Carlos, Madrid, Spain
| | - M Martin
- Medical University of Vienna, Austria; Hospital Sao Lucas da PUCRS, Oncology, Porto Alegre, Brazil; US Oncology, Dallas, TX; Hospital Universitario San Carlos, Madrid, Spain
| | - M. Gnant
- Medical University of Vienna, Austria; Hospital Sao Lucas da PUCRS, Oncology, Porto Alegre, Brazil; US Oncology, Dallas, TX; Hospital Universitario San Carlos, Madrid, Spain
| |
Collapse
|
48
|
Spizzo G, Öfner D, de Vries A, Lukas P, Steger G, Pluschnig U, Zacherl J, Widder J, Zabernigg A, Gastl G, Mühlmann G. Preoperative chemotherapy with cisplatin and docetaxel followed by surgery and clip-oriented postoperative chemoradiation in patients with localized gastric or gastroesophageal junction adenocarcinoma: results from a phase II feasibility study. Ann Surg Oncol 2010; 18:677-83. [PMID: 21063792 DOI: 10.1245/s10434-010-1388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND We conducted a phase II feasibility study using preoperative chemotherapy with cisplatin and docetaxel followed by surgical resection and postoperative chemoradiation in patients with gastric or gastroesophageal cancer. METHODS Preoperative chemotherapy (two or three cycles) consisted of 50 mg/m(2) docetaxel and 50 mg/m(2) cisplatin. Surgical resection was planned 4 weeks after the last chemotherapy cycle. Patients underwent postsurgical chemoradiation, receiving a total dose of 39.6 Gy and 5-fluorouracil (5-FU) continuous infusion (350 mg/m(2)/day). The primary end-points were feasibility, overall response rate and R0 resectability rate after preoperative chemotherapy. The secondary end-points were tolerability, treatment-associated complications, disease-free survival and overall survival. RESULTS Between 2002 and 2004, 15 patients were enrolled in this study. After neoadjuvant treatment, two patients (13%) experienced progressive disease, four patients (27%) showed partial remission and nine patients (60%) showed stable disease. In 11 patients (73%) R0 resectability could be achieved. Six of these patients (54%) were able to undergo postoperative chemoradiation. Notably, five (83%) of these patients were disease free and alive at median follow-up of 72 months. Chemotherapy-associated neutropaenia and neutropaenic fever, anastomotic dehiscence, pulmonary embolism and acute pancreatitis were observed. CONCLUSIONS The combination of preoperative chemotherapy and postoperative chemoradiation is feasible in a significant subset of gastric cancer patients.
Collapse
Affiliation(s)
- G Spizzo
- Division of Haematology and Oncology, Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Michlmayr A, Bachleitner-Hofmann T, Baumann S, Marchetti-Deschmann M, Rech-Weichselbraun I, Burghuber C, Pluschnig U, Bartsch R, Graf A, Greil R, Allmaier G, Steger G, Gnant M, Bergmann M, Oehler R. Modulation of plasma complement by the initial dose of epirubicin/docetaxel therapy in breast cancer and its predictive value. Br J Cancer 2010; 103:1201-8. [PMID: 20877360 PMCID: PMC2967072 DOI: 10.1038/sj.bjc.6605909] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite the widespread use of neoadjuvant chemotherapy in breast cancer patients, prediction of individual response to treatment remains an unsolved clinical problem. Particularly, administration of an inefficient chemotherapeutic regimen should be avoided. Therefore, a better understanding of the molecular mechanisms underlying response to neoadjuvant chemotherapy is of particular clinical interest. Aim of the present study was to test whether neoadjuvant chemotherapy with epirubicin/docetaxel induces early changes in the plasma proteome of breast cancer patients and whether such changes correlate with response to therapy. METHODS Plasma samples of 25 breast cancer patients obtained before and 24 h after initiation of epirubicin/docetaxel-based neoadjuvant chemotherapy were analysed using two-dimensional differential gel electrophoresis (2D-DIGE). Protein spots found to be differentially expressed were identified using mass spectrometry and then correlated with the pathological response after six cycles of therapy. Markers identified in a discovery set of patients (n=12) were confirmed in an independent validation set (n=13). RESULTS 2D-DIGE revealed 33 protein spots to be differentially expressed in response to chemotherapy, including the complement factors C1, C3 and C4, inter-α-trypsin inhibitor, α-1-antichymotrypsin and α-2-Heremans-Schmid glycoprotein (AHSG). With respect to cytokines, only interleukin (IL)-6, IL-10 and soluble intracellular adgesion molecule 3 (sICAM3) were minimally modulated. Moreover, two protein spots within the complement component C3 significantly correlated with response to therapy. CONCLUSION We have identified acute phase proteins and the complement system as part of the early host response to epirubicin/docetaxel chemotherapy. As complement C3 cleavage correlates with the efficacy of docetaxel/epirubicin-based chemotherapy, it has the potential as an easily accessible predictive biomarker.
Collapse
Affiliation(s)
- A Michlmayr
- Department of Surgery, Medical University of Vienna, A-1090, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Tentes IK, Schmidt WM, Krupitza G, Steger GG, Mikulits W, Kortsaris A, Mader RM. Long-term persistence of acquired resistance to 5-fluorouracil in the colon cancer cell line SW620. Exp Cell Res 2010; 316:3172-81. [PMID: 20849845 DOI: 10.1016/j.yexcr.2010.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 09/02/2010] [Accepted: 09/04/2010] [Indexed: 12/13/2022]
Abstract
Treatment resistance to antineoplastic drugs represents a major clinical problem. Here, we investigated the long-term stability of acquired resistance to 5-fluorouracil (FU) in an in vitro colon cancer model, using four sub-clones characterised by increasing FU-resistance derived from the cell line SW620. The resistance phenotype was preserved after FU withdrawal for 15weeks (~100 cell divisions) independent of the established level of drug resistance and of epigenetic silencing. Remarkably, resistant clones tolerated serum deprivation, adopted a CD133(+) CD44(-) phenotype, and further exhibited loss of membrane-bound E-cadherin together with predominant nuclear β-catenin localisation. Thus, we provide evidence for a long-term memory of acquired drug resistance, driven by multiple cellular strategies (epithelial-mesenchymal transition and selective propagation of CD133(+) cells). These resistance phenomena, in turn, accentuate the malignant phenotype.
Collapse
Affiliation(s)
- I K Tentes
- Department of Biochemistry, Medical School, Democritus University of Thrace, 6th km Alexandroupolis-Komotini (Dragana), 68100 Alexandroupolis, Greece.
| | | | | | | | | | | | | |
Collapse
|