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Kolberg HC, Schumacher J, Erber R, Braun M, Heinrich B, Hoffmann O, Fasching PA, Kunz G, Lux MP, Schem C, Grischke EM, Deryal M, Lübbe K, Hartmann A, Kasimir-Bauer S, Kolberg-Liedtke C. Abstract PD11-03: PD11-03 Comparison of a mono Atezolizumab window followed by Atezolizumab and chemotherapy with Atezolizumab and chemotherapy in triple negative breast cancer – an interim analysis of the adaptive randomized neoadjuvant trial NeoMono. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd11-03] [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: 03/06/2023]
Abstract
Abstract
Introduction: Improvement of systemic treatment of TNBC represents an unmet medical need. Targeted therapy of regulatory immune pathways has become an important option in the treatment of many malignant diseases including breast cancer. Neodjuvant trials combining chemotherapy and checkpoint inhibitors (KEYNOTE-522 and IMpassion031) have demonstrated a meaningful benefit regarding pathological complete remission (pCR) for the addition of PD-1- or PD-L1-inhibitors to chemotherapy in patients with TNBC. In the KEYNOTE-522 trial, the addition of an immune checkpoint inhibitor (ICI) to neoadjuvant chemotherapy also had a beneficial impact on event-free survival even in patients who did not achieve a pCR. Of note, in the neoadjuvant GeparNuevo trial only those patients with TNBC who received a 2-week checkpoint inhibitor monotherapy window before the start of neoadjuvant chemotherapy in combination with checkpoint inhibition, achieved a significant pCR benefit from the addition of the PD-1 inhibitor Durvalumab to neoadjuvant chemotherapy alone. Methods: NeoMono is a phase 2 randomized multicenter trial recruiting male and female patients with primary TNBC (defined as ER/PR < 10% and HER2 negative). Neoadjuvant treatment in Arm A and B consists of Atezolizumab 1200 mg every 3 weeks in addition to neoadjuvant chemotherapy (i.e., 12 x Carboplatin and Paclitaxel q1w followed by Epirubicin and Cyclophosphamide q3w). Combination therapy in arm A is preceded by an Atezolizumab monotherapy window (i.e., 840 mg Atezolizumab once two weeks prior to initiation of combination therapy). Study goals are to compare the efficacy of neoadjuvant chemotherapy with Atezolizumab with and without an Atezolizumab two-week monotherapy window (primary endpoint: pCR) and the identification of biomarkers predicting (early) response to or resistance against Atezolizumab. The extensive translational program of the neoMono trial aims at identifying these biomarkers on tumor and patient level through analysis of sequential tissue and liquid biopsies. The NeoMono statistical design adapts the idea of a proof-of-concept trial and uses Bayesian posterior and predictive probabilities for inference about the primary hypothesis. Up to four planned efficacy interim analyses provide decision points for early stopping for success or futility. The expected maximum number of patients to be recruited is 458. Results: The predefined number of 50 patients in each arm being evaluable for the primary endpoint pCR has been reached and the results of the first planned interim analysis will be presented at the meeting. Conclusion: The addition of an ICI to state of the art neoadjuvant chemotherapy has recently been established as a new standard of care in TNBC. NeoMono has the potential to answer the question if the beneficial effect of the ICI can be increased by a chemotherapy free ICI monotherapy window prior to a combination with neoadjuvant chemotherapy.
Citation Format: Hans-Christian Kolberg, Johannes Schumacher, Ramona Erber, Michael Braun, Bernhard Heinrich, Oliver Hoffmann, Peter A. Fasching, Georg Kunz, Michael P. Lux, Christian Schem, Eva-Maria Grischke, Mustafa Deryal, Kristina Lübbe, Arndt Hartmann, Sabine Kasimir-Bauer, Cornelia Kolberg-Liedtke. PD11-03 Comparison of a mono Atezolizumab window followed by Atezolizumab and chemotherapy with Atezolizumab and chemotherapy in triple negative breast cancer – an interim analysis of the adaptive randomized neoadjuvant trial NeoMono [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD11-03.
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Affiliation(s)
| | | | | | - Michael Braun
- 4Abteilung für Senologie Leiter Interdisziplinäres Brustzentrum - Rotkreuzklinikum München, Germany
| | | | | | - Peter A. Fasching
- 7Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | | | | | - Eva-Maria Grischke
- 11Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Kristina Lübbe
- 13Diakovere Henriettenstift, Breast Center, Hannover, Germany
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Nuciforo P, Townend J, Piccart MJ, Fielding S, Gkolfi P, El-Abed S, de Azambuja E, Werutsky G, Bliss J, Moebus V, Colleoni M, Aspitia AM, Gomez H, Gombos A, Coccia-Portugal MA, Tseng LM, Kunz G, Lerzo G, Sohn J, Semiglazov V, Saura C, Kroep J, Ferro A, Cameron D, Gelber R, Huober J, Di Cosimo S. Ten-year survival of neoadjuvant dual HER2 blockade in patients with HER2-positive breast cancer. Eur J Cancer 2023; 181:92-101. [PMID: 36641898 DOI: 10.1016/j.ejca.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dual anti-HER2-targeted therapy in breast cancer (BC) significantly increased the rate of pathological complete response (pCR) compared to single blockade when added to chemotherapy. However, limited data exist on the long-term impact on survival of the additional increase in pCR. METHODS Neoadjuvant lapatinib and/or trastuzumab treatment optimisation (NCT00553358) is an international, randomised, open-label, phase III study investigating the addition of lapatinib to chemotherapy plus trastuzumab in HER2-positive early BC. Ten-year event-free survival (EFS), overall survival (OS) and safety were assessed on intention-to-treat population. The association between pCR and EFS or OS was investigated in landmark population. RESULTS A total of 455 patients were randomised to receive lapatinib (154), trastuzumab (149) or the combination (152). Ten-year EFS estimates were 63% (95% confidence interval [CI], 54%-71%) in the lapatinib group, 64% (95% CI, 55%-72%) in the trastuzumab group and 67% (95% CI, 58%-74%) in the combination group. Ten-year OS rates were 76% (95% CI, 67%-83%), 75% (95% CI, 66%-82%) and 80% (95% CI, 73%-86%) in the lapatinib, trastuzumab and combination groups, respectively. Women who achieved a pCR had improved EFS (hazard ratio 0.48, 95% CI, 0.31-0.73) and OS (hazard ratio 0.37, 95% CI, 0.20-0.63) compared with those who did not. The numerical difference in survival according to pCR status was greater in women treated with the combination and those with hormone-receptor-negative tumours. There were no new or long-term safety concerns. CONCLUSIONS Patients with HER2-positive BC showed a durable survival benefit of neoadjuvant anti-HER2, irrespective of treatment arm. Patients who achieve pCR have significantly better outcomes than patients without pCR.
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Affiliation(s)
- Paolo Nuciforo
- Vall d'Hebron Institute of Oncology, Barcelona Spain. SOLTI, Barcelona, Spain.
| | - John Townend
- Frontier Science (Scotland) Ltd, Kincraig, Kingussie, UK
| | - Martine J Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB) Brussels, Belgium
| | - Shona Fielding
- Frontier Science (Scotland) Ltd, Kincraig, Kingussie, UK
| | | | | | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (ULB) Brussels, Belgium
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Judith Bliss
- The Institute of Cancer Research ICR-CTSU, London, UK
| | - Volker Moebus
- Dept. of Medicine II, Hematology & Oncology University of Frankfurt, Frankfurt, Germany
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Henry Gomez
- National Institute of Neoplastic Diseases Ricardo Palma University Lima, Peru
| | - Andrea Gombos
- Institut Jules Bordet, Université Libre de Bruxelles (ULB) Brussels, Belgium
| | | | - Ling-Ming Tseng
- Taipei-Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Georg Kunz
- Dept. Obstet./Gyn., St.-Johannes-Hospital, Dortmund, Germany
| | - Guillermo Lerzo
- Fundación CENIT Para La Investigación Ciudad Autónoma de Buenos Aires, Argentina
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Vladimir Semiglazov
- Breast Cancer Department, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russian Federation
| | - Cristina Saura
- Vall d'Hebron Institute of Oncology, Barcelona Spain. SOLTI, Barcelona, Spain
| | - Judith Kroep
- Department Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands. Dutch Breast Cancer Oncology Group (BOOG), the Netherlands
| | - Antonella Ferro
- Department of Medical Oncology, Rete Clinica Senologica- Santa Chiara Hospital, Trento, Italy
| | - David Cameron
- Edinburgh Cancer Research, The University of Edinburgh, Institute of Genetics and Cancer, Crewe Road South, Edinburgh, UK
| | - Richard Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA, USA
| | - Jens Huober
- Cantonal Hospital St.Gallen | Breast Center | St.Gallen, Switzerland. University of Ulm, Breast Center, Ulm, Germany
| | - Serena Di Cosimo
- Integrated Biology Platform, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Jackisch C, Pronin D, Dimpfl T, Büttner R, Kunz G, Langwieder C, Rees M, Anzeneder T. 162P MammaPrint 10-year follow up results from a German breast cancer cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.197] [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: 11/01/2022] Open
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Kolberg-Liedtke C, Schumacher J, Erber R, Braun M, Heinrich B, Hoffmann O, Fasching P, Forstbauer H, Kleine-Tebbe A, Kunz G, Lux M, Rom J, Schem C, Stahl N, Hartmann A, Kasimir-Bauer S, Kolberg HC. Abstract OT2-29-01: neoMono - An adaptive randomized neoadjuvant two arm trial in patients with TNBC comparing a mono atezolizumab window followed by atezolizumab and chemotherapy with atezolizumab and chemotherapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-29-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Improvement of systemic treatment of TNBC represents an unmet medical need. Recently, targeted therapy of regulatory immune pathways has become an important option in the treatment of numerous malignancies including breast cancer. Neoadjuvant trials combining chemotherapy and checkpoint inhibitors (KEYNOTE-522 and IMPASSION031) have demonstrated a meaningful benefit regarding pathological complete remission (pCR) and event-free survival (EFS) for the addition of PD-1- and PD-L1-inhibitors to chemotherapy among patients with TNBC, respectively. In addition, initial analyzes have presented promising results regarding event-free survival. In the neoadjuvant GeparNuevo trial only a subgroup of patients with TNBC, receiving a 2-week checkpoint inhibitor monotherapy window before the start of neoadjuvant chemotherapy in combination with checkpoint inhibition, achieved a pCR benefit as compared to patients treated with neoadjuvant chemotherapy alone. Trial Design: NeoMono is a phase 2 randomized multicenter trial recruiting male and female patients with primary TNBC (defined as ER/PR < 10% and HER2 negative). Neoadjuvant treatment in Arm A and B consists of Atezolizumab 1200 mg every 3 weeks in addition to neoadjuvant chemotherapy (i.e. 12 x Carboplatin and Paclitaxel q1w followed by Epirubicin and Cyclophosphamide q3w) In Arm A this therapy is preceded by Atezolizumab 840 mg q2w (Atezolizumab mono window). Study goals are the comparison of efficacy and safety of neoadjuvant chemotherapy with Atezolizumab with and without Atezolizumab two-week window (primary endpoint: pCR) and the identification of biomarkers predicting (early) response to or resistance against Atezolizumab. The broad translational program of the neoMono trial aims at identifying these biomarkers on tumor and patient level. The neoMono statistical design adapts the idea of a proof-of-concept trial and uses Bayesian posterior and predictive probabilities for inference about the primary hypothesis. Up to four planned efficacy interim analyses provide decision points for early stopping for success or futility. The expected maximum number of patients to be recruited is 458.
Citation Format: Cornelia Kolberg-Liedtke, Johannes Schumacher, Ramona Erber, Michael Braun, Bernhard Heinrich, Oliver Hoffmann, Peter Fasching, Helmut Forstbauer, Anke Kleine-Tebbe, Georg Kunz, Michael Lux, Joachim Rom, Christian Schem, Nicole Stahl, Arndt Hartmann, Sabine Kasimir-Bauer, Hans-Christian Kolberg. neoMono - An adaptive randomized neoadjuvant two arm trial in patients with TNBC comparing a mono atezolizumab window followed by atezolizumab and chemotherapy with atezolizumab and chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-29-01.
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Affiliation(s)
| | | | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | | | | | | | | | | | | | - Georg Kunz
- St. Johannes Spital Dortmund, Dortmund, Germany
| | | | | | | | | | - Arndt Hartmann
- University of Erlangen, Institute of Pathology, Erlangen, Germany
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Mamounas EP, Untch M, Mano MS, Huang CS, Geyer CE, von Minckwitz G, Wolmark N, Pivot X, Kuemmel S, DiGiovanna MP, Kaufman B, Kunz G, Conlin AK, Alcedo JC, Kuehn T, Wapnir I, Fontana A, Hackmann J, Polikoff J, Saghatchian M, Brufsky A, Yang Y, Zimovjanova M, Boulet T, Liu H, Tesarowski D, Lam LH, Song C, Smitt M, Loibl S. Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE. Ann Oncol 2021; 32:1005-1014. [PMID: 33932503 DOI: 10.1016/j.annonc.2021.04.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. PATIENTS AND METHODS KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/axilla at surgery after NACT containing a taxane (± anthracycline, ± platinum) and trastuzumab (± pertuzumab). Patients were randomized to adjuvant T-DM1 (n = 743) or trastuzumab (n = 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). RESULTS The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (∼65% versus ∼82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade ≥3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) = 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR = 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. CONCLUSIONS T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.
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Affiliation(s)
- E P Mamounas
- NSABP Foundation and; Department of Surgery, Orlando Health UF Health Cancer Center, Orlando, USA.
| | - M Untch
- AGO-B and Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - M S Mano
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C-S Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C E Geyer
- NSABP Foundation and; NSABP Foundation and Department of Internal Medicine, Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, USA
| | | | - N Wolmark
- NSABP Foundation and; NSABP Foundation and Department of Surgery, The University of Pittsburgh, Pittsburgh, USA
| | | | - S Kuemmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany; Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M P DiGiovanna
- Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, USA
| | - B Kaufman
- Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - G Kunz
- GBG, Neu-Isenburg, Germany; St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A K Conlin
- NSABP Foundation and; NSABP Foundation and Department of Medical Oncology, Providence Cancer Institute, Portland, USA
| | - J C Alcedo
- Department of Clinical Oncology, Centro Hemato Oncologico, Panama City, Panama
| | - T Kuehn
- AGO-B and Klinikum Esslingen, Esslingen, Germany
| | - I Wapnir
- NSABP Foundation and; NSABP Foundation and Stanford University School of Medicine, Stanford, USA
| | - A Fontana
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - J Hackmann
- GBG, Neu-Isenburg, Germany; Marien-Hospital Witten, SEG, Witten, Germany
| | - J Polikoff
- NSABP Foundation and; NSABP Foundation and Department of Hematology/Oncology, Kaiser Permanente, San Diego, USA
| | - M Saghatchian
- Breast Cancer Department, Institut Gustave Roussy, Villejuif, France
| | - A Brufsky
- NSABP Foundation and; NSABP Foundation and Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Y Yang
- Division of Hematology-Oncolog, Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - M Zimovjanova
- Department of Oncology, Charles University and General University Hospital, Prague, Czech Republic
| | - T Boulet
- Department of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | - H Liu
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - D Tesarowski
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - L H Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Song
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Smitt
- Product Development Oncology, Genentech, Inc., South San Francisco, USA; Seattle Genetics, South San Francisco, USA
| | - S Loibl
- GBG, Neu-Isenburg, Germany; Center for Haematology and Oncology Bethanien, Frankfurt, Germany
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6
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Delaloge S, Piccart M, Rutgers E, Litière S, van 't Veer LJ, van den Berkmortel F, Brain E, Dudek-Peric A, Gil-Gil M, Gomez P, Hilbers FS, Khalil Z, Knox S, Kuemmel S, Kunz G, Lesur A, Pierga JY, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Thompson AM, Viale G, Zoppoli G, Vuylsteke P, Tryfonidis K, Poncet C, Bogaerts J, Cardoso F. Standard Anthracycline Based Versus Docetaxel-Capecitabine in Early High Clinical and/or Genomic Risk Breast Cancer in the EORTC 10041/BIG 3-04 MINDACT Phase III Trial. J Clin Oncol 2020; 38:1186-1197. [PMID: 32083990 DOI: 10.1200/jco.19.01371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE MINDACT demonstrated that 46% of patients with early breast cancer at high clinical but low genomic risk on the basis of MammaPrint may safely avoid adjuvant chemotherapy. A second random assignment (R-C) compared docetaxel-capecitabine with an anthracycline-based regimen. PATIENTS AND METHODS R-C randomly assigned patients 1:1 between standard anthracycline-based regimens, with or without taxanes (control) and experimental docetaxel 75 mg/m2 intravenously plus oral capecitabine 825 mg/m2 two times per day for 14 days (DC) every 3 weeks for 6 cycles. The primary end point was disease-free survival (DFS). Secondary end points included overall survival and safety. RESULTS Of 2,832 patients, 1,301 (45%) were randomly assigned, and 97% complied with R-C assignment. In the control arm, 29.6% only received taxanes (0.5% of N0 patients). DFS events (n = 148) were much less than required (n = 422) as a result of a lower-than-expected accrual and event rate. At 5 years of median follow-up, DFS was not different between DC (n = 652) and control (n = 649; 90.7% [95% CI, 88% to 92.8%] v 88.8% [95% CI, 85.9% to 91.1%]; hazard ratio [HR], 0.83 [95% CI, 0.60 to 1.15]; P = .26). Overall survival (HR, 0.91 [95% CI, 0.54 to 1.53]) and DFS in the clinical high and genomic high-risk subgroup (86.1% v 88.1%; HR, 0.83 [95% CI, 0.58 to 1.21]) were similar in both arms. DC led to more grade 1 neuropathy (27.1% v 11.2%) and more grade 2 hand/foot syndrome (28.5% v 3.3%) and diarrhea (13.7% v 5.8%). Serious cardiac events occurred in 9 patients (control, n = 4; DC, n = 5). Fifty-three patients developed second cancers (control, n = 32; DC, n = 21; leukemia: 2 v 1). Five treatment-related deaths occurred (control, 2 [0.3%]; DC, 3 [0.5%]). CONCLUSION Although underpowered, this second randomization in MINDACT did not show any improvement in outcome or safety with the use of DC compared with anthracycline-based chemotherapy.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Villejuif, France.,Unicancer Breast Group, Paris, France
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Laura J van 't Veer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | - Miguel Gil-Gil
- Institut Catala D'Oncologia-Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | | | - Zaman Khalil
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Susan Knox
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Sherko Kuemmel
- Breast Unit Kliniken Essen-Mitte, Westdeutsche Studiengruppe, Mönchengladbach, Germany
| | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Jean-Yves Pierga
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France.,Institut Curie Paris Sciences et Lettres, Université de Paris, Paris, France
| | - Peter Ravdin
- The University of Texas Health Sciences Center, San Antonio, TX
| | - Isabel T Rubio
- Clinica Universidad de Navarra-Site Madrid, Madrid, Spain
| | | | | | | | - Giuseppe Viale
- University of Milan and European Institute of Oncology-Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gabriele Zoppoli
- University of Genoa and Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Peter Vuylsteke
- Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | | | - Coralie Poncet
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan Bogaerts
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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7
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Untch M, von Minckwitz G, Gerber B, Schem C, Rezai M, Fasching PA, Tesch H, Eggemann H, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Loibl S. Survival Analysis After Neoadjuvant Chemotherapy With Trastuzumab or Lapatinib in Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in the GeparQuinto (G5) Study (GBG 44). J Clin Oncol 2018. [DOI: 10.1200/jco.2017.75.9175] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The GeparQuinto phase III trial demonstrated a lower pathologic complete response (pCR; pT0 ypN0) rate when lapatinib was added to standard anthracycline–taxane chemotherapy compared with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2) –positive breast cancer. Here, we report the long-term outcomes. Methods Patients with HER2-positive tumors (n = 615) received neoadjuvant treatment with epirubicin (E) plus cyclophosphamide (C), followed by docetaxel (T) in combination with either lapatinib (L) or trastuzumab (H; ECH-TH arm: n = 307; ECL-TL arm: n = 308). All patients received adjuvant trastuzumab for a total of 12 months and 18 months in the ECH-TH and ECL-TL arms, respectively. Median follow-up was 55 months. Results Three-year disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) were not significantly different between the two treatment arms. Long-term outcomes correlated with pCR (DFS: hazard ratio [HR], 0.63; P = .042; DDFS: HR, 0.55; P = .021; and OS: HR, 0.31; P = .004). A benefit only for OS was observed in patients who were treated with trastuzumab and achieved pCR versus no pCR (HR, 0.15; P = .010), whereas no difference was found in patients with pCR versus without pCR in the lapatinib arm. DFS and DDFS remained unchanged in both treatment arms according to hormone receptor status, whereas OS was significantly better in hormone receptor–positive patients who were treated with neoadjuvant lapatinib (HR, 0.32; P = .019), followed by adjuvant trastuzumab. No difference was observed in hormone receptor–negative patients; however, the small number of events limits this interpretation. Within the hormone receptor–negative cohort, pCR was significantly associated with DFS, DDFS, and OS ( P = .002, .005, and .002, respectively). Conclusion pCR correlated with long-term outcome. In patients with hormone receptor–positive tumors, prolonged anti-HER2 treatment—neoadjuvant lapatinib for 6 months, followed by adjuvant trastuzumab for 12 months—significantly improved survival compared with anti-HER2 treatment with trastuzumab alone.
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Affiliation(s)
- Michael Untch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Gunter von Minckwitz
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Bernd Gerber
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christian Schem
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Mahdi Rezai
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Peter A. Fasching
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Hans Tesch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Holm Eggemann
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Claus Hanusch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Jens Huober
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christine Solbach
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christian Jackisch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Georg Kunz
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Jens-Uwe Blohmer
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Maik Hauschild
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Tanja Fehm
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Valentina Nekljudova
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Sibylle Loibl
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
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Ocklenburg S, Schmitz J, Moinfar Z, Moser D, Klose R, Lor S, Kunz G, Tegenthoff M, Faustmann P, Francks C, Epplen JT, Kumsta R, Güntürkün O. Epigenetic regulation of lateralized fetal spinal gene expression underlies hemispheric asymmetries. eLife 2017; 6. [PMID: 28145864 PMCID: PMC5295814 DOI: 10.7554/elife.22784] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022] Open
Abstract
Lateralization is a fundamental principle of nervous system organization but its molecular determinants are mostly unknown. In humans, asymmetric gene expression in the fetal cortex has been suggested as the molecular basis of handedness. However, human fetuses already show considerable asymmetries in arm movements before the motor cortex is functionally linked to the spinal cord, making it more likely that spinal gene expression asymmetries form the molecular basis of handedness. We analyzed genome-wide mRNA expression and DNA methylation in cervical and anterior thoracal spinal cord segments of five human fetuses and show development-dependent gene expression asymmetries. These gene expression asymmetries were epigenetically regulated by miRNA expression asymmetries in the TGF-β signaling pathway and lateralized methylation of CpG islands. Our findings suggest that molecular mechanisms for epigenetic regulation within the spinal cord constitute the starting point for handedness, implying a fundamental shift in our understanding of the ontogenesis of hemispheric asymmetries in humans. DOI:http://dx.doi.org/10.7554/eLife.22784.001
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Affiliation(s)
- Sebastian Ocklenburg
- Institute of Cognitive Neuroscience, Department Biopsychology, Ruhr University Bochum, Bochum, Germany
| | - Judith Schmitz
- Institute of Cognitive Neuroscience, Department Biopsychology, Ruhr University Bochum, Bochum, Germany
| | - Zahra Moinfar
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Bochum, Germany
| | - Dirk Moser
- Department of Genetic Psychology, Ruhr University Bochum, Bochum, Germany
| | - Rena Klose
- Institute of Cognitive Neuroscience, Department Biopsychology, Ruhr University Bochum, Bochum, Germany
| | - Stephanie Lor
- Institute of Cognitive Neuroscience, Department Biopsychology, Ruhr University Bochum, Bochum, Germany
| | - Georg Kunz
- Department of Obstetrics and Gynecology, St. Johannes Hospital, Dortmund, Germany
| | - Martin Tegenthoff
- Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - Pedro Faustmann
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Bochum, Germany
| | - Clyde Francks
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Jörg T Epplen
- Department of Human Genetics, Ruhr University Bochum, Bochum, Germany
| | - Robert Kumsta
- Department of Genetic Psychology, Ruhr University Bochum, Bochum, Germany
| | - Onur Güntürkün
- Institute of Cognitive Neuroscience, Department Biopsychology, Ruhr University Bochum, Bochum, Germany.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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9
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Peters E, Anzeneder T, Jackisch C, Dimpfl T, Kunz G, Katalinic A, Waldmann A. The Treatment of Primary Breast Cancer in Older Women With Adjuvant Therapy: A Retrospective Analysis of Data From Over 3000 Patients From the PATH Biobank, With Two-Year Follow-up. Dtsch Arztebl Int 2016; 112:577-84. [PMID: 26377529 DOI: 10.3238/arztebl.2015.0577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women in Germany. Mortality from breast cancer has declined over the past 15 years, but less so in women aged 70 or older than in younger women. The discrepancy might be explained by age-related differences in treatment. METHODS Data from the Patients' Tumor Bank of Hope (PATH) database of women who underwent adjuvant treatment for the treatment of an invasive primary tumor without distant metastases (year of diagnosis, 2006-2011) were retrospectively analyzed. The clinical and tumor-biological findings and treatment data over two years of follow-up were compared across three age groups (under age 50, ages 50 to 69, and ages 70 and up). Chi-square tests were carried out to reveal significant differences, and post-hoc multiple comparisons were performed with and without Bonferroni correction. Treatment data were adjusted for staging and grading and tested for age-dependence with logistic regression. RESULTS Follow-up data were available for 3257 (65% ) of 4981 women, of whom 61% were in the middle age group and 22% in the oldest. Compared to women aged 50 to 69, those aged 70 and up less commonly received breast-conserving treatment (68.8% vs. 86.4% ), chemotherapy (27.5% vs. 44.1% ), radiotherapy (81.8% vs. 92.4% ), and trastuzumab (52.9% vs. 79.3% ; p<0.001 for all differences). All differences remained significant after stastistical adjustment. CONCLUSION The cause of these age-related differences is unclear. It cannot be determined from these data whether concomitant disease, the older patients' individual decisions, or other factors were responsible for their not receiving treatment as often as the younger patients did.
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Affiliation(s)
- Elke Peters
- Institute of Social Medicine and Epidemiology, University Medical Center, Lübeck, PATH Biobank, Augsburg, Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Department of Obstetrics and Gynecology, Klinikum Kassel, Department of Obstetrics and Gynecology, St. Johannes Hospital, Dortmund, Institute for Cancer Epidemiology e.V., University of Lübeck
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Abstract
The authors describe the emergence, application, and advantages of a dialogal approach to phenomenological research and show how it is rooted in a particular community of psychological theory and practice. This approach assumes that dialogue itself, interpersonal conversation, is critical not only in teaching and in therapy but also in research. Further, this approach overcomes the dichotomy between the personal and professional without sacrificing "objectivity," finds commonalities between psychotherapy and research, and draws on the insights of the humanities. Most striking, it relies on cooperative group dialogue rather than specific procedures in moving toward understanding and interpretation of "data." Examples are drawn from dialogal research on forgiveness, humility, and social activism.
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Affiliation(s)
- Steen Halling
- Department of Psychology, Seattle University, Seattle, WA 98122-4460
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11
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Jackisch C, Hegg R, Stroyakovskiy D, Ahn JS, Melichar B, Chen SC, Kim SB, Lichinitser M, Starosławska E, Kunz G, Falcon S, Chen ST, Crepelle-Fléchais A, Heinzmann D, Shing M, Pivot X. HannaH phase III randomised study: Association of total pathological complete response with event-free survival in HER2-positive early breast cancer treated with neoadjuvant–adjuvant trastuzumab after 2 years of treatment-free follow-up. Eur J Cancer 2016; 62:62-75. [DOI: 10.1016/j.ejca.2016.03.087] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
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12
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Kunz G. XXXVI. Ueber neuere nordamerikanische Edelstein- Vorkommen. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1891.19.1.478] [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]
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13
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Untch M, Von Minckwitz G, Gerber B, Eidtmann H, Rezai M, Fasching P, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer J, Hauschild M, Fehm T, Nekljudova V, Loibl S. 1801 Neoadjuvant chemotherapy with trastuzumab or lapatinib: Survival analysis of the HER2-positive cohort of the GeparQuinto study (GBG 44). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30755-9] [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: 11/29/2022]
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14
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Hein A, Lambrechts D, von Minckwitz G, Häberle L, Eidtmann H, Tesch H, Untch M, Hilfrich J, Schem C, Rezai M, Gerber B, Dan Costa S, Blohmer JU, Schwedler K, Kittel K, Fehm T, Kunz G, Beckmann MW, Ekici AB, Hanusch C, Huober J, Liedtke C, Mau C, Moisse M, Müller V, Nekljudova V, Peuteman G, Rack B, Rübner M, Van Brussel T, Wang L, Weinshilboum RM, Loibl S, Fasching PA. Genetic variants in VEGF pathway genes in neoadjuvant breast cancer patients receiving bevacizumab: Results from the randomized phase III GeparQuinto study. Int J Cancer 2015; 137:2981-8. [PMID: 26100253 DOI: 10.1002/ijc.29656] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/17/2015] [Indexed: 12/28/2022]
Abstract
Studies assessing the effect of bevacizumab (BEV) on breast cancer (BC) outcome have shown different effects on progression-free and overall survival, suggesting that a subgroup of patients may benefit from this treatment. Unfortunately, no biomarkers exist to identify these patients. Here, we investigate whether single nucleotide polymorphisms (SNPs) in VEGF pathway genes correlate with pathological complete response (pCR) in the neoadjuvant GeparQuinto trial. HER2-negative patients were randomized into treatment arms receiving either BEV combined with standard chemotherapy or chemotherapy alone. In a pre-planned biomarker study, DNA was collected from 729 and 724 patients, respectively from both treatment arms, and genotyped for 125 SNPs. Logistic regression assessed interaction between individual SNPs and both treatment arms to predict pCR. Five SNPs may be associated with a better response to BEV, but none of them remained significant after correction for multiple testing. The two SNPs most strongly associated, rs833058 and rs699947, were located upstream of the VEGF-A promoter. Odds ratios for the homozygous common, heterozygous and homozygous rare rs833058 genotypes were 2.36 (95% CI, 1.49-3.75), 1.20 (95% CI, 0.88-1.64) and 0.61 (95% CI, 0.34-1.12). Notably, some SNPs in VEGF-A exhibited a more pronounced effect in the triple-negative subgroup. Several SNPs in VEGF-A may be associated with improved pCR when receiving BEV in the neoadjuvant setting. Although none of the observed effects survived correction for multiple testing, our observations are consistent with previous studies on BEV efficacy in BC. Further research is warranted to clarify the predictive value of these markers.
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Affiliation(s)
- Alexander Hein
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen-EMN Comprehensive Cancer Center, Erlangen, Germany
| | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, Belgium.,Laboratory of Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Gunter von Minckwitz
- GBG Forschungs GmbH, Neu-Isenburg, Germany.,Department of Gynecology and Obstetrics, Frankfurt University Hospital, Goethe University of Frankfurt, Frankfurt Am Main, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen-EMN Comprehensive Cancer Center, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Holger Eidtmann
- Department of Obstetrics and Gynecology, Christian-Albrechts-University, Kiel, Germany
| | - Hans Tesch
- CHOP Onkologie Bethanien, Frankfurt, Germany
| | | | | | - Christian Schem
- Department of Obstetrics and Gynecology, Christian-Albrechts-University, Kiel, Germany
| | - Mahdi Rezai
- Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany
| | - Bernd Gerber
- Department of Gynecology, University of Rostock, Rostock, Germany
| | - Serban Dan Costa
- Department of Obstetrics and Gynecology, Magdeburg University Hospital, Magdeburg, Germany
| | - Jens-Uwe Blohmer
- St. Getrauden Breast Center, St. Gertrauden Krankenhaus, Berlin, Germany
| | - Kathrin Schwedler
- Department of Gynecology and Obstetrics, Frankfurt University Hospital, Goethe University of Frankfurt, Frankfurt Am Main, Germany.,Neue Frauenklinik, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Kornelia Kittel
- Praxisklinik, Krebsheilkunde Für Frauen, Brustzentrum, Berlin, Germany
| | - Tanja Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany.,Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Georg Kunz
- St. Johannes Hospital, Dortmund, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen-EMN Comprehensive Cancer Center, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus Hanusch
- Department of Gynecology, Klinikum Zum Roten Kreuz, Munich, Germany
| | - Jens Huober
- Department of Gynecology, University of Ulm, Ulm, Germany
| | - Cornelia Liedtke
- Department of Gynecology and Obstetrics, Lübeck University Hospital, Lübeck, Germany
| | | | | | - Volkmar Müller
- Department of Gynecology and Obstetrics, Hamburg University Hospital, Hamburg, Germany
| | | | | | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig Maximilian University, Munich, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen-EMN Comprehensive Cancer Center, Erlangen, Germany
| | | | - Liewei Wang
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN
| | - Richard M Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN
| | - Sibylle Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany.,Department of Gynecology and Obstetrics, Frankfurt University Hospital, Goethe University of Frankfurt, Frankfurt Am Main, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen-EMN Comprehensive Cancer Center, Erlangen, Germany.,Division of Hematology/Oncology, Department of Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Gerber B, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, von Minckwitz G. Abstract P3-11-01: Neoadjuvant chemotherapy with or without bevacizumab or everolimus: Survival analysis of The HER2-negative cohort of the GEPARQUINTO study (GBG 44). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates from 14.9% to 18.4% (P=0.04) overall; specifically in patients with TNBC (27.9% to 39.3% (P=0.003) (von Minckwitz et al, NEJM 2012). No difference in pCR rate was observed for adding everolimus to paclitaxel patients who had no early response to neoadjuvant chemotherapy (Huober et al, Eur J Cancer 2013). Here, we present disease-free (DFS) and overall survival (OS) analyses.
PATIENTS AND METHODS: Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with 4xEC à 4x docetaxel with or without bevacizumab, 15 mg/Kg q3w before surgery. 408 patients not clinically responding to EC ± Bev were randomized to 12x weekly paclitaxel with or without everolimus 5mg/day. Patients with HR-positive tumors received endocrine treatment after surgery. 379 events are required to show a HR of 0.75 (α=0.05, ß=0.8) between the bevacizumab arms. 397 relapses and 234 deaths were observed after a median follow up of 3.8 years overall, of those 115 relapses and 75 deaths occurred in the non-responding cohort.
RESULTS: Overall, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.780 for DFS and HR 0.974; P = 0.842 for OS) compared to patients receiving chemotherapy alone. Patients with TNBC showed no improvement in DFS (HR 0.991; P = 0.948) and OS (HR 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3, cT4a-c, cT4d; pCR or not, CR, PR, NC after first 4 cycles chemotherapy) showed a benefit from bevacizumab. No difference in DFS (HR 0.997; P=0.987) and OS (HR 1.11; P=0.658) was observed for patients who had no early response to neoadjuvant chemotherapy receiving paclitaxel with or without everolimus overall as well as in subgroups.
CONCLUSIONS: Long-term results finally do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for patients who had no early response to neoadjuvant chemotherapy.
Citation Format: Bernd Gerber, Sibylle Loibl, Michael Untch, Holger Eidtmann, Mahdi Rezai, Peter A Fasching, Hans Tesch, Holm Eggemann, Iris Schrader, Kornelia Kittel, Claus Hanusch, Jens Huober, Christine Solbach, Christian Jackisch, Georg Kunz, Jens-Uwe Blohmer, Maik Hauschild, Tanja Fehm, Valentina Nekljudova, Gunter von Minckwitz. Neoadjuvant chemotherapy with or without bevacizumab or everolimus: Survival analysis of The HER2-negative cohort of the GEPARQUINTO study (GBG 44) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-11-01.
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [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: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Gerber B, von Minckwitz G, Eidtmann H, Rezai M, Fasching P, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober J, Hauschild M, Nekljudova V, Loibl S, Untch M. Surgical outcome after neoadjuvant chemotherapy and bevacizumab: results from the GeparQuinto study (GBG 44). Ann Surg Oncol 2014; 21:2517-24. [PMID: 24740826 DOI: 10.1245/s10434-014-3606-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, has shown increased pathological complete response rates when added to neoadjuvant chemotherapy. In various cancer types, bevacizumab treatment was accompanied by an increased risk of bleedings and other surgical complications. We assessed associated surgical complications. METHODS In the GeparQuinto trial, 1,948 patients were randomized to receive four cycles epirubicin/cyclophosphamide (EC, 90/600 mg/m(2) q3w) followed by four cycles docetaxel (D, 100 mg/m(2) q3w) each with (ECB-DB) or without (EC-D) bevacizumab (B, 15 mg/kg q3w) concurrent with chemotherapy. Surgery had to be performed not earlier than 28 days after the last bevacizumab infusion, but within days 21 and 35 after the last chemotherapy. RESULTS In 743 (38.1 %) patients, a surgical complication (bleedings, hematomas, necrosis, wound infections, abscess) was documented prospectively. Baseline characteristics of the patients were well balanced between both arms. The breast-conserving surgery (BCS) rate (N = 502) was 69.1 % (EC-D) and 71.9 % (ECB-DB; p = 0.464). The first surgical procedure was performed at a median of 29 (EC-D) and 34 days (ECB-DB) after last chemotherapy with or without bevacizumab infusion (p < 0.001). Surgical complications were documented in 38 (10.9 %; EC-D) and 59 (15.0 %; ECB-DB) patients (p = 0.103). Surgical complications were significantly higher after ECD-DB only in patients treated with BCS (N = 53; p = 0.029) or in those requiring repeat surgery in order achieve clear margins (N = 23; p = 0.037) compared to the EC-D group. CONCLUSIONS Addition of bevacizumab to neoadjuvant chemotherapy might be associated with an increased risk for surgical complications in patients treated with BCS or after repeated surgeries.
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Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
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Issa-Nummer Y, Darb-Esfahani S, Loibl S, Kunz G, Nekljudova V, Schrader I, Sinn BV, Ulmer HU, Kronenwett R, Just M, Kühn T, Diebold K, Untch M, Holms F, Blohmer JU, Habeck JO, Dietel M, Overkamp F, Krabisch P, von Minckwitz G, Denkert C. Prospective validation of immunological infiltrate for prediction of response to neoadjuvant chemotherapy in HER2-negative breast cancer--a substudy of the neoadjuvant GeparQuinto trial. PLoS One 2013; 8:e79775. [PMID: 24312450 PMCID: PMC3846472 DOI: 10.1371/journal.pone.0079775] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/04/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction We have recently described an increased lymphocytic infiltration rate in breast carcinoma tissue is a significant response predictor for anthracycline/taxane-based neoadjuvant chemotherapy (NACT). The aim of this study was to prospectively validate the tumor-associated lymphocyte infiltrate as predictive marker for response to anthracycline/taxane-based NACT. Patients and Methods The immunological infiltrate was prospectively evaluated in a total of 313 core biopsies from HER2 negative patients of the multicenter PREDICT study, a substudy of the neoadjuvant GeparQuinto study. Intratumoral lymphocytes (iTuLy), stromal lymphocytes (strLy) as well as lymphocyte-predominant breast cancer (LPBC) were evaluated by histopathological assessment. Pathological complete response (pCR) rates were analyzed and compared between the defined subgroups using the exact test of Fisher. Results Patients with lymphocyte-predominant breast cancer (LPBC) had a significantly increased pCR rate of 36.6%, compared to non-LPBC patients (14.3%, p<0.001). LPBC and stromal lymphocytes were significantly independent predictors for pCR in multivariate analysis (LPBC: OR 2.7, p = 0.003, strLy: OR 1.2, p = 0.01). The amount of intratumoral lymphocytes was significantly predictive for pCR in univariate (OR 1.2, p = 0.01) but not in multivariate logistic regression analysis (OR 1.2, p = 0.11). Conclusion Confirming previous investigations of our group, we have prospectively validated in an independent cohort that an increased immunological infiltrate in breast tumor tissue is predictive for response to anthracycline/taxane-based NACT. Patients with LPBC and increased stromal lymphocyte infiltration have significantly increased pCR rates. The lymphocytic infiltrate is a promising additional parameter for histopathological evaluation of breast cancer core biopsies.
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Affiliation(s)
| | | | | | - Georg Kunz
- Department of Gynecology and Obstetrics, St. Johannes Hospital, Dortmund, Germany
| | | | | | | | | | | | | | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Kurt Diebold
- Gemeinschaftspraxis für Pathologie Hamm, Hamm, Germany
| | - Michael Untch
- Breast Center, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Holms
- Gynäkologie und Geburtshilfe, St. Barbara-Klinik Hamm-Heessen, Germany
| | - Jens-Uwe Blohmer
- Breast Center, St. Gertrauden Krankenhaus Berlin, Berlin, Germany
| | | | - Manfred Dietel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany
- University Women's Hospital, Frankfurt, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Gerber B, Loibl S, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Kreienberg R, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober J, Hauschild M, Nekljudova V, Untch M, von Minckwitz G. Neoadjuvant bevacizumab and anthracycline-taxane-based chemotherapy in 678 triple-negative primary breast cancers; results from the geparquinto study (GBG 44). Ann Oncol 2013; 24:2978-84. [PMID: 24136883 DOI: 10.1093/annonc/mdt361] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m(2); q3w) followed by four cycles docetaxel (100 mg/m(2); q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. RESULTS TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. CONCLUSIONS The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates.
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Affiliation(s)
- B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock
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Melichar B, Stroyakovskiy D, Ahn J, Kopp M, Srimuninnimit V, Kunz G, Li J, van der Horst T, Muehlbauer S, Jackisch C. Pathological Complete Response to Trastuzumab Subcutaneous Fixed-Dose Formulation in the Hannah Study: Subgroup Analysis of Patient Demographics and Tumor Characteristics and Influence of Body Weight (BW) and Serum Trough Concentration (Ctrough) of Trastuzumab. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Baselga J, Bradbury I, Eidtmann H, Di Cosimo S, de Azambuja E, Aura C, Gómez H, Dinh P, Fauria K, Van Dooren V, Aktan G, Goldhirsch A, Chang TW, Horváth Z, Coccia-Portugal M, Domont J, Tseng LM, Kunz G, Sohn JH, Semiglazov V, Lerzo G, Palacova M, Probachai V, Pusztai L, Untch M, Gelber RD, Piccart-Gebhart M. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet 2012; 379:633-40. [PMID: 22257673 PMCID: PMC5705192 DOI: 10.1016/s0140-6736(11)61847-3] [Citation(s) in RCA: 966] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer. We argue that the two anti-HER2 agents given together would be better than single-agent therapy. METHODS In this parallel groups, randomised, open-label, phase 3 study undertaken between Jan 5, 2008, and May 27, 2010, women from 23 countries with HER2-positive primary breast cancer with tumours greater than 2 cm in diameter were randomly assigned to oral lapatinib (1500 mg), intravenous trastuzumab (loading dose 4 mg/kg [DOSAGE ERROR CORRECTED], subsequent doses 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab. Treatment allocation was by stratified, permuted blocks randomisation, with four stratification factors. Anti-HER2 therapy alone was given for the first 6 weeks; weekly paclitaxel (80 mg/m(2)) was then added to the regimen for a further 12 weeks, before definitive surgery was undertaken. After surgery, patients received adjuvant chemotherapy followed by the same targeted therapy as in the neoadjuvant phase to 52 weeks. The primary endpoint was the rate of pathological complete response (pCR), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00553358. FINDINGS 154 patients received lapatinib, 149 trastuzumab, and 152 the combination. pCR rate was significantly higher in the group given lapatinib and trastuzumab (78 of 152 patients [51·3%; 95% CI 43·1-59·5]) than in the group given trastuzumab alone (44 of 149 patients [29·5%; 22·4-37·5]; difference 21·1%, 9·1-34·2, p=0·0001). We recorded no significant difference in pCR between the lapatinib (38 of 154 patients [24·7%, 18·1-32·3]) and the trastuzumab (difference -4·8%, -17·6 to 8·2, p=0·34) groups. No major cardiac dysfunctions occurred. Frequency of grade 3 diarrhoea was higher with lapatinib (36 patients [23·4%]) and lapatinib plus trastuzumab (32 [21·1%]) than with trastuzumab (three [2·0%]). Similarly, grade 3 liver-enzyme alterations were more frequent with lapatinib (27 [17·5%]) and lapatinib plus trastuzumab (15 [9·9%]) than with trastuzumab (11 [7·4%]). INTERPRETATION Dual inhibition of HER2 might be a valid approach to treatment of HER2-positive breast cancer in the neoadjuvant setting. FUNDING GlaxoSmithKline.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Breast Neoplasms/chemistry
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Chemotherapy, Adjuvant
- Diarrhea/chemically induced
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Lapatinib
- Liver/drug effects
- Liver/metabolism
- Middle Aged
- Neoadjuvant Therapy/methods
- Paclitaxel/administration & dosage
- Paclitaxel/adverse effects
- Quinazolines/administration & dosage
- Quinazolines/adverse effects
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/antagonists & inhibitors
- Trastuzumab
- Treatment Outcome
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Affiliation(s)
- José Baselga
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA.
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von Minckwitz G, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Kreienberg R, Solbach C, Gerber B, Jackisch C, Kunz G, Blohmer JU, Huober J, Hauschild M, Fehm T, Müller BM, Denkert C, Loibl S, Nekljudova V, Untch M. Neoadjuvant chemotherapy and bevacizumab for HER2-negative breast cancer. N Engl J Med 2012; 366:299-309. [PMID: 22276820 DOI: 10.1056/nejmoa1111065] [Citation(s) in RCA: 418] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bevacizumab, a monoclonal antibody against vascular endothelial growth factor A, has shown clinical efficacy in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer. We evaluated the efficacy, measured according to the rate of pathological complete response (absence of invasive and intraductal disease in the breast and the axillary lymph nodes), and the safety of adding bevacizumab to neoadjuvant chemotherapy in patients with early-stage breast cancer. METHODS We randomly assigned 1948 patients with a median tumor size of 40 mm on palpation to receive neoadjuvant epirubicin and cyclophosphamide followed by docetaxel, with or without concomitant bevacizumab. Patients with untreated HER2-negative breast cancer were eligible if they had large tumors, hormone-receptor-negative disease, or hormone-receptor-positive disease with palpable nodes or positive findings on sentinel-node biopsy, and no increased cardiovascular or bleeding risk. RESULTS Overall, the rates of pathological complete response were 14.9% with epirubicin and cyclophosphamide followed by docetaxel and 18.4% with epirubicin and cyclophosphamide followed by docetaxel plus bevacizumab (odds ratio with addition of bevacizumab, 1.29; 95% confidence interval, 1.02 to 1.65; P=0.04); the corresponding rates of pathological complete response were 27.9% and 39.3% among 663 patients with triple-negative tumors (P=0.003) and 7.8% and 7.7% among 1262 patients with hormone-receptor-positive tumors (P=1.00). Breast-conserving surgery was possible in 66.6% of the patients in both groups. The addition of bevacizumab, as compared with neoadjuvant therapy alone, was associated with a higher incidence of grade 3 or 4 toxic effects (febrile neutropenia, mucositis, the hand-foot syndrome, infection, and hypertension) but with a similar incidence of surgical complications. CONCLUSIONS The addition of bevacizumab to neoadjuvant chemotherapy significantly increased the rate of pathological complete response among patients with HER2-negative early-stage breast cancer. Efficacy was restricted primarily to patients with triple-negative tumors, in whom the pathological complete response is considered to be a reliable predictor of long-term outcome. (Funded by Sanofi-Aventis and Roche, Germany; ClinicalTrials.gov number, NCT00567554.).
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Brosens I, Kunz G, Benagiano G. Is adenomyosis the neglected phenotype of an endomyometrial dysfunction syndrome? ACTA ACUST UNITED AC 2011; 9:131-137. [PMID: 22611349 PMCID: PMC3338914 DOI: 10.1007/s10397-011-0723-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/24/2011] [Indexed: 11/03/2022]
Abstract
Since the dissociation between adenomyoma and endometriosis in the 1920s and the laparoscopic progress in the diagnosis and surgery of endometriosis, the literature has been greatly focused on the disease endometriosis. The study of adenomyosis, on the other hand, has been neglected as the diagnosis remained based on hysterectomy specimens. However, since the introduction of magnetic resonance and sonographic imaging techniques in the 1980s, the myometrial junctional zone has been identified as a third uterine zone and interest in adenomyosis was renewed. This has also been the start for the interest in the role of the myometrial junctional zone dysfunction and adenomyosis in reproductive and obstetrical disorders.
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Denkert C, Kronenwett R, Loibl S, Nekljudova V, Darb-Esfahani S, Gerber B, Sinn B, Petry C, Bauerfeind I, Budczies J, Rezai M, Dietel M, Schrader I, Kunz G, Von Minckwitz G. RNA-based molecular tumor typing and immunological infiltrate as response predictors to neoadjuvant chemotherapy: Prospective validation in the GeparQuinto-PREDICT substudy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gerber B, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch CA, Kreienberg R, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober JB, Hauschild M, Loibl S, Nekljudova V, Untch M, Von Minckwitz G. Neoadjuvant bevacizumab and anthracycline–taxane-based chemotherapry in 686 triple-negative primary breast cancers: Seconday endpoint analysis of the GeparQuinto study (GBG 44). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gevensleben H, Göhring UJ, Büttner R, Heukamp LC, Kunz G, Dimpfl T, Jackisch C, Ortmann O, Albert US, Bender R, De Snoo F, Krijgsman O, Glas AM, Ergönenc YH, Vogel C, Dykgers A, Langwieder C, Rees M, Anzeneder T. Comparison of MammaPrint and TargetPrint results with clinical parameters in German patients with early stage breast cancer. Int J Mol Med 2011; 26:837-43. [PMID: 21042777 DOI: 10.3892/ijmm_00000532] [Citation(s) in RCA: 15] [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] [Indexed: 11/06/2022] Open
Abstract
The 70-gene expression profile MammaPrint is a powerful prognostic indicator for disease outcome in breast cancer patients with improved prediction of recurrence risk compared to currently used guidelines. The microarray-based test TargetPrint further provides reliable, quantitative assessment of mRNA expression levels of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). This study was performed as a validation of MammaPrint and TargetPrint in an unselected German breast cancer population and was designed to determine the degree of concordance with currently applied clinical parameters. One hundred and forty cases of breast cancer stage I and II were classified as being low or high risk for distant metastasis using MammaPrint. Results were compared to current clinical risk classifications and adjuvant treatment management. Immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH)/chromogenic in situ hybridization (CISH) assessments of ER, PR and HER2 were further compared with gene expression read-outs using TargetPrint. Thirty-two percent of patients (19/59) with a poor prognosis-signature identified via MammaPrint did not receive adjuvant systemic treatment apart from endocrine therapy and were potentially undertreated; whereas 42% (35/77) of patients with a good prognosis-signature received chemotherapy and were potentially overtreated. Comparison of microarray receptor results with IHC and FISH/CISH were concordant in 97% for ER; 86% for PR; and 94% for HER2. In this German study population, MammaPrint would have resulted in altered treatment advice for adjuvant systemic therapy in 40% of patients. Furthermore, TargetPrint presented high concordance for ER, PR and Her2 with IHC and FISH/CISH analysis.
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Affiliation(s)
- Heidrun Gevensleben
- Institute of Pathology, University Hospital Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany.
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Kunz G. Use of a genomic test (MammaPrint™) in daily clinical practice to assist in risk stratification of young breast cancer patients. Arch Gynecol Obstet 2010; 283:597-602. [DOI: 10.1007/s00404-010-1454-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 03/19/2010] [Indexed: 11/28/2022]
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Kunz G, Glas A, de Snoo F, Simon I. 0075 Use of the genomic test MammaPrint in daily clinical practice to assist in risk stratification of young breast cancer patients. Breast 2009. [DOI: 10.1016/s0960-9776(09)70120-1] [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: 12/01/2022] Open
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Kunz G. Tubargravidität und kontralaterales Corpus luteum graviditatis. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kissler S, Zangos S, Kohl J, Wiegratz I, Rody A, Gätje R, Vogl T, Kunz G, Leyendecker G, Kaufmann M. Duration of dysmenorrhoea and extent of adenomyosis visualised by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2008; 137:204-9. [DOI: 10.1016/j.ejogrb.2007.01.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 12/24/2006] [Accepted: 01/19/2007] [Indexed: 11/29/2022]
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Kissler S, Schmidt M, Keller N, Wiegratz I, Kohl J, Baumann R, Kunz G, Kaufmann M, Leyendecker G. Real-Time PCR-Analyse für Östrogen-Rezeptor beta, Progesteronrezeptor und P-450-Aromatase im Menstrualblut – eine Pilotstudie über die Bedeutung des basalen Endometriums in der Pathogenese der Endometriose. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989163] [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: 10/19/2022] Open
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Abstract
Rhythmic peristaltic contractions of the muscular wall of the non-pregnant uterus, as well as rapid sperm transport from the vagina to the Fallopian tubes, have long been documented by means of vaginal sonography and hysterosalpingoscintigraphy. Uterine peristaltic activity reaches a maximum before ovulation and is controlled via oestradiol secretion from the dominant follicle systemically and into the utero-ovarian countercurrent system; it is also enhanced by oxytocin. In this study, the effect of oxytocin and its receptor antagonist atosiban on uterine peristalsis and thus directed sperm transport during the mid and late follicular phases was examined. Atosiban did not show any effect either on frequency or on pattern of the peristaltic contractions. However, oxytocin significantly increased the rapid and directed transport of radiolabelled particles representing spermatozoa from the vagina into the Fallopian tube ipsilateral to the site of the dominant follicle (P = 0.02, 0.04 and 0.02 after 1, 16 and 32 min of documentation respectively). It seems reasonable to assume that oxytocin plays an important, although not critical, role in the mechanisms governing rapid sperm ascension that, at least in humans, were developed to rapidly preserve an aliquot of spermatozoa following intercourse.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology of St Johannes Hospital Dortmund, Dortmund, Germany.
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Kissler S, Zangos S, Wiegratz I, Kohl J, Rody A, Gaetje R, Doebert N, Wildt L, Kunz G, Leyendecker G, Kaufmann M. Utero-Tubal Sperm Transport and Its Impairment in Endometriosis and Adenomyosis. Ann N Y Acad Sci 2007; 1101:38-48. [PMID: 17344532 DOI: 10.1196/annals.1389.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [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: 11/12/2022]
Abstract
The uterus is composed of different smooth muscle layers that serve various functions. First, menstrual debris is expulsed at the time of the menses. Second, sperm is transported in the preovulatory phase to maximize fertility, and third, the human embryo is placed in an adequate setting during implantation. Endometriosis is a gynecologic disorder leading to severe pain symptoms such as severe pain during menstruation (dysmenorrhea), chronic pelvic pain, pain during sexual intercourse (dyspareunia), and abnormal uterine bleeding. Besides, endometriosis is often associated with female infertility and exhibits a massive impairment in the physiology of uterine contractility that can be documented by the in vivo examination method of hysterosalpingoscintigraphy (HSSG). In addition, endometriosis is associated in 80-90% of subjects with adenomyosis and our data clearly indicate that sperm transport is disturbed by hyperperistalsis when at least one focus of adenomyosis can be detected via magnetic resonance imaging (MRI) and turns into dysperistalsis (a complete failure in sperm transport capacity) when diffuse adenomyosis affecting all myometrial uterine muscle layers is detected. Hence, dysperistalsis is significantly associated with reduced spontaneous pregnancy rates. We therefore recommend MRI and HSSG in every sterility workup.
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Affiliation(s)
- Stefan Kissler
- Department Obstetrics and Gynecology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Abstract
Evidence has been provided that pelvic endometriosis is significantly associated with uterine adenomyosis and that the latter constitutes the major factor of infertility in such conditions. Furthermore, it has become evident that both adenomyosis and endometriosis constitute a pathophysiological and nosological entity. Mild peritoneal endometriosis of the fertile woman and premenopausal adenomyosis of the parous and non-parous woman, as well as adenomyosis in association with endometriosis of the infertile woman, constitute a pathophysiological continuum that is characterized by the dislocation of basal endometrium. Due to the postponement of childbearing late into the period of reproduction, premenopausal adenomyosis might increasingly become a factor for infertility in addition to adenomyosis associated with endometriosis of younger women. In any event, the presence or absence of uterine adenomyosis should be examined in a sterility work-up.
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Affiliation(s)
- Gerhard Leyendecker
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Grafenstr. 9, 64283 Darmstadt, Germany.
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Kissler S, Hamscho N, Zangos S, Wiegratz I, Schlichter S, Menzel C, Doebert N, Gruenwald F, Vogl TJ, Gaetje R, Rody A, Siebzehnruebl E, Kunz G, Leyendecker G, Kaufmann M. Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility. BJOG 2006; 113:902-8. [PMID: 16753046 DOI: 10.1111/j.1471-0528.2006.00970.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease. DESIGN A prospective observational study. SETTING University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year. POPULATION Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis. METHODS All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG. MAIN OUTCOME MEASURES Influence of adenomyosis on uterotubal transport capacity in endometriosis. RESULTS In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport). CONCLUSIONS Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.
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Affiliation(s)
- S Kissler
- Division of Gynaecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynaecology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
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Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Reply: Adenomyosis in endometriosis – prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 2006. [DOI: 10.1093/humrep/dei449] [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
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Studer G, Huguenin PU, Davis JB, Kunz G, Lütolf UM, Glanzmann C. IMRT using simultaneously integrated boost (SIB) in head and neck cancer patients. Radiat Oncol 2006; 1:7. [PMID: 16722599 PMCID: PMC1459185 DOI: 10.1186/1748-717x-1-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 03/31/2006] [Indexed: 11/28/2022] Open
Abstract
Background Preliminary very encouraging clinical results of intensity modulated radiation therapy (IMRT) in Head Neck Cancer (HNC) are available from several large centers. Tumor control rates seem to be kept at least at the level of conventional three-dimensional radiation therapy; the benefit of normal tissue preservation with IMRT is proven for salivary function. There is still only limited experience with IMRT using simultaneously integrated boost (SIB-IMRT) in the head and neck region in terms of normal tissue response. The aim of this work was (1) to establish tumor response in HNC patients treated with SIB-IMRT, and (2) to assess tissue tolerance following different SIB-IMRT schedules. Results Between 1/2002 and 12/2004, 115 HNC patients have been curatively treated with IMRT. 70% received definitive IMRT (dIMRT), 30% were postoperatively irradiated. In 78% concomitant chemotherapy was given. SIB radiation schedules with 5–6 × 2 Gy/week to 60–70 Gy, 5 × 2.2 Gy/week to 66–68.2 Gy (according to the RTOG protocol H-0022), or 5 × 2.11 Gy/week to 69.6 Gy were used. After mean 18 months (10–44), 77% of patients were alive with no disease. Actuarial 2-year local, nodal, and distant disease free survival was 77%, 87%, and 78%, respectively. 10% were alive with disease, 10% died of disease. 20/21 locoregional failures occurred inside the high dose area. Mean tumor volume was significantly larger in locally failed (63 cc) vs controlled tumors (32 cc, p <0.01), and in definitive (43 cc) vs postoperative IMRT (25 cc, p <0.05); the locoregional failure rate was twofold higher in definitively irradiated patients. Acute reactions were mild to moderate and limited to the boost area, the persisting grade 3/4 late toxicity rate was low with 6%. The two grade 4 reactions (dysphagia, laryngeal fibrosis) were observed following the SIB schedule with 2.2 Gy per session. Conclusion SIB-IMRT in HNC using 2.0, 2.11 or 2.2 Gy per session is highly effective and safe with respect to tumor response and tolerance. SIB with 2.2 Gy is not recommended for large tumors involving laryngeal structures.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - PU Huguenin
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - JB Davis
- Department of Radiation Physics, University Hospital, Zurich, Switzerland
| | - G Kunz
- Department of Radiation Physics, University Hospital, Zurich, Switzerland
| | - UM Lütolf
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - C Glanzmann
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
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Abstract
Rhythmic peristaltic contractions of the muscular wall of the non-pregnant uterus can be demonstrated throughout the menstrual cycle, with a maximum just before ovulation. However, not only during the follicular phase but also during the luteal phase, the uterus shows remarkable contractile activity. The present study was conducted in order to examine uterine peristaltic activity and its function during the luteal phases of the human menstrual cycle. The results of vaginal sonography of uterine peristalsis, of hysterosalpingoscintigraphy and of the documentation of the sites of embryo implantation in natural and artificial cycles have shown that uterine peristalsis during the luteal phase is controlled by systemic and probably even more by local hormonal secretion from the fresh corpus luteum, and facilitates the fundal implantation of the blastocyst predominantly ipsilateral to the site of the dominant ovarian structure. Furthermore, this study suggests that the defence against the infiltration and inflammation of the upper genital tract, and thus the degradation of the implanted embryo, represents a further and phylogenetically old and genuine function of the archimetra, which in placentalia was modified in order to participate in the control of invasion of the endometrium by the trophoblast.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, St Johannes Hospital Dortmund, Dortmund, and Department of Obstetrics and Gynaecology, Academic Teaching Hospital to the University of Frankfurt, Darmstadt, Germany.
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Abstract
Peristaltic activity of the non-pregnant uterus serves fundamental functions in the early process of reproduction. Hyperperistalsis of the uterus is significantly associated with the development of endometriosis and adenomyosis. In women with hyperperistalsis fragments of basal endometrium are detached during menstruation and transported into the peritoneal cavity. Fragments of basal endometrium have an increased potential of implantation and proliferation resulting in pelvic endometriosis. In addition, hyperperistalsis induces the proliferation of basal endometrium into myometrial dehiscencies. This results in endometriosis-associated adenomyosis with a prevalence of about 90%. Adenomyosis results in impaired directed sperm transport and thus constitutes an important cause of sterility in women with endometriosis. The principal mechanism of endometriosis/adenomyosis is the paracrine interference of endometrial estrogen with the cyclical endocrine control of archimyometrial peristalsis exerted by the ovary thus resulting in hyperperistalsis. Minimal endometriosis of the fertile women, endometriosis and adenomyosis of the infertile women and adenomyosis of the parous peri- and postmenopausal women are considered as phenotypes of a pathophysiological continuum with uterine peristalsis playing a prominent role.
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Affiliation(s)
- G Leyendecker
- Frauenklinik des Klinikum Darmstadt, Akademisches Lehrkrankenhaus der Universitäten Frankfurt und Heidelberg/Mannheim, Darmstadt.
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Reiner B, Burger C, Kunz G, Davis J. 276 Measurement of small volumes and the partial volume effect in PET images. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81252-6] [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: 11/29/2022]
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Hartmann M, Fippel M, Kunz G. 338 Commissioning of a photon beam model for Monte Carlo dose calculation in dynamic IMRT and comparison with a treatment planning system. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 2005; 20:2309-16. [PMID: 15919780 DOI: 10.1093/humrep/dei021] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The hypothesis is tested that there is a strong association between endometriosis and adenomyosis and that adenomyosis plays a role in causing infertility in women with endometriosis. METHODS. Magnetic resonance imaging of the uteri was performed in 160 women with and 67 women without endometriosis. The findings were correlated with the stage of the disease, the age of the women and the sperm count parameters of the respective partners. RESULTS The posterior junctional zone (PJZ) was significantly thicker in women with endometriosis than in those without the disease (P<0.001). There was a positive correlation of the diameter of the PJZ with the stage of the disease and the age of the patients. The PJZ was thicker in patients with endometriosis with fertile than in patients with subfertile partners. The prevalence of adenomyotic lesions in all 160 women with endometriosis was 79%. In women with endometriosis below an age of 36 years and fertile partners, the prevalence of adenomyosis was 90% (P<0.01) CONCLUSIONS With a prevalence of up to 90%, uterine adenomyosis is significantly associated with pelvic endometriosis and constitutes an important factor of sterility in endometriosis presumably by impairing uterine sperm transport.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Klinikum Darmstadt, Darmstadt, Germany
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Leyendecker G, Kunz G, Herbertz M, Beil D, Huppert P, Mall G, Kissler S, Noe M, Wildt L. Uterine Peristaltic Activity and the Development of Endometriosis. Ann N Y Acad Sci 2004; 1034:338-55. [PMID: 15731324 DOI: 10.1196/annals.1335.036] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Peristaltic activity of the nonpregnant uterus serves fundamental functions in the early process of reproduction, such as directed transport of spermatozoa into the tube ipsilateral to the dominant follicle, high fundal implantation of the embryo, and, possibly, retrograde menstruation. Hyperperistalsis of the uterus is significantly associated with the development of endometriosis and adenomyosis. In women with hyperperistalsis, fragments of basal endometrium are detached during menstruation and transported into the peritoneal cavity. Fragments of basal endometrium have, because of their equipment with estrogen and progesterone receptors and because of their ability to produce estrogen, an increased potential of implantation and proliferation, resulting in pelvic endometriosis. In addition, hyperperistalsis induces the proliferation of basal endometrium into myometrial dehiscencies. This results in endometriosis-associated adenomyosis with a prevalence of approximately 90%. Adenomyosis results in impaired directed sperm transport and thus constitutes an important cause of sterility in women with endometriosis. Our own date and that from the literature strongly suggest that the principal mechanism of endometriosis/adenomyosis is the paracrine interference of endometrial estrogen with the cyclical endocrine control of archimyometrial peristalsis exerted by the ovary, thus resulting in hyperperistalsis.
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Affiliation(s)
- Gerhard Leyendecker
- Department of Obstetrics and Gynecology, Klinikum Darmstadt, 64283 Darmstadt, Germany.
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Gualandi F, Trabanelli C, Rimessi P, Calzolari E, Toffolatti L, Patarnello T, Kunz G, Muntoni F, Ferlini A. Multiple exon skipping and RNA circularisation contribute to the severe phenotypic expression of exon 5 dystrophin deletion. J Med Genet 2003; 40:e100. [PMID: 12920092 PMCID: PMC1735543 DOI: 10.1136/jmg.40.8.e100] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Gualandi
- Sezione di Genetica Medica, Dipartimento di Medicina Sperimentale e Diagnostica, Università di Ferrara, Italy
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Abstract
Unlike other smooth muscle organs, the uterine muscle was regarded to be normally functional for only a brief period, following a lengthy gestation. However, recently it has been shown that uterine peristalsis constitutes one of the fundamental functions of the non-pregnant uterus. Its morphological basis is the archimyometrium, which is the muscular component of the archimetra and which preserves a functional bipartition of the primarily unpaired uterus. Three types of uterine peristaltic contractions can be distinguished: cervico-fundal, fundo-cervical and isthmical peristaltic activity, which changes during the menstrual cycle and is controlled by the dominant ovarian structure via the secretion of sex steroids systemically and into the utero-ovarian vascular countercurrent system. Uterine peristalsis of the non-pregnant uterus is actively involved in very early reproductive processes, such as rapid and sustained directed sperm transport and high fundal implantation, as well as serving retrograde menstruation for the preservation of body iron content. Furthermore, it became apparent that hyper- and dysfunctions of this contractile activity, such as hyper- and dysperistalsis, might be causally involved in the development of pelvic endometriosis, uterine adenomyosis and infertility, as obtained from immunohistochemistry, vaginal sonography, hysterosalpingoscintigraphy and magnetic resonance imaging.
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Affiliation(s)
- Georg Kunz
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Klinikum Darmstadt, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Grafenstr. 9, 64283 Darmstadt, Germany.
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48
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Abstract
BACKGROUND The hypothesis is tested that both adenomyotic and endometriotic lesions are derived from basal endometrium. METHODS Normal uteri and uteri with adenomyosis obtained by hysterectomy, excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. Estrogen receptor (ER), progesterone receptor (PR), progesterone receptor B isoform (PR(B)) and P450 aromatase (P450A) immunohistochemistry was performed with the use of specific monoclonal antibodies. RESULTS With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium. The endometrium of endometriotic and adenomyotic lesions mimicked the cyclical pattern of the basalis. The peristromal muscular tissue of endometriotic and adenomyotic lesions displayed the same cyclical pattern of ER and PR expression as the archimyometrium. There was a significantly higher prevalence of fragments of shed basalis in menstrual blood of women with endometriosis than in healthy controls. CONCLUSIONS These data suggest that ectopic endometrial lesions result from dislocation of basal endometrium. Dislocated basal endometrium has stem cell character resulting in the ectopic formation of all archimetrial components such as epithelial and stromal endometrium as well as peristromal muscular tissue.
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Affiliation(s)
- G Leyendecker
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg, Grafenstrasse 9, Germany.
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49
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Kunz G, Britzen S, Busch HP. [Influence of tandem optics and television tube of modern digital fluoroscopy equipment on image quality]. Z Med Phys 2001; 11:124-30. [PMID: 11480370 DOI: 10.1016/s0939-3889(15)70500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The influence of the tandem optics and the TV-tube to the image quality of 1k- and 2k-radiographs of a modern fluoroscopy equipment should be assessed on the basis of objective parameters and clinical requirements. Radiographs of different phantoms with 1k- and 2k-image matrix, different illumination point corrections (IPC) and signal gray levels were taken, examined and evaluated, in order to determine the objective image parameters and the clinical relevancy of these parameters. On the one hand, the digital images data could be used directly for evaluation; on the other hand, the radiographs could be visually evaluated by experienced radiologists within the framework of a blind study. The IPC is controlled by the aperture of the iris diaphragm and the insertion of a neutral gray filter in the tandem optics. The larger the aperture of the iris diaphragm (at constant image receiver dose) the higher were gradation, signal to noise ratio (SNR) and image homogeneity. Furthermore, the larger the aperture, the lower was the square wave response function (SWRF). The insertion of a gray filter in the tandem optics decreases gradation, SNR and homogeneity, and improves the SWRF.
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Affiliation(s)
- G Kunz
- Klinik für Radio-Onkologie, Universitätsspital Zürich
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50
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Breier F, Khanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, Tappeiner G. Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144:387-92. [PMID: 11251580 DOI: 10.1046/j.1365-2133.2001.04034.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 64-year-old woman presented with bullous and ulcerating lichen sclerosus et atrophicus (LSA) on the neck, trunk, genital and perigenital area and the extremities. Histology of lesional skin showed the typical manifestations of LSA; in one of the biopsies spirochaetes were detected by silver staining. Despite treatment with four courses of ceftriaxone with or without methylprednisone for up to 20 days, progression of LSA was only stopped for a maximum of 1 year. Spirochaetes were isolated from skin cultures obtained from enlarging LSA lesions. These spirochaetes were identified as Borrelia afzelii by sodium dodecyl sulphate--polyacrylamide gel electrophoresis and polymerase chain reaction (PCR) analyses. However, serology for B. burgdorferi sensu lato was repeatedly negative. After one further 28-day course of ceftriaxone the lesions stopped expanding and sclerosis of the skin was diminished. At this time cultures for spirochaetes and PCR of lesional skin for B. afzelii DNA remained negative. These findings suggest a pathogenetic role for B. afzelii in the development of LSA and a beneficial effect of appropriate antibiotic treatment.
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Affiliation(s)
- F Breier
- Department of Dermatology, Lainz Municipal Hospital, Wolkersbergenstrasse 1, A-1130 Vienna, Austria.
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