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Hass HG. [Oncological Rehabilitation for Breast Cancer]. Rehabilitation (Stuttg) 2024; 63:119-130. [PMID: 38626791 DOI: 10.1055/a-2129-9279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
As a result of increasingly individualized and multimodal therapy, prognosis of breast cancer has improved significantly over the last years. However, multimodal treatment and the use of new medications can lead to a variety of somatic, sometimes new, side effects such as fatigue, polyneuropathy or autoimmune toxicities. This and the oncological diagnosis lead to a high level of psychological distress in the women affected and often to subsequent psychological disorders (sleep/anxiety disorders, depression, ...). Both the diverse complaints after oncological therapy and the increasingly improved overall prognosis underline the importance of multimodal rehabilitation concepts to improve quality of life and successful professional reintegration.In the following, these secondary disorders after breast cancer, their multimodal therapy and their significance for social-medical performance assessment are presented in more detail.
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Hass HG, Seywald M, Wöckel A, Muco B, Tanriverdi M, Stepien J. Psychological distress in breast cancer patients during oncological inpatient rehabilitation: incidence, triggering factors and correlation with treatment-induced side effects. Arch Gynecol Obstet 2023; 307:919-925. [PMID: 35732979 DOI: 10.1007/s00404-022-06657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/01/2022] [Indexed: 11/02/2022]
Abstract
As a result of the cancer diagnosis and the mostly multimodal, stressful therapy, psychological distress is a common symptom in breast cancer patients. As part of this prospective study, 1400 patients who were admitted to the hospital for oncological rehabilitation were screened for distress and somatic, therapy-induced secondary disorders. Mean distress in the screened population was 5.6 ± 2.56 (range 0-10). In 942 cases (67.3%) a significant distress score (≥ 5) was detected and in 587 cases (41.9%) very high levels of distress (≥ 7) was observed. Psychological distress significantly correlated with younger age, presence of triple negative breast cancer (TNBC), tumor recurrence and metastasis, and inability to work. Treatment-induced side effects such as lymphedema, CIPN or extensive tumor resection (mastectomy) showed a (not significant) trend for higher distress. The high incidence of distress underscores the importance of psycho-oncological therapy offers and the great importance of occupational measures during oncological rehabilitation such as the importance of a successful return to work for a better quality of life in breast cancer patients.
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Affiliation(s)
- Holger G Hass
- Klinik Gais, Abteilung Onkologie, Dep. Innere Medizin, Gäbrisstrasse 1172, 9056, Gais, Switzerland. .,Institut Für Rehabilitationsforschung Und Survivorship (IREFOS), 88175, Scheidegg, Germany.
| | - Marianne Seywald
- Institut Für Rehabilitationsforschung Und Survivorship (IREFOS), 88175, Scheidegg, Germany.,Paracelsus-Klinik, 88175, Scheidegg, Germany
| | - Achim Wöckel
- Frauenklinik, Universitätsklinikum, 97080, Würzburg, Germany
| | - Blerta Muco
- Universität Würzburg, 97080, Würzburg, Germany
| | | | - Jürgen Stepien
- Institut Für Rehabilitationsforschung Und Survivorship (IREFOS), 88175, Scheidegg, Germany.,Paracelsus-Klinik, 88175, Scheidegg, Germany
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Meng K, Fahmer N, Engehausen D, Hass HG, Reuss-Borst M, Duelli K, Wöckel A, Heuschmann PU, Faller H. Patientenkompetenz zur Krankheitsbewältigung – eine
qualitative Analyse bei Frauen mit Brustkrebs und gynäkologischen
Tumoren. Psychother Psychosom Med Psychol 2022; 73:187-196. [PMID: 36413985 DOI: 10.1055/a-1956-9153] [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: 11/24/2022]
Abstract
Zusammenfassung
Ziel Die Studie exploriert Herausforderungen, persönliche
Kompetenzen und hilfreiche Unterstützung bei der
Krankheitsbewältigung von Patienteninnen mit Brustkrebs und
gynäkologischen Tumoren und wie die Patientenkompetenz als Zusammenspiel
dieser Faktoren gefördert werden kann.
Methodik Teilstrukturierte Leitfadeninterviews wurden mit 19 Patientinnen
im Akutsetting, 20 Rehabilitandinnen und 16 Teilnehmerinnen einer
Selbsthilfegruppe geführt und mittels qualitativer Inhaltsanalyse
ausgewertet.
Ergebnisse Die thematisierten Herausforderungen sind in die
Hauptkategorien – Diagnoseverarbeitung,
Behandlungs-/Rezidivängste, Krankheitsverarbeitung und
Adaptation, Sorgen um Angehörige, Reaktionen des sozialen Umfeldes,
Sorgen um den Arbeitsplatz – zusammengefasst. Die benannten
persönlichen Kompetenzen im Umgang mit diesen Herausforderungen sind den
folgenden Hauptkategorien zugeordnet: kognitionsbezogenes Coping,
handlungsbezogenes Coping, Selbstregulation Krankheitsverarbeitung,
Unterstützung einholen und annehmen, selbstbestimmte Kommunikation der
Erkrankung, hilfreiche Strategien identifizieren und anwenden,
krankheitsbezogene Erfahrung, günstige Lebensumstände, Offenheit
für Hilfsangebote. Hilfreiche emotionale, informationelle oder
instrumentelle Unterstützung wird durch Angehörige, Freunde,
Tiere, Arbeitskollegen/Arbeitgeber, Behandler, Rehabilitation,
Mitpatientinnen/Betroffene, Selbsthilfe und Beratungseinrichtungen
wahrgenommen.
Diskussion Die Frauen beschreiben eine Vielzahl an persönlichen
Kompetenzen, die einem bedürfnisorientierten, selbstgesteuerten
Bewältigungsprozess entsprechen. Die Individualität und
Komplexität des Zusammenspiels der Komponenten der Patientenkompetenz
unterstreicht die Relevanz von patientenorientierter Versorgung. Empowerment und
eine aktive Patientenrolle sind erforderlich, um bedürfnisbezogen
Bewältigungsfertigkeiten zu fördern. Unterstützung durch
Behandler oder das private Umfeld kann dabei Herausforderungen vermindern oder
Kompetenzen und deren Anwendung fördern.
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Affiliation(s)
- Karin Meng
- Institut für Klinische Epidemiologie und Biometrie,
Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
| | - Natascha Fahmer
- Institut für Klinische Epidemiologie und Biometrie,
Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
| | | | - Holger G. Hass
- Abteilung Onkologie, Dep. Innere Medizin, Klinik Gais AG, Gais,
Switzerland
- Institut für Rehabilitationsforschung und Survivorship
(IREFOS), Scheidegg, Germany
| | | | - Kristin Duelli
- Universitätsklinikum Würzburg Frauenklinik und
Poliklinik, Würzburg, Germany
| | - Achim Wöckel
- Universitätsklinikum Würzburg Frauenklinik und
Poliklinik, Würzburg, Germany
| | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie,
Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
- Zentrale für Klinische Studien, Universitätsklinikum
Würzburg, Würzburg, Germany
| | - Hermann Faller
- Institut für Klinische Epidemiologie und Biometrie,
Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
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Hass HG, Herzberger A, Wöckel A, Stepien J. Male Breast Cancer: Therapy-Induced Toxicities, Psychological Distress, and Individual Patient Goals during Oncological Inpatient Rehabilitation. Oncol Res Treat 2022; 45:736-743. [PMID: 36265447 DOI: 10.1159/000526704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Male breast cancer (MBC) is a rare malignancy that accounts for less than 1% of all cancers in men and less than 1% of all breast cancers worldwide. Understandably, due to the low incidence of this rare cancer, there is a lack of prospective clinical data. The aim of this retrospective study was the analysis of therapy-induced toxicities as well as the assessment of psychological distress in the affected men during oncological inpatient rehabilitation. METHODS Fifty-one MBC patients were evaluated for the presence of treatment-induced side effects, toxicities, and psychological distress (using German version of the 11-stage NCCN distress thermometer; cut-off ≥5) during oncological indoor rehabilitation. The collected data were checked for correlation with sociodemographic and clinical factors (SPSS 22). RESULTS The mean age was 62.0 ± 10.6 years, in 96% a hormone-dependent breast tumor (ER+), and in over 75%, overweight or obesity (BMI >25/>30) was diagnosed. Most reported side effects included weakness/fatigue (74.5%), arthralgia after surgery/chemotherapy (43.1%), chemotherapy-induced polyneuropathy (36.3%), and/or lymphedema (13.7%). Psychological distress was detected in 24 cases (47.0%; ≥5), in 13 cases even with significantly high levels (25.5%; ≥7). There was no correlation between psychological distress and clinical factors such as age, performed treatment (e.g., chemotherapy), or therapy-induced side effects (e.g., lymphedema) in our small collective. CONCLUSIONS Psychological distress and somatic side effects are common in MBC. These data demonstrate the importance of routine screening for psychological distress and the high need for psycho-oncological therapy (regardless of gender) in multimodal oncological rehabilitation.
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Affiliation(s)
- Holger G Hass
- Abt. Onkologie, Klinik Gais, Gais, Switzerland.,Dep. Innere Medizin, Klinik Gais, Gais, Switzerland.,Institut für Rehabilitrationsforschung und Survivorship (IREFOS), Scheidegg, Germany
| | - Andrea Herzberger
- Abt. Onkologie, Klinik Gais, Gais, Switzerland.,Dep. Innere Medizin, Klinik Gais, Gais, Switzerland.,Paracelsus-Klinik, Scheidegg, Germany
| | - Achim Wöckel
- Frauenklinik, Universitätsklinikum, Würzburg, Germany
| | - Jürgen Stepien
- Abt. Onkologie, Klinik Gais, Gais, Switzerland.,Dep. Innere Medizin, Klinik Gais, Gais, Switzerland.,Paracelsus-Klinik, Scheidegg, Germany
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Fahmer N, Faller H, Engehausen D, Hass HG, Reuss-Borst M, Duelli K, Wöckel A, Heuschmann PU, Meng K. Patients' challenges, competencies, and perceived support in dealing with information needs - A qualitative analysis in patients with breast and gynecological cancer. Patient Educ Couns 2022; 105:2382-2390. [PMID: 34930628 DOI: 10.1016/j.pec.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to investigate challenges, competencies, and support in breast and gynecological cancer patients when dealing with information needs and how health literacy as an interplay of these factors might be improved. METHODS Semi-structured interviews were conducted with patients in acute care (n = 19), undergoing rehabilitation (n = 20) or attending self-help groups (n = 16). Interviews were analyzed using content analysis. RESULTS Challenges: gain information according to own needs, internet as information source, information evaluation and decisions, doctor-patient communication, situationally limited information processing, difficult access to information. Competencies: self-regulation of information needs, media and social competencies, communication skills in the doctor-patient conversation, internet competencies, self-directed decisions according to own needs, interest/self-efficacy, previous knowledge, trust in the doctor. SUPPORT by professionals (e.g., patient-centered communication), relatives (e.g., support during consultations), peers (e.g., exchange), facilities (e.g., clinics). CONCLUSIONS Our findings provide insight into challenges and competencies relevant to patients' health literacy and the influence of support. The individuality of the interplay highlights the relevance of an active patient role and patient-centered care. PRACTICE IMPLICATIONS Patients' health literacy should be improved in (psycho)oncological work by both reducing challenges (e.g., by communication skills training, involving relatives) and promoting competencies (e.g., by needs- and competence-oriented information offers).
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Affiliation(s)
- Natascha Fahmer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany.
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | | | - Holger G Hass
- Paracelsus Clinic Scheidegg, 88175 Scheidegg, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, 97708 Bad Bocklet, Germany
| | - Kristin Duelli
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
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Hass HG, Seywald M, Stepien J, Muco B, Tanriverdi M, Beckmann MW, Kunzmann V, Wöckel A. [Early and Late Toxicities and Socio-Medical Relevant Disorders after Oncological Treatment for Breast Cancer-Implications and Assessment of Rehabilitation Requirement]. REHABILITATION 2021; 60:77-85. [PMID: 33858016 DOI: 10.1055/a-1361-3666] [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: 10/21/2022]
Abstract
INTRODUCTION Reasonable to the improved prognosis of breast cancer (BC) long-term toxicities and side effects of oncological therapy gain more importance for work ability and social life of BC patients. Aim of this study was the analysis of occurence and differences of treatment-related side effects in relation to type of rehabilitation (so-called AHB vs. later rehabilitation) after therapy for BC. METHODS Clinical and patient related data as early and late toxicities after oncological treatment of 8.000 patients with BC (55.7±10.4y) were analyzed and compared with current literature. RESULTS In 23.9% a mastectomy was performed, in 87.3% radiotherapy. In most cases an additional systemic treatment (57,6% CTX, 15,1% anti-Her2, 71% antihormonal treatment) was carried out. In 8.1% women suffered from recurrent or metastatic BC. As most common side effects of multimodal treatment weakness/fatigue (73,6%), insomnia (51,9%), CIPN (33%), lymph edema (13,9%) and drug-induced arthralgia (24,8%) were detected. In addition, 60.4% of women reported high levels of psychological distress. Shortly after therapy typical side effects were drug-induced toxicities (Leucopenia, p<0.0001; anemia, p<0.001; weakness/fatigue p<0.001; CIPN, p<0.0001), whereas in a later course chronic lymphedema (p<0.0001), chronic or recurrent disease (p<0.0001), status after mastectomy (p<0.0001) and psychological distress (p<0.0001) were significantly more often seen. Moreover, in this collective patients were significantly younger (53,7±9,8 vs. 56,3±10,7y). CONCLUSIONS In BC patients, significantly different impairments and toxicities were documented between patients with early rehabilitation and patients with later onset of rehabilitation. These data may help to establish more individual and focused rehabilitation concepts in specialized centers.
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Affiliation(s)
- Holger G Hass
- Paracelsus-Klinik, Scheidegg.,Institut für Rehabilitationsforschung und Survivorship (IREFOS), Scheidegg
| | - Marianne Seywald
- Paracelsus-Klinik, Scheidegg.,Institut für Rehabilitationsforschung und Survivorship (IREFOS), Scheidegg
| | | | | | | | | | - Volker Kunzmann
- Medizinische Klinik 2, Abt. Hämatologie, Onkologie, Gastroenterologie und Rheumathologie, Universitätsklinikum Würzburg
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Rick O, Reuß-Borst M, Dauelsberg T, Hass HG, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. [Role of Clinical, Sociomedical and Psychological Factors on Return to Work of Patients with Breast Cancer 6 Months after Rehabilitation]. REHABILITATION 2021; 60:253-262. [PMID: 33477192 DOI: 10.1055/a-1288-5824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM OF THE STUDY The majority of patients with non-metastatic breast cancer return to work after tumor therapy. A rate of up to 80% is given in national and international studies, which can vary considerably depending on the study population and the various social systems. However, it is unclear how many patients are reintegrated into work after medical rehabilitation and which clinical, sociodemographic and psychological factors play a role. METHODS In a multicentre study, clinical and sociodemographic data were collected from breast cancer patients at the beginning of their medical rehabilitation. Subjectively experienced deficits in attention performance (FEDA), depressive symptoms (PHQ-9) and health-related quality of life (EORTC QLQ-C30) were recorded using standardized questionnaires. The cognitive performance was also examined using a computer-based test battery (NeuroCog FX). A follow-up survey was carried out 6-9 months after medical rehabilitation. The subjective assessment of one's own cognitive performance (FEDA) was recorded again at this time. RESULTS 396 of the originally 476 patients were included in the study. In the follow-up survey, 323/396 patients (82%) were again employed. In a regression model, sociodemographic factors proved to be particularly predictive with regard to occupational reintegration: employment at the time of the tumor diagnosis, job preserved after medical rehabilitation, employee status and gradual reintegration according to the Hamburg model (Nagelkerke R2=0.685). This model could not be improved by adding psychological variables. The subjective patient information in all questionnaires was highly correlated (r>0.57; p<0.001). CONCLUSION The vast majority of breast cancer patients return to work after medical rehabilitation. Socio-demographic factors play a crucial role in this. The regression model developed here, including the employment status, professional orientation and gradual reintegration, is of predictive importance and can be used in medical rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Klaus Fliessbach
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinik Bonn
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Faller H, Hass HG, Engehausen D, Reuss-Borst M, Wöckel A. Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study. Acta Oncol 2019; 58:417-424. [PMID: 30632891 DOI: 10.1080/0284186x.2018.1543947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with breast or gynecological cancer, supportive care needs are both highly prevalent and enduring. However, little is known about whether meeting patients' needs is accompanied by increased quality of life (QoL). We aimed to explore patients' supportive care needs reported at the beginning of inpatient rehabilitation and examined whether meeting these needs resulted in improved QoL. MATERIAL AND METHODS In a multicenter, prospective cohort study with 2 measurement occasions (beginning and end of inpatient rehabilitation), 292 patients with breast and gynecological cancer (mean age 55 years; 71% breast cancer) were enrolled. In 73%, time since diagnosis was longer than 6 months. We obtained self-reports of supportive care needs in 12 domains and measured QoL using the EORTC QLQ-C30 functioning subscales. RESULTS At the beginning of inpatient rehabilitation, top-ranking severe supportive care needs concerned coordination of care (48%), medical information (45%), alleviation of physical symptoms (42%) and support with improving health behaviors (36%). At the end of inpatient rehabilitation, all needs assessed declined significantly, although many patients still expressed strong needs in some domains. However, meeting patients' needs was accompanied by improvements in all functioning subscales. CONCLUSIONS This is the first study to show that meeting breast and gynecological cancer patients' supportive care needs during inpatient rehabilitation resulted in improved QoL. Given the considerable proportions of patients still reporting unmet needs at the end of their stay, stronger and continuing efforts seem warranted to meet these needs and thus further increase QoL.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | - Dirk Engehausen
- Sinntal Clinic Bad Brückenau, German Statutory Pension Insurance of Northern Bavaria, Bad Brückenau, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, Bad Bocklet, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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Hass HG, Vogel U, Scheurlen M, Jobst J. Subclassification and Detection of New Markers for the Discrimination of Primary Liver Tumors by Gene Expression Analysis Using Oligonucleotide Arrays. Gut Liver 2018; 12:306-315. [PMID: 29271183 PMCID: PMC5945262 DOI: 10.5009/gnl17277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background/Aims The failure to correctly differentiate between intrahepatic cholangiocarcinoma (CC) and hepatocellular carcinoma (HCC) is a significant clinical problem, particularly in terms of the different treatment goals for both cancers. In this study a specific gene expression profile to discriminate these two subgroups of liver cancer was established and potential diagnostic markers for clinical use were analyzed. Methods To evaluate the gene expression profiles of HCC and intrahepatic CC, Oligonucleotide arrays (AffymetrixU133A) were used. Overexpressed genes were checked for their potential use as new markers for discrimination and their expression values were validated by reverse transcription polymerase chain reaction and immunohistochemistry analyses. Results 695 genes/expressed sequence tags (ESTs) in HCC (245 up-/450 down-regulated) and 552 genes/ESTs in CC (221 up-/331 down-regulated) were significantly dysregulated (p<0.05, fold change >2, ≥70%). Using a supervised learning method, and one-way analysis of variance a specific 270-gene expression profile that enabled rapid, reproducible differentiation between both tumors and nonmalignant liver tissues was established. A panel of 12 genes (e.g., HSP90β, ERG1, GPC3, TKT, ACLY, and NME1 for HCC; SPT2, T4S3, CNX43, TTD1, HBD01 for CC) were detected and partly described for the first time as potential discrimination markers. Conclusions A specific gene expression profile for discrimination of primary liver cancer was identified and potential marker genes with feasible clinical impact were described.
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Affiliation(s)
- Holger G Hass
- Department of Internal Medicine, Oncology and Rehabilitation, Paracelsus Hospital, Scheidegg, Germany
| | - Ulrich Vogel
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Michael Scheurlen
- Department of Gastroenterology, Oncology, Rheumatology, University of Würzburg, Würzburg, Germany
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Hass HG, Seywald M, Wöckel A, Flentje M, Weigel M, Beckmann MW, Kunzmann V. Clinical and histopathological differences between premenopausal and postmenopausal ER+ breast cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- HG Hass
- Paracelsus-Klinik, Scheidegg, Deutschland
- Praxis für Onkologie und Hämatologie Westallgäu, Scheidegg, Deutschland
| | - M Seywald
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - A Wöckel
- Frauenklinik Universität Würzburg, Würzburg, Deutschland
| | - M Flentje
- Klinik und Poliklinik für Strahlentherapie, Universität Würzburg, Würzburg, Deutschland
| | - M Weigel
- Frauenklinik Leopoldina, Schweinfurt, Deutschland
| | - MW Beckmann
- Frauenklinik Universität Erlangen, Erlangen, Deutschland
| | - V Kunzmann
- Medizinische Klinik und Poliklinik 2, Universität Würzburg, Würzburg, Deutschland
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Hass HG, Seywald M, Wöckel A, Flentje M, Weigel M, Beckmann MW, Kunzmann V. Prognostic value of Ki67 labelling index in different subtypes of invasive breast cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- HG Hass
- Paracelsus-Klinik, Scheidegg, Deutschland
- Praxis für Onkologie und Hämatologie Westallgäu, Scheidegg, Deutschland
| | - M Seywald
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - A Wöckel
- Frauenklinik Universität Würzburg, Würzburg, Deutschland
| | - M Flentje
- Klinik und Poliklinik für Strahlentherapie, Universität Würzburg, Würzburg, Deutschland
| | - M Weigel
- Frauenklinik Leopoldina, Schweinfurt, Deutschland
| | - MW Beckmann
- Frauenklinik Universität Erlangen, Erlangen, Deutschland
| | - V Kunzmann
- Medizinische Klinik und Poliklinik 2, Universität Würzburg, Würzburg, Deutschland
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Hass HG, Rockstroh J, Pech I, Drews S, Stepien J, Lerch J. Medical-professional rehabilitation after cancer – 2-years experience and evaluation of a multimodal rehabilitation concept. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- HG Hass
- Paracelsus-Klinik, Scheidegg, Deutschland
- Praxis für Onkologie und Hämatologie Westallgäu, Scheidegg, Deutschland
| | | | - I Pech
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - S Drews
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - J Stepien
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - J Lerch
- Paracelsus-Klinik, Scheidegg, Deutschland
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Hass HG, Seywald M, Wöckel A, Flentje M, Weigel M, Beckmann MW, Kunzmann V. Early and late Toxicity and side effects with relevance for social medicine in patients with breast cancer – Time-dependent analysis of 5800 breast cancer patients. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- HG Hass
- Paracelsus-Klinik, Scheidegg, Deutschland
- Praxis für Onkologie und Hämatologie Westallgäu, Scheidegg, Deutschland
| | - M Seywald
- Paracelsus-Klinik, Scheidegg, Deutschland
| | - A Wöckel
- Frauenklinik Universität Würzburg, Würzburg, Deutschland
| | - M Flentje
- Klinik und Poliklinik für Strahlentherapie, Universität Würzburg, Würzburg, Deutschland
| | - M Weigel
- Frauenklinik Leopoldina, Schweinfurt, Deutschland
| | - MW Beckmann
- Frauenklinik Universität Erlangen, Erlangen, Deutschland
| | - V Kunzmann
- Medizinische Klinik und Poliklinik 2, Universität Würzburg, Würzburg, Deutschland
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Hass HG, Vogel U, Scheurlen M, Jobst J. Use of Gene Expression Analysis for Discrimination of Primary and Secondary Adenocarcinoma of the Liver. Oncology 2018; 95:211-219. [PMID: 29920486 DOI: 10.1159/000489563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Due to late diagnosis and resistance to chemotherapy, most patients with cholangiocarcinoma have an unfavorable prognosis. Despite the use of immunohistochemistry (IHC) in clinical routine, differentiation between intrahepatic cholangiocarcinoma (ICC) and secondary adenocarcinomas of the liver is frequently not clear, leading to false diagnosis and treatment decisions. METHODS Oligonucleotide microarrays (Affymetrix Hu133A©) were used for gene expression analysis of ICC (n = 11) and secondary adenocarcinomas (colorectal metastases; n = 6). By two-dimensional cluster analysis a specific gene expression profile of these tumors was established and confirmed by real-time polymerase chain reaction and IHC. RESULTS A total of 338 genes were significantly dysregulated (gene expression/fc ≥2; dysregulation in ≥60%) in both tumor groups. Using two-dimensional cluster analysis a fast, clear, and reproducible differentiation between ICC and colorectal metastases was possible in all cases. As potential biomarkers for differentiation, twelve genes (ICC: KRT7, DBN1, LCTB, LIF, STK17A, PIGF; metastases: TDGF1, HOXA9, TFF3, MYB, ABP1, BCL11A) were detected and will be used for further investigations. CONCLUSIONS A specific gene expression profile for discrimination of primary and secondary adenocarcinoma of the liver could be established. In addition, marker genes for both cancers and their potential use as discrimination markers in clinical routine were also described partially for the first time.
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Affiliation(s)
- Holger G Hass
- Department of Internal Medicine, Oncology, and Rehabilitation, Paracelsus Hospital, Scheidegg, Germany
| | - Ulrich Vogel
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Michael Scheurlen
- Department of Medicine II, University of Würzburg, Würzburg, Germany
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Rick O, Reuß-Borst M, Dauelsberg T, Hass HG, König V, Caspari R, Götz-Keil G, Pfitzner J, Kerschgens C, Fliessbach K, Hoppe C. NeuroCog FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer. Psychooncology 2018; 27:2016-2022. [DOI: 10.1002/pon.4763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Klaus Fliessbach
- Clinic for Neurodegenerative Disease and Geriatric Psychiatry; University of Bonn Medical Centre; Bonn Germany
| | - Christian Hoppe
- Department of Epileptology; University of Bonn Medical Centre; Bonn Germany
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Hass HG, Vogel U, Scheurlen M, Jobst J. Gene-expression Analysis Identifies Specific Patterns of Dysregulated Molecular Pathways and Genetic Subgroups of Human Hepatocellular Carcinoma. Anticancer Res 2017; 36:5087-5095. [PMID: 27798868 DOI: 10.21873/anticanres.11078] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 08/05/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hepatocellular carcinoma comprises of a group of heterogeneous tumors of different etiologies. The multistep process of liver carcinogenesis involves various genetic and phenotypic alterations. The molecular pathways and driver mutations involved are still under investigation. MATERIALS AND METHODS DNA micorarray technology was used to identify differentially expressed genes between human hepatocarcinoma and non-tumorous liver tissues to establish a unique specific gene-expression profile independent of the underlying liver disease. The validity of this global gene-expression profile was tested for its robustness against biopsies from other liver entities (cirrhotic and non-cirrhotic liver) by diagnosing HCC in blinded samples. RESULTS Most of the consistently and strongly overexpressed genes were related to cell-cycle regulation and DNA replication [27 genes, e.g. cyclin B1, karyopherin alpha 2 (KPNA2), cyclin-dependent kinase 2 (CDC2)], G-protein depending signaling [e.g. Rac GTPase activating protein 1 (RACGAP1), Rab GTPase YPT1 homolog (RAB1), and ADP-ribosylation factor-like 2 (ARL2)] and extracellular matrix re-modelling or cytoskeleton structure [22 genes, e.g. serine proteinase inhibitor 1 kazal-type (SPINK1), osteopontin (OPN), secreted protein acidic and rich in cysteine (SPARC), collagen type 1 alpha2 (COL1A2), integrin alpha6 (ITGA6), and metalloproteinase 12 (MMP12)]. Furthermore, significantly differentially expressed genes (e.g. calcium-binding proteins, G-proteins, oncofetal proteins) in relation to tumor differentiation were detected using gene-expression analysis. CONCLUSION It is suggested that these significantly dysregulated genes are highly specific and potentially utilizable as prognostic markers and may lead to a better understanding of human hepatocarcinogenesis.
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Affiliation(s)
- Holger G Hass
- Department of Oncology, Paracelsus Hospital, Scheidegg, Germany
| | - Ulrich Vogel
- Department of Pathology, University of Tuebingen, Tuebingen, Germany
| | - Michael Scheurlen
- Department of Gastroenterology, Hematology, Oncology and Rheumatology, University of Wuerzburg, Wuerzburg, Germany
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17
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G. Hass H, Markmann HU, Sch鋐fer M, Wellh鋟遝r U, Smith U, Denzlinger C. Diagnostic and Prognostic Aspects of Hepatocellular Carcinoma – A Retrospective
Analysis in 145 Patients. ACTA ACUST UNITED AC 2017. [DOI: 10.17554/j.issn.2224-3992.2017.06.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hass HG, Jobst J, Scheurlen M, Vogel U, Nehls O. Gene expression analysis for evaluation of potential biomarkers in hepatocellular carcinoma. Anticancer Res 2015; 35:2021-2028. [PMID: 25862856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The poor prognosis of hepatocellular carcinoma (HCC) and the lack of specific screening markers underline the need for new biomarkers for human hepatocarcinogenesis. MATERIALS AND METHODS We investigated 10 postulated biomarkers for HCC (AFP, GPC3, OPN, IGF1, HGF, SPINK1, KPNA, FUCA1, CgA, HSP90) with microarray gene expression analysis and real-time polymerase chain reaction (RT-PCR) in HCC tissues of different etiologies. RESULTS Four candidate genes (FUCA1, HGF, IGF1, CgA) showed low median fold changes (fc) of expression compared to corresponding non-malignant liver tissues (fc range=0.2-0.8; maximum 15% of samples). The classic biomarker, alpha-fetoprotein (AFP), was significantly over-expressed (fc=2.4) in 30% of tumors. High tumor AFP expression was associated with significantly elevated serum AFP concentrations (>90% of cases). Five genes (OPN, SPINK1, GPC3, HSP90, KNPA2) showed significantly higher expression than AFP in 64% to 82% of samples (median fc range=2.9-8.3). RT-PCR analyses gave similar results. CONCLUSION Unlike previous studies, our results did not confirm FUCA1, HGF, IGF1 or CgA as potential markers for HCC. In contrast, OPN, SPINK1, GPC3 and KNPA2 were significantly over-expressed in HCC tissues. These genes may be useful in developing future biomarkers and therapeutic strategies for HCC.
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Affiliation(s)
- Holger G Hass
- Department of Oncology, Paracelsus Hospital, Scheidegg, Germany
| | - Juergen Jobst
- Department of Oncology, Paracelsus Hospital, Scheidegg, Germany
| | - Michael Scheurlen
- Department of Gastroenterology, Hematology, Oncology and Rheumatology, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrich Vogel
- Department of Pathology, University of Tuebingen, Tuebingen, Germany
| | - Oliver Nehls
- Praxis of Gastroenterology and Tumor Medicine, Stuttgart, Germany
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Hass HG, Jobst J, Vogel U, Scheurlen M, Nehls O. Overexpression of Tumor-Associated Trypsin Inhibitor (SPINK1/TATI) in Hepatitis C-Associated Hepatocellular Carcinoma: Potential Implications for Viral Hepatocarcinogenesis. Oncol Res Treat 2014; 37:732-8. [DOI: 10.1159/000369151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022]
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von Einem JC, Heinemann V, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, Decker T, Klein S, Held S, Jung A, Kirchner T, Haas M, Holch J, Michl M, Aubele P, Boeck S, Schulz C, Giessen C, Stintzing S, Modest DP. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial. J Cancer Res Clin Oncol 2014; 140:1607-14. [PMID: 24816724 PMCID: PMC4131148 DOI: 10.1007/s00432-014-1678-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Purpose AIO KRK-0104 investigated first-line therapy of metastatic colorectal cancer (mCRC) with cetuximab, capecitabine and irinotecan versus cetuximab, capecitabine and oxaliplatin. This analysis investigated the impact of primary tumor location on outcome of patients. Patients and methods Left-sided primary tumors were defined as tumors from rectum to left flexure, while tumors in the remaining colon were regarded right sided. Overall survival (OS), progression-free survival (PFS) and response rate were correlated with primary tumor location. A Cox regression model was used to evaluate interaction between primary tumor location and KRAS mutation. Results Of 146 patients of the AIO KRK-0104 trial, 100 patients presented left-sided (of those 68 KRAS codon 12/13 wild-type) and 46 patients right-sided primary tumors (of those 27 KRAS codon 12/13 wild-type). Left-sided tumors were associated with significantly longer OS (p = 0.016, HR = 0.63) and PFS (p = 0.02, HR = 0.67) as compared to right-sided tumors. These effects were present in the KRAS codon 12/13 wild-type population (HR OS: 0.42; HR PFS: 0.54), while no impact of primary tumor location was evident in patients with KRAS codon 12/13 mutant tumors (HR OS: 1.3; HR PFS: 1.01). A significant interaction of KRAS status and primary tumor location concerning OS and PFS was observed. Conclusion Our findings suggest that primary tumor location and KRAS codon 12/13 mutational status interact on the outcome of patients with mCRC receiving cetuximab-based first-line therapy. Left-sided primary tumor location might be a predictor of cetuximab efficacy.
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Affiliation(s)
- J C von Einem
- Department of Medicine III, University Hospital Grosshadern, University of Munich, Munich, Germany,
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21
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Hass HG, Smith U, Jäger C, Schäffer M, Wellhäuber U, Hehr T, Markmann HU, Nehls O, Denzlinger C. Signet ring cell carcinoma of the stomach is significantly associated with poor prognosis and diffuse gastric cancer (Lauren's): single-center experience of 160 cases. ACTA ACUST UNITED AC 2011; 34:682-6. [PMID: 22156447 DOI: 10.1159/000334545] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to evaluate survival rates and treatment response in stage I-IV gastric cancer in relation to tumor stage (TNM), histology, Lauren's classification and tumor localization. PATIENTS AND METHODS Clinical and histopathological data of 160 patients with stage I-IV gastric cancer were analyzed in this retrospective, single-center study. RESULTS Most patients (73.1%) showed an advanced or metastatic tumor stage (III/IV). The median 3-year overall survival (OS) was 20 ± 16.8 months and correlated significantly with tumor stage (I: OS 30.6 ± 15 months vs. IV: 10.4 ± 9.3 months; p < 0.0001). Stage III/IV tumors were significantly more often poorly differentiated (G3; p = 0.011) and located in the corpus region. Signet ring cell (SRC) cancers were found in a larger proportion of these tumors when compared with locally limited gastric cancers (43.1% vs. 16.3%; p = 0.002). SRC tumors occurred predominantly in women and younger patients and histology was significantly more often of the diffuse subtype according to Lauren (7.5% vs. 63.2%; p < 0.0001) and poorly differentiated (G3 in 95% vs. 73%; p = 0.001). CONCLUSIONS SRC gastric cancer correlates with poor histopathological criteria and poor prognosis when compared with other histological subtypes. These observations underline the need for more effective treatment in addition to standard approaches.
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Affiliation(s)
- Holger G Hass
- Department of Internal Oncology and Rehabilitation, Paracelsus Hospital Scheidegg, Germany
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22
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Moosmann N, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, Dietzfelbinger H, Oruzio D, Klein S, Zellmann K, Decker T, Schulze M, Abenhardt W, Puchtler G, Kappauf H, Mittermüller J, Haberl C, Schalhorn A, Jung A, Stintzing S, Heinemann V. Cetuximab plus capecitabine and irinotecan compared with cetuximab plus capecitabine and oxaliplatin as first-line treatment for patients with metastatic colorectal cancer: AIO KRK-0104--a randomized trial of the German AIO CRC study group. J Clin Oncol 2011; 29:1050-8. [PMID: 21300933 DOI: 10.1200/jco.2010.31.1936] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The AIO KRK-0104 randomized phase II trial investigated the efficacy and safety of cetuximab combined with capecitabine and irinotecan (CAPIRI) or capecitabine and oxaliplatin (CAPOX) in the first-line treatment of metastatic colorectal cancer (mCRC). PATIENTS AND METHODS A total of 185 patients with mCRC were randomly assigned to cetuximab (400 mg/m(2) day 1, followed by 250 mg/m(2) weekly) plus CAPIRI (irinotecan 200 mg/m(2), day 1; capecitabine 800 mg/m(2) twice daily days 1 through 14, every 3 weeks; or cetuximab plus CAPOX (oxaliplatin 130 mg/m(2) day 1; capecitabine 1,000 mg/m(2) twice daily day 1 through 14, every 3 weeks). The primary study end point was objective response rate (ORR). RESULTS In the intention-to-treat patient population (n = 177), ORR was 46% (95% CI, 35 to 57) for CAPIRI plus cetuximab versus 48% (95% CI, 37 to 59) for CAPOX plus cetuximab. Analysis of the KRAS gene mutation status was performed in 81.4% of the intention to treat population. Patients with KRAS wild-type in the CAPIRI plus cetuximab arm showed an ORR of 50.0%, a PFS of 6.2 months and an OS of 21.1 months. In the CAPOX plus cetuximab arm, an ORR of 44.9%, a PFS of 7.1 months and an OS of 23.5 months were observed. While ORR and PFS were comparable in KRAS wild-type and mutant subgroups, a trend toward longer survival was associated with KRAS wild-type. Both regimens had manageable toxicity profiles and were safe. CONCLUSION This randomized trial demonstrates that the addition of cetuximab to CAPIRI or CAPOX is effective and safe in first-line treatment of mCRC. In the analyzed regimens, ORR and PFS did not differ according to KRAS gene mutation status.
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Hass HG, Bock T, Nehls O, Kaiser S. Rapid HBV DNA decrease (week 12) is an important prognostic factor for first-line treatment with adefovir dipivoxil for chronic hepatitis B. J Gastroenterol 2009; 44:871-7. [PMID: 19458896 DOI: 10.1007/s00535-009-0078-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 04/17/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to estimate the effect of viral factors (HBV genotype, viral load and kinetics) to treatment response in chronic hepatitis B (CHB) and first-line therapy with adefovir dipivoxil (ADV). METHODS Sixty-six patients (60% males, 65% HBeAg negative) were treated with 10 mg ADV QD. Quantitative HBV DNA and ALT levels were determined at weeks 4, 12, 24, 48, 72 and 96. Nonresponse or viral resistance to ADV was assessed in patients with either persistent elevated HBV DNA levels (week 24) or with an increase in HBV DNA of at least 1 log after initial decline. RESULTS Most patients were infected with genotype D (66.7%; genotype A: 27.3%; genotype E: 6%); 86.4% achieved a virological (VR) and 54.5% a biochemical response (BR) in week 48, more often in patients with genotype A (P < 0.01). In week 96, BR increased to 60.5%, whereas a negative HBV DNA was observed in 83.3%. In 3% an ADV-induced viral resistance was detected. As an important predictive parameter for VR, a rapid decline of viral load at week 12 was observed. Of the patients with a negative PCR or drop of viral load of at least 3 log, 96% were still HBV DNA negative at the end of week 96; 77% of patients with a partial response achieved a VR. In contrast, no patient with nonresponse (week 12) reached a negative PCR at week 96 (P < 0.0001). CONCLUSIONS These results underline the importance of early viral kinetics to assess treatment response in CHB. In ADV nonresponders (week 12), an advanced antiviral therapy or switch to another nucleoside analogue should be considered.
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Affiliation(s)
- Holger G Hass
- Department of Internal Medicine and Oncology, Paracelsus Hospital, Scheidegg, Germany.
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Nehls O, Hass HG, Okech T, Zenner S, Hsieh CJ, Sarbia M, Borchard F, Gruenagel HH, Gaco V, Porschen R, Gregor M, Klump B. Prognostic implications of BAX protein expression and microsatellite instability in all non-metastatic stages of primary colon cancer treated by surgery alone. Int J Colorectal Dis 2009; 24:655-63. [PMID: 19221769 DOI: 10.1007/s00384-009-0635-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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] [Accepted: 01/08/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE This study examined whether the apoptosis-related protein, BAX, or the microsatellite-instability phenotype provide prognostic information in patients with resected colon cancer. METHODS A total of 371 stage I-III patients that previously underwent radical surgery were included (mean follow-up 51.8 months). BAX expression was examined by immunohistochemical staining; high-frequency microsatellite instability (MSI+) was determined by assessing the specific marker, BAT26, using single-strand conformation polymorphism (SSCP)-based analysis. RESULTS High BAX expression was found in 66.4% of patients. MSI+ tumors were observed in 14.8% of 344 patients. Univariate analysis showed that unlike MSI, low BAX expression was significantly correlated with poor disease-specific overall survival (OS) in stages I-III (p = 0.04). Multivariate subgroup analyses revealed that unlike MSI, low BAX was an independent predictor for OS in stage II (p = 0.009); however, in stages I or III, BAX or MSI were not independent predictors of OS. CONCLUSIONS In stage II colon cancer treated with surgery alone, BAX protein expression may be a predictor for prognosis.
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Affiliation(s)
- Oliver Nehls
- Department of Internal Medicine I, University Hospital, 72076, Tübingen, Germany.
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Hass HG, Nehls O, Jobst J, Frilling A, Vogel U, Kaiser S. Identification of osteopontin as the most consistently over-expressed gene in intrahepatic cholangiocarcinoma: Detection by oligonucleotide microarray and real-time PCR analysis. World J Gastroenterol 2008; 14:2501-10. [PMID: 18442196 PMCID: PMC2708360 DOI: 10.3748/wjg.14.2501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the molecular pathways involved in human cholangiocarcinogenesis by gene expression profiling.
METHODS: Oligonucleotide arrays (Affymetrix U133A) were used to establish a specific gene expression profile of intrahepatic CCC in comparison to corresponding non-malignant liver tissue. To validate the expression values of the most overexpressed genes, RT-PCR experiments were performed.
RESULTS: Five hundred and fifty-two statistically differentially expressed genes/ESTs (221 probes significantly up-regulated, 331 probes down-regulated; P < 0.05; fold change > 2; ≥ 70%) were identified. Using these data and two-dimensional cluster analysis, a specific gene expression profile was obtained allowing fast and reproducible differentiation of CCC, which was confirmed by supervised neuronal network modelling. The most consistently overexpressed gene (median fold change 33.5, significantly overexpressed in 100%) encoded osteopontin. Furthermore, an association of various genes with the histopathological grading could be demonstrated.
CONCLUSION: A highly specific gene expression profile for intrahepatic CCC was identified, allowing for its fast and reproducible discrimination against non-malignant liver tissue and other liver masses. The most overexpressed gene in intrahepatic CCC was the gene encoding osteopontin. These data may lead to a better understanding of human cholangiocarcinogenesis.
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Affiliation(s)
- O Nehls
- Department of Gastroenterology, Hepatology and Infectious Diseases, Internal Medicine I, University Hospital, Tuebingen, Germany
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27
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Nehls O, Oettle H, Hartmann JT, Hofheinz RD, Hass HG, Horger MS, Koppenhöfer U, Hochhaus A, Stieler J, Trojan J, Gregor M, Klump B. Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase II trial. Br J Cancer 2008; 98:309-15. [PMID: 18182984 PMCID: PMC2361467 DOI: 10.1038/sj.bjc.6604178] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This prospective multicentre phase II study characterises the toxicity and activity of first-line capecitabine and oxaliplatin combination therapy (CAPOX) in advanced biliary system adenocarcinomas. Patients received oxaliplatin (130 mg m−2, day 1) plus capecitabine (1000 mg m−2 b.i.d., days 1–14) every 3 weeks. Patients were stratified prospectively into two groups based on location of the primary (gallbladder carcinoma (GBC) or extrahepatic cholangiocarcinoma (ECC) versus intrahepatic mass-forming type cholangiocarcinoma (ICC)). Sixty-five patients were evaluable. The response rate in 47 patients with GBC/ECC was 27% (4% complete responses), and in 23 patients (49%) stable disease (SD) was encountered. In 18 patients with ICC, we observed no objective responses, but 6 patients (33%) had SD. Median survival was 12.8 months (95% CI, 10.0–15.6) for patients with GBC or ECC (GBC: 8.2 months; 95% CI, 4.3–11.7; ECC: 16.8 months; 95% CI, 12.7–20.5), and 5.2 months (95% CI, 0.6–9.8) for ICC patients. In both cohorts, therapy was well tolerated. The most common grade 3–4 toxicity was peripheral sensory neuropathy (11 patients). Our data suggest that the CAPOX regimen is a well-tolerated and active treatment option for advanced ECC and GBC but might produce poorer results for ICC.
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Affiliation(s)
- O Nehls
- Department of Internal Medicine I, University Hospital, Tübingen, Germany.
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Hass HG, Schmidt A, Nehls O, Kaiser S. DNA ploidy, proliferative capacity and intratumoral heterogeneity in primary and recurrent head and neck squamous cell carcinomas (HNSCC) – Potential implications for clinical management and treatment decisions. Oral Oncol 2008; 44:78-85. [PMID: 17350326 DOI: 10.1016/j.oraloncology.2006.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 12/19/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
Despite new diagnostic and therapeutic strategies (combined radiochemotherapy, EGFR antibody Cetuximab), the prognosis of head and neck squamous cell carcinoma (HNSCC) is still poor and more information regarding prognosis is essential to establish earlier and better treatment options. To elucidate the role of DNA ploidy and cellular proliferation, resected tumors of 48 patients with primary or recurrent HNSCC were analyzed by flow cytometry and in vitro-5-bromodeoxyuridine incorporation (BrdU). The results were compared with histopathological findings such as tumor size, lymph node involvement and tumor differentiation. To assess the influence of intratumoral heterogeneity of these biological parameters, multiple biopsies (>3) were analyzed by flow cytometry and BrdU-incorporation in 12 larger (>4 cm diameter) tumors. BrdU-labeling index (LI%) was significantly higher in aneuploid HNSCC and correlated significantly with poor histologic differentiation of the analyzed tumor tissues (P<0.001). Furthermore, a trend for higher LI% in nodal positive tumors was observed. Aneuploid HNSCC showed significantly more often tissue dedifferentiation (P=0.049) and in most cases an advanced tumor stage, especially in tumors with biclonal cell lines. Lymph node involvement was also seen more often in aneuploid and undifferentiated tumors. As in aneuploid tumors recurrent HNSCC showed in most cases a higher LI% and poor tissue differentiation, but as a result of the small collection of samples there was no correlation between aneuploidy and tumor recurrence. To proof the robustness of the acquired data and to estimate the influence of intratumoral heterogeneity to ploidy and LI% multiple biopsies were analyzed in larger tumors. Using a specific statistical algorithm a secure estimation of ploidy and LI% was possible by a single biopsy in these tumors. These findings indicate aneuploidy and proliferative activity as important findings for malignant progression in HNSCC. An estimation of these biological parameters may be useful for identification of patients with high risk for lymph node involvement or tumor recurrence and pre-treatment can be performed by a single biopsy. As a conclusion, these patients may benefit from more aggressive treatment.
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Affiliation(s)
- Holger G Hass
- Department of Oncology, Haematology and Palliative Care, Marienhospital (Teaching Hospital University of Tuebingen), Boeheimstr. 37, 70199 Stuttgart, Germany.
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Nehls O, Okech T, Hsieh CJ, Enzinger T, Sarbia M, Borchard F, Gruenagel HH, Gaco V, Hass HG, Arkenau HT, Hartmann JT, Porschen R, Gregor M, Klump B. Studies on p53, BAX and Bcl-2 protein expression and microsatellite instability in stage III (UICC) colon cancer treated by adjuvant chemotherapy: major prognostic impact of proapoptotic BAX. Br J Cancer 2007; 96:1409-18. [PMID: 17426704 PMCID: PMC2360187 DOI: 10.1038/sj.bjc.6603728] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [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] [Indexed: 01/05/2023] Open
Abstract
We evaluated the expression patterns of proapoptotic BAX, antiapoptotic Bcl-2 and p53, the proposed upstream effector of these molecules, as potential prognostic markers in UICC stage III colon cancer by immunohistochemical staining. To identify high-frequency microsatellite instability (MSI+) individuals, we performed single-strand conformation polymorphism-based analysis for BAT26. A total of 188 patients who had received 5-fluorouracil (5-FU)-based adjuvant chemotherapy (5-FU/folinic acid or 5-FU/levamisole) were enrolled. Median follow-up was 84.5 months. We found that BAX, Bcl-2 and p53 protein expressions were high or positive in 59, 70 and 50% of 188 cases, respectively. MSI+ tumours were detected in 9% of 174 evaluable patients. BAX or Bcl-2 was correlated with a higher degree of differentiation or left-sided tumours (P=0.01 or P=0.03, respectively); MSI was correlated with right-sided tumours (P<0.0001). In contrast to p53, Bcl-2, or MSI, low BAX, advanced pN category, low grade of differentiation and treatment with 5-FU/levamisole were univariately associated with poorer disease-free survival (DFS) (P=0.0005, P=0.001, P=0.005 and P=0.01, respectively) and poorer overall survival (OS) (P=0.002, P=0.0001, P=0.003 and P=0.02, respectively). Besides pN category and treatment arm, BAX was an independent variable related to both OS and DFS (P=0.003 and P=0.001, respectively). In both univariate and multivariate analysis, the p53−/BAX high in comparison with the p53+/BAX high subset conferred a significantly improved DFS (P=0.03 and P=0.03, respectively) as well as a marginally improved OS (P=0.07 and P=0.08, respectively). BAX protein expression may be of central significance for clinical outcome to 5-FU-based adjuvant chemotherapy in stage III colon cancer, and bivariate analysis of p53/BAX possibly may provide further prognostic evidence.
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Affiliation(s)
- O Nehls
- Department of Internal Medicine I, University Hospital, Tübingen, Germany.
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Hass HG, Kaiser S. [A 56-year-old female patient with Raynaud's syndrome, increased liver enzymes and neuropsychiatric symptoms]. Dtsch Med Wochenschr 2006; 131:2213-6. [PMID: 17021989 DOI: 10.1055/s-2006-951354] [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: 10/24/2022]
Abstract
CASE HISTORY A 56-year-old woman presented with increased liver enzymes (GPT, GOT), arthralgias, Raynaud's syndrome and disturbance of sleep and concentration. FINDINGS AND DIAGNOSIS Serology and liver biopsy indicated chronic hepatitis C infection (HCV) and viral-induced liver cirrhosis with unremarkable liver synthesizing parameters. An HCV-triggered cryoglobinemia was excluded, but high elevated antinuclear antibodies (ANA) and anti-RNP autoantibodies, typical serological parameters of mixed tissue collagenous (Sharp}s disease), were detectable. Magnetic resonance spectroscopy (H-MRS) was performed to differentiate between cerebral vasculitis and mild hepatic encephalopathy. This detected abnormal pattern of cerebral metabolites (myo-inositol and choline), is specific for HE. TREATMENT AND COURSE After onset of an antiviral therapy (terferon/ribavirin), low protein diet with supplementation of l-ornithine-l-aspartate the arthralgia and neuropsychiatric symptoms rapidly improved and HCV-RNA PCR became negative. Unfortunately, after cessation of antiviral treatment the patient had a relapse of HCV with a worsening of the arthralgia and the Raynaud symptoms (HCV-triggered Sharp}s disease). CONCLUSION Even in patients with mildly abnormal liver function and liver cirrhosis it is important to consider (mild) hepatic encephalopathy if neuropsychiatric symptoms occur.
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Affiliation(s)
- H G Hass
- Abteilung Innere Medizin 3, Marienhospital, Stuttgart
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Hass HG, Nägele T, Seeger U, Hösl F, Gregor M, Kaiser S. [Detection of subclinical and overt hepatic encephalopathy and treatment control after L-ornithine-L-aspartate medication by magnetic resonance spectroscopy ((1)H-MRS)]. Z Gastroenterol 2005; 43:373-8. [PMID: 15830303 DOI: 10.1055/s-2004-813917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hepatic encephalopathy (HE) is a common problem in liver cirrhosis and is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance spectroscopy (MRS). In HE, a reduction of the cerebral myo-inositol (mI) and choline (Cho) and an increase of glutamine/glutamate (Glx) can typically be detected with this method. In the present study MRS was used to assess prospectively specific parameters of cerebral metabolism before and after 6 days of treatment with a low-protein diet and with L-ornithine-L-aspartate (LOLA). 6 patients with liver cirrhosis were included in this pilot study. According to standardized neuropsychological tests overt HE or subclinical HE was detected in all patients. All patients received a low-protein diet (< 60 g/d) and were treated additionally with LOLA (20 g QD i. v.). MRS examinations were done before and after 6 days of treatment and the results were compared with those of healthy volunteers. Before treatment mI/Cr ratios in the grey matter were reduced significantly in cirrhotic patients as compared to healthy volunteers (0.30 +/- 0.22 vs. 0.68 +/- 0.11; P = 0.028). In addition, patients showed a (non-significant) reduction of the Cho/Cr-ratio (0.19 +/- 0.03 vs. 0.25 +/- 0.02; P = 0.17) and an elevated Glx/Cr-ratio (1.84 +/- 0.63 vs. 1.29 +/- 0.31; P = 0.05). After 6 days of treatment a significant increase of the Cho/Cr ratio (0.23 +/- 0.03 vs. 0.19 +/- 0.03; P = 0.028) was detectable and 5 of the 6 patients showed a (not significant) decrease of the elevated Glx/Cr ratios. After cessation of treatment an improvement in neuropsychological tests as shown by number-connection testing (P = 0.046) as well as a decrease of elevated pre-treatment ammonia blood levels were noted. These findings, however, did not correlate with the Child-Pugh classification or evidence of clinical/subclinical HE. Using (1)H-MRS it is possible to observe a specific pattern of cerebral metabolites in patients with overt and subclinical HE. In this pilot study a fast change of cerebral metabolite pattern after specific therapy of HE with LOLA was detected. Therefore, future studies with larger patient groups are needed to establish (1)H-MRS as an objective method for detection and treatment control in overt and subclinical HE, especially when compared to commonly used parameters such as ammonia levels or standardized neuropsychological tests.
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Affiliation(s)
- H G Hass
- Abteilung Gastroenterologie, Hepatologie und Infektiologie, Medizinische Klinik, Universität Tübingen.
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Hass HG, Nehls O, Gregor M, Kaiser S, Kreysel C. Treatment of chronic hepatitis C in naive patients with high-dose interferon-alpha2a induction therapy and two different ribavirin doses. Dig Liver Dis 2004; 36:367-8. [PMID: 15191208 DOI: 10.1016/j.dld.2004.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Nehls O, Klump B, Arkenau HT, Hass HG, Greschniok A, Gregor M, Porschen R. Oxaliplatin, fluorouracil and leucovorin for advanced biliary system adenocarcinomas: a prospective phase II trial. Br J Cancer 2002; 87:702-4. [PMID: 12232749 PMCID: PMC2364257 DOI: 10.1038/sj.bjc.6600543] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2002] [Accepted: 07/15/2002] [Indexed: 11/09/2022] Open
Abstract
We studied the activity of combined oxaliplatin and fluorouracil-leucovorin in 16 consecutive patients with advanced biliary tract adenocarcinomas. The disease control rate (responses and stable disease) was 56% (95% confidence interval, 29-84%) and the median overall survival time was 9.5 months (range 0.9-26.8+). Therefore, this regimen might be active in biliary adenocarcinomas with further evaluation necessary.
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Affiliation(s)
- O Nehls
- Department of Internal Medicine I, University Hospital, Otfried-Müller-Str. 10, 72076 Tübingen, Germany.
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