1
|
Pfob A, Cai L, Schneeweiss A, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten MM, Sidey-Gibbons C, Wallwiener M, Golatta M, Heil J. Minimally Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment: A New Concept. Ann Surg Oncol 2024; 31:957-965. [PMID: 37947974 PMCID: PMC10761434 DOI: 10.1245/s10434-023-14551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Breast cancer patients with residual disease after neoadjuvant systemic treatment (NAST) have a worse prognosis compared with those achieving a pathologic complete response (pCR). Earlier identification of these patients might allow timely, extended neoadjuvant treatment strategies. We explored the feasibility of a vacuum-assisted biopsy (VAB) after NAST to identify patients with residual disease (ypT+ or ypN+) prior to surgery. METHODS We used data from a multicenter trial, collected at 21 study sites (NCT02948764). The trial included women with cT1-3, cN0/+ breast cancer undergoing routine post-neoadjuvant imaging (ultrasound, MRI, mammography) and VAB prior to surgery. We compared the findings of VAB and routine imaging with the histopathologic evaluation of the surgical specimen. RESULTS Of 398 patients, 34 patients with missing ypN status and 127 patients with luminal tumors were excluded. Among the remaining 237 patients, tumor cells in the VAB indicated a surgical non-pCR in all patients (73/73, positive predictive value [PPV] 100%), whereas PPV of routine imaging after NAST was 56.0% (75/134). Sensitivity of the VAB was 72.3% (73/101), and 74.3% for sensitivity of imaging (75/101). CONCLUSION Residual cancer found in a VAB specimen after NAST always corresponds to non-pCR. Residual cancer assumed on routine imaging after NAST corresponds to actual residual cancer in about half of patients. Response assessment by VAB is not safe for the exclusion of residual cancer. Response assessment by biopsies after NAST may allow studying the new concept of extended neoadjuvant treatment for patients with residual disease in future trials.
Collapse
Affiliation(s)
- André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.
| | - Lie Cai
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tübingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Medical Faculty, Breast Cancer Center, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Frauenklinik, Interdisziplinäres Brustzentrum des Klinikums rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Chris Sidey-Gibbons
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| |
Collapse
|
2
|
Pfob A, Cai L, Schneeweiss A, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten MM, Sidey-Gibbons C, Wallwiener M, Golatta M, Heil J. ASO Visual Abstract: Minimally-Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment-A New Concept. Ann Surg Oncol 2024; 31:1033-1034. [PMID: 38093166 DOI: 10.1245/s10434-023-14747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany.
- Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.
| | - Lie Cai
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Cancer Center, Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Frauenklinik, Interdisziplinäres Brustzentrum des Klinikums rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | | | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Chris Sidey-Gibbons
- Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| |
Collapse
|
3
|
Gluz O, Nitz U, Kolberg-Liedtke C, Prat A, Christgen M, Kuemmel S, Mohammadian MP, Gebauer D, Kates R, Paré L, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Wuerstlein R, Graeser M, Pelz E, Jóźwiak K, Zu Eulenburg C, Kreipe HH, Harbeck N. De-escalated Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer (TNBC): Impact of Molecular Markers and Final Survival Analysis of the WSG-ADAPT-TN Trial. Clin Cancer Res 2022; 28:4995-5003. [PMID: 35797219 DOI: 10.1158/1078-0432.ccr-22-0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/13/2022] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Although optimal treatment in early triple-negative breast cancer (TNBC) remains unclear, de-escalated chemotherapy appears to be an option in selected patients within this aggressive subtype. Previous studies have identified several pro-immune factors as prognostic markers in TNBC, but their predictive impact regarding different chemotherapy strategies is still controversial. EXPERIMENTAL DESIGN ADAPT-TN is a randomized neoadjuvant multicenter phase II trial in early patients with TNBC (n = 336) who were randomized to 12 weeks of nab-paclitaxel 125 mg/m2 + gemcitabine or carboplatin d 1,8 q3w. Omission of further (neo-) adjuvant chemotherapy was allowed only in patients with pathological complete response [pCR, primary endpoint (ypT0/is, ypN0)]. Secondary invasive/distant disease-free and overall survival (i/dDFS, OS) and translational research objectives included quantification of a predictive impact of markers regarding selection for chemotherapy de-escalation, measured by gene expression of 119 genes (including PAM50 subtype) by nCounter platform and stromal tumor-infiltrating lymphocytes (sTIL). RESULTS After 60 months of median follow-up, 12-week-pCR was favorably associated (HR, 0.24; P = 0.001) with 5y-iDFS of 90.6% versus 62.8%. No survival advantage of carboplatin use was observed, despite a higher pCR rate [HR, 1.04; 95% confidence interval (CI), 0.68-1.59]. Additional anthracycline-containing chemotherapy was not associated with a significant iDFS advantage in pCR patients (HR, 1.29; 95% CI, 0.41-4.02). Beyond pCR rate, nodal status and high sTILs were independently associated with better iDFS, dDFS, and OS by multivariable analysis. CONCLUSIONS Short de-escalated neoadjuvant taxane/platinum-based combination therapy appears to be a promising strategy in early TNBC for using pCR rate as an early decision point for further therapy (de-) escalation together with node-negative status and high sTILs. See related commentary by Sharma, p. 4840.
Collapse
Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Mohammad Parsa Mohammadian
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | | | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Michael Braun
- Rotkreuz Clinics Munich, Breast Center, Munich, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
| | | |
Collapse
|
4
|
Kolberg-Liedtke C, Feuerhake F, Garke M, Christgen M, Kates R, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Wuerstlein R, Graeser M, Nitz U, Kreipe H, Gluz O, Harbeck N. Impact of stromal tumor-infiltrating lymphocytes (sTILs) on response to neoadjuvant chemotherapy in triple-negative early breast cancer in the WSG-ADAPT TN trial. Breast Cancer Res 2022; 24:58. [PMID: 36056374 PMCID: PMC9438265 DOI: 10.1186/s13058-022-01552-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Higher density of stromal tumor-infiltrating lymphocytes (sTILs) at baseline has been associated with increased rates of pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in triple-negative breast cancer (TNBC). While evidence supports favorable association of pCR with survival in TNBC, an independent impact of sTILs (after adjustment for pCR) on survival is not yet established. Moreover, the impact of sTIL dynamics during NACT on pCR and survival in TNBC is unknown. METHODS The randomized WSG-ADAPT TN phase II trial compared efficacy of 12-week nab-paclitaxel with gemcitabine versus carboplatin. This preplanned translational analysis assessed impacts of sTIL measurements at baseline (sTIL-0) and after 3 weeks of chemotherapy (sTIL-3) on pCR and invasive disease-free survival (iDFS). Predictive performance of sTIL-0 and sTIL-3 for pCR was quantified by ROC analysis and logistic regression; Kaplan-Meier estimation and Cox regression (with mediation analysis) were used to determine their impact on iDFS. RESULTS For prediction of pCR, the AUC statistics for sTIL-0 and sTIL-3 were 0.60 and 0.63, respectively, in all patients; AUC for sTIL-3 was higher in NP/G. The positive predictive value (PPV) of "lymphocyte-predominant" status (sTIL-0 ≥ 60%) at baseline was 59.3%, though only 13.0% of patients had this status. To predict non-pCR, the cut point sTIL-0 ≤ 10% yielded PPV = 69.5% while addressing 33.8% of patients. Higher sTIL levels (particularly at 3 weeks) were independently and favorably associated with better iDFS, even after adjusting for pCR. For example, the adjusted hazard ratio for 3-week sTILs ≥ 60% (vs. < 60%) was 0.48 [0.23-0.99]. Low cellularity in 3-week biopsies was the strongest individual predictor for pCR (in both therapy arms), but not for iDFS. CONCLUSION The independent impact of sTILs on iDFS suggests that favorable immune response can influence key tumor biological processes for long-term survival. The results suggest that the reliability of pCR following neoadjuvant therapy as a surrogate for survival could vary among subgroups in TNBC defined by immune response or other factors. Dynamic measurements of sTILs under NACT could support immune response-guided patient selection for individualized therapy approaches for both very low levels (more effective therapies) and very high levels (de-escalation concepts). TRIAL REGISTRATION Clinical trials No: NCT01815242, retrospectively registered January 25, 2013.
Collapse
Affiliation(s)
- Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | | | | | | | - Ronald Kates
- West German Study Group, Mönchengladbach, Germany
| | | | | | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | - Mathias Warm
- Breast Center, City Hospital Holweide, Cologne, Germany
| | | | | | - Bahriye Aktas
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Mönchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany.,Breast Center, LMU University Hospital, Munich, Germany
| | - Monika Graeser
- West German Study Group, Mönchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Hans Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany.,Breast Center, LMU University Hospital, Munich, Germany
| |
Collapse
|
5
|
Pfob A, Sidey-Gibbons C, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten M, Golatta M, Heil J. Intelligent Vacuum-Assisted Biopsy to Identify Breast Cancer Patients With Pathologic Complete Response (ypT0 and ypN0) After Neoadjuvant Systemic Treatment for Omission of Breast and Axillary Surgery. J Clin Oncol 2022; 40:1903-1915. [PMID: 35108029 DOI: 10.1200/jco.21.02439] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 01/05/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Neoadjuvant systemic treatment (NST) elicits a pathologic complete response in 40%-70% of women with breast cancer. These patients may not need surgery as all local tumor has already been eradicated by NST. However, nonsurgical approaches, including imaging or vacuum-assisted biopsy (VAB), were not able to accurately identify patients without residual cancer in the breast or axilla. We evaluated the feasibility of a machine learning algorithm (intelligent VAB) to identify exceptional responders to NST. METHODS We trained, tested, and validated a machine learning algorithm using patient, imaging, tumor, and VAB variables to detect residual cancer after NST (ypT+ or in situ or ypN+) before surgery. We used data from 318 women with cT1-3, cN0 or +, human epidermal growth factor receptor 2-positive, triple-negative, or high-proliferative Luminal B-like breast cancer who underwent VAB before surgery (ClinicalTrials.gov identifier: NCT02948764, RESPONDER trial). We used 10-fold cross-validation to train and test the algorithm, which was then externally validated using data of an independent trial (ClinicalTrials.gov identifier: NCT02575612). We compared findings with the histopathologic evaluation of the surgical specimen. We considered false-negative rate (FNR) and specificity to be the main outcomes. RESULTS In the development set (n = 318) and external validation set (n = 45), the intelligent VAB showed an FNR of 0.0%-5.2%, a specificity of 37.5%-40.0%, and an area under the receiver operating characteristic curve of 0.91-0.92 to detect residual cancer (ypT+ or in situ or ypN+) after NST. Spiegelhalter's Z confirmed a well-calibrated model (z score -0.746, P = .228). FNR of the intelligent VAB was lower compared with imaging after NST, VAB alone, or combinations of both. CONCLUSION An intelligent VAB algorithm can reliably exclude residual cancer after NST. The omission of breast and axillary surgery for these exceptional responders may be evaluated in future trials.
Collapse
Affiliation(s)
- André Pfob
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chris Sidey-Gibbons
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Cancer Center, Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Department of Gynecology/Breast Unit, Hospital rechts der Isar, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | - Maggie Banys-Paluchowski
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Karsten
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Heil
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
6
|
Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke EM, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N, von Schumann R, Kuhn W, Polata S, Bielecki W, Meyer R, Just M, Kraudelt S, Siggelkow W, Wortelmann H, Kleine-Tebbe A, Leitzen L, Kirchhof H, Krabisch P, Hackmann J, Depenbusch R, Gnauert K, Staib P, Lehnert A, Hoffmann O, Briest S, Lindner C, Heyl V, Bauer L, Uleer C, Mohrmann S, Viehstaedt N, Malter W, Link T, Buendgen N, Tio J. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23:625-635. [DOI: 10.1016/s1470-2045(22)00159-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
|
7
|
Heil J, Pfob A, Sinn HP, Rauch G, Bach P, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Ditsch N, Rody A, Große R, van Mackelenbergh M, Reinisch M, Karsten M, Golatta M. Diagnosing Pathologic Complete Response in the Breast After Neoadjuvant Systemic Treatment of Breast Cancer Patients by Minimal Invasive Biopsy: Oral Presentation at the San Antonio Breast Cancer Symposium on Friday, December 13, 2019, Program Number GS5-03. Ann Surg 2022; 275:576-581. [PMID: 32657944 DOI: 10.1097/sla.0000000000004246] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 11/25/2022]
Abstract
OBJECTIVE We evaluated the ability of minimally invasive, image-guided vacuum-assisted biopsy (VAB) to reliably diagnose a pathologic complete response in the breast (pCR-B). SUMMARY BACKGROUND DATA Neoadjuvant systemic treatment (NST) elicits a pathologic complete response in up to 80% of women with breast cancer. In such cases, breast surgery, the gold standard for confirming pCR-B, may be considered overtreatment. METHODS This multicenter, prospective trial enrolled 452 women presenting with initial stage 1-3 breast cancer of all biological subtypes. Fifty-four women dropped out; 398 were included in the full analysis. All participants had an imaging-confirmed partial or complete response to NST and underwent study-specific image-guided VAB before guideline-adherent breast surgery. The primary endpoint was the false-negative rate (FNR) of VAB-confirmed pCR-B. RESULTS Image-guided VAB alone did not detect surgically confirmed residual tumor in 37 of 208 women [FNR, 17.8%; 95% confidence interval (CI), 12.8-23.7%]. Of these 37 women, 12 (32.4%) had residual DCIS only, 20 (54.1%) had minimal residual tumor (<5 mm), and 19 of 25 (76.0%) exhibited invasive cancer cellularity of ≤10%. In 19 of the 37 cases (51.4%), the false-negative result was potentially avoidable. Exploratory analysis showed that performing VAB with the largest needle by volume (7-gauge) resulted in no false-negative results and that combining imaging and image-guided VAB into a single diagnostic test lowered the FNR to 6.2% (95% CI, 3.4%-10.5%). CONCLUSIONS Image-guided VAB missed residual disease more often than expected. Refinements in procedure and patient selection seem possible and necessary before omitting breast surgery.
Collapse
Affiliation(s)
- Joerg Heil
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - André Pfob
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Paul Bach
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology/Breast Unit, University Hospital Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology/Breast Unit, University Hospital of Cologne, Köln, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology/Breast Unit, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - Sylvie Joos
- Department of Radiology, Visiorad, Pinneberg, Germany
| | - Stefan Paepke
- Department of Gynecology/Breast Unit, Hospital rechts der Isar, Munich, Germany
| | - Nina Ditsch
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
- Department of Gynecology/Breast Unit, University Hospital Augsburg, Augsburg, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | | | - Maria Karsten
- Department of Gynecology/Breast Unit, University Hospital Berlin, Berlin, Germany
| | - Michael Golatta
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
8
|
Pfob A, Sidey-Gibbons C, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, Große R, van Mackelenbergh M, Reinisch M, Karsten M, Golatta M, Heil J. Abstract PD7-02: Intelligent vacuum-assisted breast biopsy to identify breast cancer patients with pathologic complete response after neoadjuvant systemic treatment for omission of breast and axillary surgery. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd7-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant systemic treatment (NST) elicits a pathologic complete response (pCR, ypT0, ypN0) in 40-70% of women with HER2 positive, triple-negative, and high-proliferative Luminal B breast cancer. These patients may not need surgery as all local tumor has already been eradicated by NST. However, their safe identification prior to surgery is a major challenge: imaging after NST, minimally-invasive biopsies, or combinations of both using narrow patient selection criteria are not accurate enough either because they showed high rates of missed cancer or high rates of missed pCR. Recently, the concept of an intelligent, minimally-invasive, vacuum-assisted biopsy (intelligent VAB) was introduced to identify exceptional responders to NST. The intelligent VAB is a multivariate risk algorithm that uses artificial intelligence techniques to analyze conventional VAB results alongside contextualizing patient, imaging, and tumor information. It showed great potential to reliably identify patients with a pCR in the breast (ypT0). However, the absent integration of the axillary status impairs clinical applicability. In this study, we evaluated the feasibility of an intelligent VAB to identify exceptional responders to NST in the breast and axilla. Methods: We trained, tested, and validated a machine learning algorithm (Extreme Gradient Boosting Tree) using patient, imaging, tumor, and conventional VAB variables to detect residual cancer after NST (ypT+/is or ypN+) prior to surgery. We used data from 318 women with cT1-3, cN0/+, HER2 positive, triple-negative breast or high-proliferative Luminal B breast cancer who underwent VAB before surgery (NCT02948764). We used 10-fold cross-validation to train and test the algorithm which was externally validated using data of an independent, similar trial (NCT02575612). Findings were compared to the histopathologic evaluation of the surgical specimen. False-negative rate (FNR), specificity, and area under the ROC curve (AUROC) were the main outcome measures. Results: In the development set (n=318), mean patient age was 52.5 years and 45.3% (144 of 318) achieved a pCR (ypT0 and ypN0). Using resampling methods, the intelligent VAB showed an FNR of 5.2% (9 of 174, 95% CI 2.4-9.5), a specificity of 37.5% (54 of 144, 95% CI 29.6-45.9), and an AUROC of 0.92 (95% CI 0.90-0.94) in the development set to detect residual cancer (ypT+/is or ypN+) after NST. In the external validation set (n=45), mean patient age was 48.1 years and 44.4% (20 of 45) achieved a pCR. The intelligent VAB showed an FNR of 0% (0 of 25, 95% CI 0.0-13.7), a specificity of 40.0% (8 of 20, 95% CI 19.1-63.9) and an AUROC of 0.91 (95% CI 0.82-0.97). Spiegelhalter’s Z confirmed a well-calibrated model (z score -0.746, P 0.228). FNR of the intelligent VAB was lower compared to imaging after NST, conventional VAB, or combinations of both using narrow patient selection criteria. Conclusion: An intelligent VAB can reliably exclude residual cancer after NST for women with cT1-3, cN0/+, HER2 positive, triple-negative breast or high-proliferative Luminal B breast cancer. The omission of breast and axillary surgery for these exceptional responders may be evaluated in future trials. Trial registration: NCT02948764 and NCT02575612. Funding: German Research Foundation (DFG)
Diagnostic Performance ComparisonFalse-negative rate - % (95% CI); no.Specificity - % (95% CI); no.Negative predictive value - % (95% CI); no.Positive predictive value - % (95% CI); no.AUROC - value (95% CI)Development set (n=318)Imaging after NST24.4% (18.0-13.7); 40 of 16452.2% (43.4-61.0); 69 of 13263.3% (53.5-72.3); 69 of 10966.3% (59.1-73.0); 124 of 187-Conventional VAB32.8% (25.8-40.3); 57 of 174100% (97.5-100); 144 of 14471.6% (64.9-77.8); 144 of 201100% (96.9-100); 117 of 117-Imaging after NST + VAB16.7% (11.4-23.2); 28 of 16832.1% (24.4-40.6); 44 of 13761.1% (48.9-72.4); 44 of 7260.1% (56.1-69.1); 140 of 223-VAB + patient selection9.1% (5.0-14.1) 15 of 17036.3% (28.2-45.0); 49 of 13576.6% (64.3-86.2); 49 of 6464.3% (57.9-70.4); 155 of 241-Intelligent VAB (Extreme Gradient Boosting tree)5.2% (2.4-9.6); 9 of 17437.5% (29.6-45.9); 54 of 14485.7% (74.6-93.3); 54 of 6364.7% (58.5-70.6); 165 of 2550.92 (0.90-0.94)External validation (n=45)Imaging after NST24.0% (9.4-45.1%);6 of 2565.0% (40.8-84.6%);13 of 2068.4% (43.4-87.4%);13 of 1973.1% (52.2-88.4%);19 of 26-Conventional VAB28.0% (12.1-49.4%);7 of 25100% (83.2-100%);20 of 2074.1% (53.7-88.9%);20 of 27100% (81.5-100%);18 of 18-Imaging after NST + VAB12.0% (2.5-31.2); 3 of 2565.0% (40.8-84.6%);13 of 2081.3% (54.4-96.0%); 13 of 1675.9% (56.5-89.7%); 22 of 29-VAB + patient selection4.0% (1.0-2.4); 1 of 2530.0% (9.4-45.1%); 6 of 2085.7% (69.8-99.8); 6 of 763.2% (46.0-78.2); 24 of 38-Intelligent VAB (Extreme Gradient Boosting tree)0.0% (0.0-13.7%);0 of 2540.0% (19.1-63.9%);8 of 20100% (63.1-100%);8 of 867.8% (50.2-82.0%);25 of 370.91 (0.82 - 0.97)AUROC = Area under the receiver operating characteristic curve; CI = confidence interval
Citation Format: André Pfob, Chris Sidey-Gibbons, Geraldine Rauch, Bettina Thomas, Benedikt Schaefgen, Sherko Kuemmel, Toralf Reimer, Markus Hahn, Marc Thill, Jens-Uwe Blohmer, John Hackmann, Wolfram Malter, Inga Bekes, Kay Friedrichs, Sebastian Wojcinski, Sylvie Joos, Stefan Paepke, Tom Degenhardt, Joachim Rom, Achim Rody, Regina Große, Marion van Mackelenbergh, Mattea Reinisch, Maria Karsten, Michael Golatta, Joerg Heil. Intelligent vacuum-assisted breast biopsy to identify breast cancer patients with pathologic complete response after neoadjuvant systemic treatment for omission of breast and axillary surgery [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 PD7-02.
Collapse
Affiliation(s)
- André Pfob
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | | | | | - Markus Hahn
- University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | | | | | | | - Joachim Rom
- Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | | | | | | | | | - Joerg Heil
- Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
9
|
Graeser M, Feuerhake F, Gluz O, Volk V, Hauptmann M, Jozwiak K, Christgen M, Kuemmel S, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kolberg-Liedtke C, Kates R, Wuerstlein R, Nitz U, Kreipe HH, Harbeck N. Immune cell composition and functional marker dynamics from multiplexed immunohistochemistry to predict response to neoadjuvant chemotherapy in the WSG-ADAPT-TN trial. J Immunother Cancer 2021; 9:jitc-2020-002198. [PMID: 33963012 PMCID: PMC8108653 DOI: 10.1136/jitc-2020-002198] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The association of early changes in the immune infiltrate during neoadjuvant chemotherapy (NACT) with pathological complete response (pCR) in triple-negative breast cancer (TNBC) remains unexplored. Methods Multiplexed immunohistochemistry was performed in matched tumor biopsies obtained at baseline and after 3 weeks of NACT from 66 patients from the West German Study Group Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer - Triple Negative Breast Cancer (WSG-ADAPT-TN) trial. Association between CD4, CD8, CD73, T cells, PD1-positive CD4 and CD8 cells, and PDL1 levels in stroma and/or tumor at baseline, week 3 and 3-week change with pCR was evaluated with univariable logistic regression. Results Compared with no change in immune cell composition and functional markers, transition from ‘cold’ to ‘hot’ (below-median and above-median marker level at baseline, respectively) suggested higher pCR rates for PD1-positive CD4 (tumor: OR=1.55, 95% CI 0.45 to 5.42; stroma: OR=2.65, 95% CI 0.65 to 10.71) and PD1-positive CD8 infiltrates (tumor: OR=1.77, 95% CI 0.60 to 5.20; stroma: OR=1.25, 95% CI 0.41 to 3.84; tumor+stroma: OR=1.62, 95% CI 0.51 to 5.12). No pCR was observed after ‘hot-to-cold’ transition in PD1-positive CD8 cells. pCR rates appeared lower after hot-to-cold transitions in T cells (tumor: OR=0.26, 95% CI 0.03 to 2.34; stroma: OR=0.35, 95% CI 0.04 to 3.25; tumor+stroma: OR=0.00, 95% CI 0.00 to 1.04) and PD1-positive CD4 cells (tumor: OR=0.60, 95% CI 0.11 to 3.35; stroma: OR=0.22, 95% CI 0.03 to 1.92; tumor+stroma: OR=0.32, 95% CI 0.04 to 2.94). Higher pCR rates collated with ‘altered’ distribution (levels below-median and above-median in tumor and stroma, respectively) of T cell (OR=3.50, 95% CI 0.84 to 14.56) and PD1-positive CD4 cells (OR=4.50, 95% CI 1.01 to 20.14). Conclusion Our exploratory findings indicate that comprehensive analysis of early immune infiltrate dynamics complements currently investigated predictive markers for pCR and may have a potential to improve guidance for individualized de-escalation/escalation strategies in TNBC.
Collapse
Affiliation(s)
- Monika Graeser
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
- Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Friedrich Feuerhake
- Institute of Pathology, Medical School Hannover, Hannover, Germany
- Institute of Neuropathology, University Clinic Freiburg, Freiburg, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
- University Clinics Cologne, Cologne, Germany
| | - Valery Volk
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Katarzyna Jozwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- University Hospital Charité, Humboldt University, Berlin, Germany
| | | | | | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | - Mathias Warm
- Breast Center, City Hospital Holweide, Cologne, Germany
| | | | | | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany
- Women's Clinic, University Clinics Leipzig, Leipzig, Germany
| | | | - Cornelia Kolberg-Liedtke
- University Hospital Charité, Humboldt University, Berlin, Germany
- Women's Clinic, University Clinics Essen, Essen, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Munich, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany
- Breast Center Niederrhein, Bethesda Protestant Hospital Monchengladbach, Monchengladbach, Germany
| | | | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Munich, Germany
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Villegas SL, Nekljudova V, Pfarr N, Engel J, Untch M, Schrodi S, Holms F, Ulmer HU, Fasching PA, Weber KE, Albig C, Heinrichs C, Marmé F, Hartmann A, Hanusch C, Schmitt WD, Huober J, Lederer B, van Mackelenbergh M, Tesch H, Jackisch C, Rezai M, Sinn P, Sinn BV, Hackmann J, Kiechle M, Schneeweiss A, Weichert W, Denkert C, Loibl S. Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors - An analysis of 2765 patients from neoadjuvant clinical trials. Eur J Cancer 2021; 148:159-170. [PMID: 33743484 DOI: 10.1016/j.ejca.2021.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate HER2-negative breast cancer (BC) with a low hormone receptor (HR) expression, with regard to pathological complete response (pCR) and survival, in comparison to triple-negative BC (TNBC) and strong HR-positive BC. METHODS We compared negative [oestrogen (ER) and progesterone receptor (PR) <1%], low-positive (ER and/or PR 1-9%) and strong-positive (ER or PR 10-100%) HR-expression in neoadjuvant clinical trial cohorts (n = 2765) of BC patients. End-points were disease-free survival (DFS), distant-disease free survival (DDFS) and overall survival (OS). We performed RNA sequencing on available tumour tissue samples from patients with low-HR expression (n = 38). RESULTS Ninety-four (3.4%) patients had low HR-positive tumours, 1769 (64.0%) had strong HR-positive tumours, and 902 (32.6%) had TNBC. There were no significant differences in pCR rates between women with low HR-positive tumours (27.7%) and women with TNBC (35.5%). DFS and DDFS were also not different [for DFS, hazard ratio 1.26, 95%-CI (confidence interval) : 0.87-1.83, log-rank test p = 0.951; for DDFS, hazard ratio 1.17, 95%-CI: 0.78-1.76, log-rank test p = 0.774]. Patients with strong HR-positive tumours had a significantly lower pCR rate (pCR 9.4%; odds ratio 0.38, 95%-CI: 0.23-0.63), but better DFS (hazard ratio 0.48, 95%-CI: 0.33-0.70) and DDFS (hazard ratio 0.49, 95%-CI: 0.33-0.74) than patients with low HR-positive tumours. Molecular subtyping (RNA sequencing) of low HR-positive tumours classified these predominantly into a basal subtype (86.8%). CONCLUSION Low HR-positive, HER2-negative tumours have a similar clinical behaviour to TNBC showing high pCR rates and poor survival and also a basal-like gene expression signature. Patients with low HR-positive tumours should be regarded as candidates for therapy strategies targeting TNBC.
Collapse
Affiliation(s)
- Sonia L Villegas
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Nicole Pfarr
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR), Bavarian Cancer Registry - Regional Centre Munich (LGL) at the University Hospital of Munich, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Untch
- Breast Cancer Center, HELIOS Klinikum, Berlin, Germany
| | - Simone Schrodi
- Munich Cancer Registry (MCR), Bavarian Cancer Registry - Regional Centre Munich (LGL) at the University Hospital of Munich, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Peter A Fasching
- Department of Gynecology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Karsten E Weber
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | - Christian Albig
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | | | - Frederik Marmé
- Department of Gynecology, University Hospital Mannheim, Mannheim, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Wolfgang D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Huober
- Department of Gynecology, University of Ulm, Ulm, Germany
| | - Bianca Lederer
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Peter Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Bruno V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - John Hackmann
- Department of Gynecology, Marien Hospital Witten, Witten, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich (CCCM), Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universität Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Sibylle Loibl
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany.
| |
Collapse
|
12
|
Kuemmel S, Gluz O, Christgen M, Potenberg J, Hackmann J, von Schumann R, Graeser M, Mangold M, Wuerstlein R, Kates R, Kreipe HH, Nitz U, Harbeck N. Abstract P2-16-05: Efficacy of response- and toxicity-guided neoadjuvant chemotherapy in elderly early breast cancer patients: Results of WSG ADAPT elderly sub-trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-16-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: More than 1/3 of early breast cancers (EBC) are diagnosed in women ≥ 70 years. Although polychemotherapy has been shown to be more effective than monochemotherapy also in these patients, only limited prospective data on efficacy of neoadjuvant therapy are available so far. Here, we present results of the prospective ADAPT Elderly sub-study from the WSG ADAPT umbrella protocol.
Methods: Patients ≥70 years with high-risk HR+/HER2- EBC (i.e. Recurrence Score (RS)>25 or RS 12-25 with post-endocrine Ki67 of >10% or ≥cN2) or HR-/HER2- EBC were treated by 2 cycles of liposomal doxorubicin (Myocet® 60 mg/m2)/cyclophosphamide 600 mg/m2 (MC). In case of clinical response by ultrasound (>50% reduction in the sum of two largest diameters) and no AE grade 3-4, patients received an additional 2 cycles MC, otherwise they were switched to 6 cycles of paclitaxel (80 mg/m2) weekly. A sample size of n=150 was planned to demonstrate non-inferiority of the response- and toxicity-guided regimen vs. 4 cycles MC in responding patients (25% assumed pCR). The study was stopped early due to slow recruitment.
Results: Between 09/2014 and 10/2015, 83 EBC patients from 31 centers were registered; 78 started with therapy (40 HR+/HER2-; 38 HR-/HER2-). Median age was 74 years. 64% had G3 tumors, 66% cT24, and 34% cN+. Median Ki67 was 40%. 75/78 pts underwent stratification after 2 cycles; 1 pt withdrew consent: 45(61%) were responders with no severe toxicities, 29 (39%) non-responders or suffered toxicity grade 3-4. Surgical information is available in 72 patients (43 responder/no toxicity, 29 no response/toxicity groups respectively). pCR was observed in 7 patients in the responder/no toxicity group (i.e. 16% irrespective of HR status) and in n=3 patients in the no response/toxicity group (10%). Updated efficacy and safety data will be presented at the meeting.
Discussion: In one of the largest neoadjuvant chemotherapy-studies specifically for elderly pts with HER2- EBC, we observed a lower than expected pCR rate after 4 cycles of anthracycline-containing neoadjuvant chemotherapy. Taxane-based standard chemotherapy may thus be preferable in this population. Nevertheless, neoadjuvant chemotherapy seems feasible in elderly pts with high-risk HER2- EBC and should further be explored in the context of potential pCR-based (de)escalation strategies.
Citation Format: Sherko Kuemmel, Oleg Gluz, Matthias Christgen, Jochem Potenberg, John Hackmann, Raquel von Schumann, Monika Graeser, Marina Mangold, Rachel Wuerstlein, Ronald Kates, Hans H. Kreipe, Ulrike Nitz, Nadia Harbeck, West German Study Group. Efficacy of response- and toxicity-guided neoadjuvant chemotherapy in elderly early breast cancer patients: Results of WSG ADAPT elderly sub-trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-05.
Collapse
Affiliation(s)
| | - Oleg Gluz
- 2West German Study Group and Breast Center Niederrhein Johanniter Clincs Moenchengladbach and University Hospital Cologne, Moenchengladbach, Germany
| | | | - Jochem Potenberg
- 4Ev. Waldkrankenhaus Spandau, Department of Oncology, Berlin, Germany
| | | | | | - Monika Graeser
- 7West German Study Group and Breast Center Niederrhein Johanniter Clinics, Moenchengladbach, Germany
| | | | - Rachel Wuerstlein
- 9Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Ronald Kates
- 8West German Study Group, Moenchengladbach, Germany
| | - Hans H. Kreipe
- 3Medical School Hannover, Institute of Pathology, Hannover, Germany
| | - Ulrike Nitz
- 7West German Study Group and Breast Center Niederrhein Johanniter Clinics, Moenchengladbach, Germany
| | - Nadia Harbeck
- 9Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | |
Collapse
|
13
|
Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kümmel S, Warm M, Fasching PA, Just M, Hanusch C, Hackmann J, Blohmer JU, Rhiem K, Schmitt WD, Furlanetto J, Gerber B, Huober J, Nekljudova V, von Minckwitz G, Loibl S. NAB-Paclitaxel Improves Disease-Free Survival in Early Breast Cancer: GBG 69–GeparSepto. J Clin Oncol 2019; 37:2226-2234. [DOI: 10.1200/jco.18.01842] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The GeparSepto trial demonstrated that weekly nanoparticle albumin-bound (NAB)–paclitaxel significantly improves the pathologic complete remission rate compared with weekly solvent-based (sb) paclitaxel followed by epirubicin plus cyclophosphamide as neoadjuvant treatment in patients with primary breast cancer (BC). Here, we report data on long-term outcomes. METHODS Patients with histologically confirmed primary BC were randomly assigned in a 1:1 ratio to 12 times weekly NAB-paclitaxel 150 mg/m2 (after study amendment, 125 mg/m2) or weekly sb-paclitaxel 80 mg/m2 followed in both arms by four times epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks. Patients with human epidermal growth factor receptor 2 (HER2)-positive BC received dual antibody treatment with trastuzumab (8 mg/kg loading dose followed by 6 mg/kg every 3 weeks) and pertuzumab (840 mg loading dose followed by 420 mg every 3 weeks) concurrently to chemotherapy and continued for 1 year. RESULTS A total of 1,206 patients started treatment, 606 with NAB-paclitaxel and 600 with sb-paclitaxel. After a median follow-up of 49.6 months (range, 0.5 to 64.0 months), 243 invasive disease–free survival (iDFS) events were reported (143 in the sb-paclitaxel and 100 in the NAB-paclitaxel arm). At 4 years, overall patients treated with NAB-paclitaxel had a significantly better iDFS compared with sb-paclitaxel (84.0% v 76.3%; hazard ratio, 0.66; 95% CI, 0.51 to 0.86; P = .002), whereas overall survival did not significantly differ between the two treatment arms (89.7% v 87.2%, respectively; hazard ratio, 0.82; 95% CI, 0.59 to 1.16; P = .260). Long-term follow-up of the treatment-related peripheral sensory neuropathy (PSN) showed a significant decrease of the median time to resolve PSN after NAB-paclitaxel 125 mg/m2 compared with NAB-paclitaxel 150 mg/m2. CONCLUSION The significantly higher pathologic complete response rate with NAB-paclitaxel translated into a significantly improved iDFS in patients with early BC as compared with sb-paclitaxel. PSN improved much faster under NAB-paclitaxel 125 mg/m2 compared with NAB-paclitaxel 150 mg/m2.
Collapse
Affiliation(s)
| | | | | | | | - Bahriye Aktas
- Klinik und Poliklinik für Frauenheilkunde Leipzig, Leipzig, Germany
| | | | | | | | - Sherko Kümmel
- Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - Mathias Warm
- Brustzentrum im Krankenhaus Köln-Holweide, Cologne, Germany
| | | | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gluz O, Kolberg-Liedtke C, Prat A, Christgen M, Gebauer D, Kates R, Paré L, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Wuerstlein R, Pelz E, Nitz U, Kreipe HH, Harbeck N. Efficacy of deescalated chemotherapy according to PAM50 subtypes, immune and proliferation genes in triple-negative early breast cancer: Primary translational analysis of the WSG-ADAPT-TN trial. Int J Cancer 2019; 146:262-271. [PMID: 31162838 DOI: 10.1002/ijc.32488] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
In the neoadjuvant WSG-ADAPT-TN trial, 12-week nab-paclitaxel + carboplatin (nab-pac/carbo) was highly effective and superior to nab-paclitaxel + gemcitabine (nab-pac/gem) in triple-negative breast cancer regarding pathological complete response (pCR). Predictive markers for deescalated taxane/carbo use in TNBC need to be identified. Patients received 4 × nab-pac 125 mg/m2 (plus carbo AUC2 or gem 1,000 mg/m2 d1,8 q21). Expression of 119 genes and PAM50 scores by nCounter were available in 306/336 pretherapeutic samples. Interim survival analysis was planned after 36 months median follow-up. Basal-like (83.3%) compared to other subtypes was positively associated with pCR (38% vs. 20%, p = 0.015), as was lower HER2 score (p < 0.001). Proliferation biomarkers were positively associated with pCR, that is, PAM50 proliferation, ROR scores (all p < 0.004), higher Ki-67 (IHC; p < 0.001). For nab-pac/carbo, expression of immunological (CD8, PD1 and PFDL1) genes and proliferation markers (proliferation and ROR scores, MKI67, CDC20, NUF2, KIF2C, CENPF, EMP3 and TYMS) were positively associated with pCR (p < 0.05 for all). For nab-pac/gem, angiogenesis genes were negatively associated with pCR (ANGPTL4: p = 0.05; FGFR4: p = 0.02; VEGFA: p = 0.03). pCR after 12 weeks was strongly associated with favorable outcome (3y event-free survival: 92% vs. 71%, p < 0.001). In early TNBC, basal-like subtype, higher Ki-67 (IHC) and lower HER2 score were, associated with chemosensitivity. Chemoresistance pathways differed between the two taxane based combinations. Combination of proliferation/immune markers and PAM50 subtype could allow patient selection for further deescalated chemotherapy and/or immune treatment approaches.
Collapse
Affiliation(s)
- Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Ronald Kates
- West German Study Group, Mönchengladbach, Germany
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Michael Braun
- Rotkreuz Clinics Munich, Breast Center, Munich, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany.,Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany.,Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| |
Collapse
|
15
|
Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. Abstract GS5-06: No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Immune markers such as tumor infiltrating lymphocytes (TILs), CD8, PDL1, PD1 and other protein or mRNA-based genomic markers have been identified as prognostic / predictive in TNBC regarding survival / chemotherapy (CTx) efficacy.
In the adjuvant WSG-PlanB trial, patients with high TILs and/or CD8 by mRNA had excellent outcome, irrespective of anthracycline use; in the neoadjuvant ADAPT-TN trial, high PDL1, PD1 and CD8 and/or TILs were predictive for pCR. Still, optimal markers for potential treatment de-escalation have yet to be determined. Here, we analyse for the first time impact of immune mRNA-based markers and TIL's as prognostic and predictive survival markers.
Methods: TNBC patients (ER/PR<1%, HER2-,) were randomized to neoadjuvant 4x nab-paclitaxel 125 mg/m2/gemcitabine 1000 mg/m2 d1/8 q3w (gem arm) or 4x nab-paclitaxel 125 mg/m2/carboplatin AUC2 day 1/8 3-weekly (q3w) (carbo arm). Primary endpoint of WSG-ADAPT-TN was pCR (ypT0/is/ypN0); secondary endpoints included translational analyses, e.g., TILs or expression of 119 genes by nCounter platform. Standard adjuvant chemotherapy (4xEC) was optional (not randomized) in patients achieving pCR after 12 weeks. According to protocol, 1st safety survival analysis was performed after 3y median follow-up.
Results: Present translational analysis included 306 of 336 TNBC patients (36 months median FU). pCR was associated with significantly better survival (3y EFS: 92% vs. 71%, p<.001), but despite substantially higher pCR in the carbo arm (46% vs. 29%), no significant EFS advantage was seen (p=.6) (gem: 78%; carbo: 80%; 3y-EFS).
Bivariate Spearman correlations among CD8, PD1, and PDL1 were strongly positive; their correlations with TILs were moderately positive.
Preliminary Cox analysis of EFS was performed with clinical variables (cN, cT, menopausal status); neoadjuvant study arm; pCR; TILs; proliferation markers (baseline Ki67 by IHC, scores derived from PAM50); baseline immune markers; risk scores; and individual gene expression scores previously identified as prognostic for pCR in one or both neoadjuvant arms. Independent prognostic factors included pCR, cN, Ki67, PD1, and CD8; these were entered into (prognostic) interaction analysis. The resulting model contained cN, high Ki67 and low TILs as (unfavorable) main effects and the interaction of (higher) PD1*pCR (favorable).
Among pCR patients, the groups with/without additional adjuvant CTX were similar with respect to explanatory factors. Baseline TILs, Ki67, cN, and PD1 were entered into exploratory predictive analysis; the model retained only the interaction [adjuvant CTx * (fractionally ranked) PD1]. In patients with pCR, those with low PD1 benefited from standard anthracycline-containing adjuvant CTx, whereas patients high PD1 did not with an 98% 3y-EFS.
Conclusions: Our exploratory results suggest independent prognostic impact of mRNA markers and TIL's in early TNBC. Patients with both pCR (after 12 weeks) and “high-immune” signature (defined here by PD1) had excellent 3y-EFS and may be candidates for treatment de-escalation (e.g. omission of anthracyclines), whereas “low-immune” pCR patients may benefit from standard adjuvant poly-chemotherapy.
Citation Format: Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke E-M, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-06.
Collapse
Affiliation(s)
- O Gluz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - U Nitz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Liedtke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - A Prat
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Christgen
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - F Feuerhake
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Garke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E-M Grischke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - H Forstbauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Braun
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Warm
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - J Hackmann
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Uleer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - B Aktas
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Schumacher
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - S Kuemmel
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E Pelz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - D Gebauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - L Paré
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Kates
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Wuerstlein
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - HH Kreipe
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - N Harbeck
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| |
Collapse
|
16
|
Villegas SL, Lederer B, Untch M, Holms F, Ulmer HU, Diebold K, Fasching PA, Weber K, Schmitt WD, Tesch H, Rezai M, Marmé F, Sinn B, Hackmann J, Schneeweiss A, Tannapfel A, Nekljudova V, Denkert C, Loibl S. Abstract P2-08-10: Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-10] [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:
Currently, patients with breast cancer (BC) with hormone receptor (HR) immunohistochemical expression between 1-9% are eligible to receive endocrine therapy. However, recent data suggest that these tumors express a basal-like molecular phenotype associated with triple negative BC (TNBC) rather than luminal phenotype associated with HR positive BC. Here, we aimed to determine the differences between strong HR positive, low HR positive and negative HR BC, in regard to responsiveness to neoadjuvant chemotherapy (NACT) and disease free survival (DFS) in large cohorts from GBG clinical trials.
Methods:
In this retrospective analysis of data from women with BC treated in the neoadjuvant GeparQuinto (n=2572), GeparSixto (n=588) and GeparSepto (n=1206) clinical trials, we compared patients with three HR phenotypes: low positive (ER and/or PR= 1-9%), strong positive (ER or PR= 10-100%), and negative (ER and PR= <1%), regarding pathological complete response (pCR, ypT0 ypN0) and DFS. A logistic regression model for endpoint pCR was performed on pooled data from all trials. Cox regression was used to model DFS for patients participating in GeparQuinto and GeparSixto trial, including 71 with low HR positive phenotype. The models were adjusted by age, tumor and nodal status, grading, Her2 status, histological type, stromal and tumor infiltrating lymphocytes and clinical trial. The survival model was additionally adjusted by pCR after NACT.
Results:
Patients median age was 49 years, the majority had clinical tumor stage 2 (54.1%), negative nodal status (54.7%), and Her2 negative tumors (72.4%). 85.1% of women had BC classified as no special histological type. The pCR rate across the studies was 26.2%. 145 (3.4%) patients had low HR positive, 2417 (57.3%) strong HR positive and 1658 (39.3%) HR negative tumors. After NACT, 16.3% of patients with strong HR positive BC achieved a pCR, while among those with HR negative and low HR positive tumors, pCR rates were 40.2% and 37.9%, respectively (p<0.001). In the adjusted logistic regression model, there was no statistically significant difference between low HR positive and HR negative tumors (OR: 1.34, 95%-CI: (0.84-2.13), p=0.222). But strong HR positive tumors had a significantly lower chance of achieving a pCR compared to low HR positives (OR 0.48, 95%-CI: 0.30-0.76, p=0.002). Patients with strong HR positive BC had a better DFS than patients with low HR positive tumors (hazard ratio 0.35, 95%-CI: 0.18-0.70, p=0.003). DFS was not significantly different between patients with HR negative and low HR positive tumors (hazard ratio 0.74, 95%-CI: 0.38-1.43, p=0.370).
Conclusions:
Similarly to patients with negative HR tumors, patients with low HR positive tumors have a better responsiveness to NACT and worse survival rates, compared to patients with strongly HR positive BC. We suggest that studies on treatment options for basal-like/TNBC, should also consider including patients with low HR positive tumors.
Citation Format: Villegas SL, Lederer B, Untch M, Holms F, Ulmer H-U, Diebold K, Fasching PA, Weber K, Schmitt WD, Tesch H, Rezai M, Marmé F, Sinn B, Hackmann J, Schneeweiss A, Tannapfel A, Nekljudova V, Denkert C, Loibl S. Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-10.
Collapse
Affiliation(s)
- SL Villegas
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - B Lederer
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - M Untch
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - F Holms
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - H-U Ulmer
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - K Diebold
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - PA Fasching
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - K Weber
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - WD Schmitt
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - H Tesch
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - M Rezai
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - F Marmé
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - B Sinn
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - J Hackmann
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - A Schneeweiss
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - A Tannapfel
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - V Nekljudova
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - S Loibl
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| |
Collapse
|
17
|
Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kümmel S, Rhiem K, Warm M, Fasching P, Just M, Hanusch C, Hackmann J, Blohmer JU, Furlanetto J, Nekljudova V, von Minckwitz G, Loibl S. Impact of nab-paclitaxel dose reduction on survival of the randomized phase III GeparSepto trial comparing neoadjuvant chemotherapy of weekly nab-paclitaxel (nP) with solvent-based paclitaxel (P) followed by anthracycline/cyclophosphamide for patients with early breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Lindner C, Kümmel S, Kates R, Potenberg J, Staib P, Wuerstlein R, Kreipe H, Harbeck N. Prognostic impact of anthracyclines and immune/proliferation markers in TNBC according to pCR after de-escalated neoadjuvant chemotherapy with 12 weeks of nab-paclitaxel/carboplatin or gemcitabine: Survival results of WSG-ADAPT-TN phase II trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
19
|
Heil J, Sinn P, Richter H, Pfob A, Schaefgen B, Hennigs A, Riedel F, Thomas B, Thill M, Hahn M, Blohmer JU, Kuemmel S, Karsten MM, Reinisch M, Hackmann J, Reimer T, Rauch G, Golatta M. RESPONDER - diagnosis of pathological complete response by vacuum-assisted biopsy after neoadjuvant chemotherapy in breast Cancer - a multicenter, confirmative, one-armed, intra-individually-controlled, open, diagnostic trial. BMC Cancer 2018; 18:851. [PMID: 30144818 PMCID: PMC6109284 DOI: 10.1186/s12885-018-4760-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NACT) is a standard approach of the multidisciplinary treatment of breast cancer. Depending on the biological subtype a pathological complete response in the breast (bpCR) can be achieved in up to 60% of the patients. However, only limited accuracy can be reached when using imaging for prediction of bpCR prior to surgery. Due to this diagnostic uncertainty, surgery after NACT is considered to be obligatory for all patients in order to either completely remove residual disease or to diagnose a bpCR histologically. The purpose of this trial is to evaluate the accuracy of a vacuum-assisted biopsy (VAB) to diagnose a bpCR after NACT prior to surgery. Methods This study is a multicenter, confirmative, one-armed, intra-individually-controlled, open, diagnostic trial. The study will take place at 21 trial sites in Germany. Six hundred female patients with breast cancer after completed NACT showing at least a partial response to NACT treatment will be enrolled. A vacuum-assisted biopsy (VAB) guided either by ultrasound or mammography will be performed followed by histopathological evaluation of the VAB specimen before standard, guideline-adherent breast surgery. The study is designed to prove that the false negative rate of the VAB is below 10%. Discussion As a bpCR is becoming a more frequent result after NACT, the question arises whether breast surgery is therapeutically necessary in such cases. To study this subject further, it will be crucial to develop a reliable test to diagnose a bpCR without surgery. During the study we anticipate possible problems in patient recruitment as the VAB intervention does not provide participating patients with any personal benefit. Hence, a proficient informed consent discussion with the patient and a detailed explanation of the study aim will be crucial for patient recruitment. Another critical issue is the histopathological VAB evaluation of a non-tumorous specimen as this may have been taken either from the former tumor region (bpCR) or outside of the (former) tumor region (non-representative VAB, sampling error). Trial registration The trial has been registered at clinicaltrials.gov with the identifier NCT02948764 on October 28, 2016 and at the German Clinical Trials Register (DRKS00011761) on February 20, 2017. The date of enrolment of the first participant to the trial was on March 8, 2017.
Collapse
Affiliation(s)
- Joerg Heil
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany.
| | - Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Hannah Richter
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - André Pfob
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| | - Bettina Thomas
- Koordinierungszentrum für Klinische Studien (KKS), Heidelberg University, Heidelberg, Germany
| | - Marc Thill
- Department of Gynecology, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Markus Hahn
- Department of Gynecology, Tuebingen University, Tuebingen, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Sherko Kuemmel
- Department of Gynecology, Hospital Kliniken Essen-Mitte, Essen, Germany
| | | | - Mattea Reinisch
- Department of Gynecology, Hospital Kliniken Essen-Mitte, Essen, Germany
| | - John Hackmann
- Department of Gynecology, Marien Hospital Witten, Witten, Germany
| | - Toralf Reimer
- Department of Gynecology, Rostock University, Rostock, Germany
| | - Geraldine Rauch
- Charité Universitaetsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Institute of Medical biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Center, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
20
|
Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun MW, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kummel S, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Impact of 12 weeks nab-paclitaxel + carboplatin or gemcitabine followed by anthracycline administration according to pCR in triple-negative early breast cancer: Survival results of WSG-ADAPT-TN phase II trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oleg Gluz
- Breast Center Niederrhein and University Clinics Cologne, Moenchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group/ Breast Center Niederrhein, Moenchengladbach, Germany
| | | | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | - Mathias Warm
- City Hospital Cologne, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Hospital Essen/Univeristy Hospital Leipzig, Essen, Germany
| | | | | | | | | | | | | | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
| | | |
Collapse
|
21
|
Loibl S, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Wiebringhaus H, Kümmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Dan Costa S, Gerber B, Engels K, Nekljudova V, von Minckwitz G, Untch M. Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: a subanalysis of data from the randomized phase III GeparSepto trial. Ann Oncol 2017; 28:497-504. [PMID: 27831502 DOI: 10.1093/annonc/mdw610] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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 neoadjuvant phase III GeparSepto study showed that substituting nab-paclitaxel for standard solvent-based paclitaxel significantly improved the pathologic complete response (pCR) rate achieved with a sequential neoadjuvant chemotherapy regimen of paclitaxel, epirubicin, and cyclophosphamide for high-risk primary breast cancer. Recent trials demonstrated that in HER2+ breast cancer pCR can be increased by using pertuzumab in addition to trastuzumab and chemotherapy. The present analysis focuses on efficacy and safety data from the subset of patients with HER2+ tumors from the GeparSepto trial (n = 396) in comparison to the HER2- cohort. Patients and methods Patients with histologically confirmed breast cancer (n = 1206) received four cycles of weekly paclitaxel [either solvent-based (Pac) or nab-paclitaxel (nab-Pac), according to randomization] followed by 4 cycles of epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 q3w, with concurrent trastuzumab and pertuzumab q3w for those with HER2+ tumors. The primary endpoint was pCR defined as ypT0 ypN0. Results Higher rates of pCR were achieved in HER2+ than in HER2- tumors (57.8% versus 22.0%, P < 0.0001), with the highest rate in the HER2+/HR- cohort (71.0%; 66.7% Pac, 74.6% nab-Pac). In HER2+/HR+ tumors, the pCR rate was 52.9% (49.7% Pac, 56.4% nab-Pac). Grade ≥3 toxic effects were significantly more common in HER2+ than in HER2- patients, with grade 3-4 diarrhea in 7.6% versus 0.9% (P < 0.001) and febrile neutropenia in 6.3% versus 3.3% (P = 0.023) of patients. Left ventricular ejection fraction decreases from baseline were uncommon, with 2.0% versus 0.4% of patients showing decreases to <50% along with a ≥10% decrease from baseline. Conclusion In HER2+ early breast cancer, a dual HER2-targeted combination of pertuzumab and trastuzumab, together with taxane-epirubicin-cyclophosphamide neoadjuvant chemotherapy, achieved high rates of pCR.
Collapse
Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, , Germany
| | - C Jackisch
- Department of Obstetrics & Gynecology, Sana Klinikum, Offenbach, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, , Germany
| | - S Schmatloch
- Breast Cancer Center, Elisabeth Krankenhausx, Weinbergstraße 7, Kassel, Germany
| | - B Aktas
- Department of Gynecology & Obstetrics, University Women's Hospital Essen, Essen, Germany
| | - C Denkert
- Department of Pathology, University Hospital Charité, Berlin, Germany
| | - H Wiebringhaus
- Gynecology, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
| | - S Kümmel
- Breast Unit, Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - M Warm
- Breast Unit, Brustzentrum im Krankenhaus Köln-Holweide, Köln, Germany
| | - S Paepke
- Women's Clinic, Klinikum Rechts der Isar der TU München, Klinik und Poliklinik für Frauenheilkunde, München, Germany
| | - M Just
- Oncology, Onkologische Schwerpunktpraxis Bielefeld, Germany
| | - C Hanusch
- Women's Clinic, Klinikum zum Roten Kreuz, München, Germany
| | - J Hackmann
- Breast Unit, Marien Hospital Witten, Witten, Germany
| | - J-U Blohmer
- Women's Clinic, Klinik für Gynäkologie am Campus Charité Mitte, Berlin, Germany
| | - M Clemens
- Women's Clinic, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - S Dan Costa
- Department of Gynecology, Universitäts-Frauenklinik, Magdeburg, Germany
| | - B Gerber
- Women's Clinic, Universitäts-Frauenklinik, Rostock, Germany
| | - K Engels
- Department of Pathology, Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Germany
| | | | | | - M Untch
- Department of Gynecology and Obstetrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | | |
Collapse
|
22
|
Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, von Schumann R, Kates R, Kates R, Schumacher J, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of Neoadjuvant Nab-Paclitaxel+Carboplatin vs Nab-Paclitaxel+Gemcitabine in Triple-Negative Breast Cancer: Randomized WSG-ADAPT-TN Trial Results. J Natl Cancer Inst 2017; 110:628-637. [PMID: 29228315 DOI: 10.1093/jnci/djx258] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/08/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Oleg Gluz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
- University Clinics Cologne
| | - Ulrike Nitz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | - Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Clinics Schleswig-Holstein/Campus Luebeck
| | | | | | | | | | - Mathias Warm
- Breast Center, City Hospital of Cologne Holweide
| | | | | | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen
- Department of Gynecology, University Hospital Leipzig
| | | | | | - Christoph Lindner
- Clinic of Gynecology, Charité University Clinics Berlin
- Department of Gynecology and Obstetrics, Agaplesion Diakonie Clinic
| | | | | | | | - Peter Staib
- Department of Oncology, St. Antonius Hospital
| | - Andreas Kohls
- Department of Gynecology and Obstetrics, Evangelical Hospital Ludwigsfelde
| | - Raquel von Schumann
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | | | | | | | - Rachel Wuerstlein
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | - Nadia Harbeck
- Moenchengladabach, West German Study Group
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| |
Collapse
|
23
|
Gluz O, Liedtke C, Prat A, Christgen M, Gebauer D, Kates RE, Grischke EM, Forstbauer H, Braun MW, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kummel S, Wuerstlein R, Pelz E, Nitz U, Kreipe HH, Harbeck N. Association of molecular subtype, proliferation, and immune genes with efficacy of carboplatin versus gemcitabine addition to taxane-based, anthracycline-free neoadjuvant chemotherapy in early triple-negative breast cancer (TNBC): Results of the randomized WSG ADAPT-TN trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
573 Background: In the ADAPT-TN neoadjuvant trial, 12-week nab-paclitaxel (nab- pac)+carboplatin (carbo) was highly effective and superior to nab-pac+gemcitabine (gem). However, within TNBC, reliable predictive markers for carbo use have yet to be identified. Methods: Patients with early TNBC (centrally confirmed) were treated by nab-pac 125 mg/m2 with either carbo AUC2 or gem 1000 mg/m2 d 1,8 q21 given for 4 cycles. Genomic data (80 genes) and Prosigna (PAM-50) scores were available in 306 pre-therapeutic samples of 331 treated patients. Fisher’s exact test was performed for pCR differences; associations of continuous measurements or scores with pCR were analyzed by the Mann-Whitney statistic. Results: pCR was 44.5% to 28.4% (p=.004) in favor of nab-pac - carbo. Specifically within the carbo- containing arm, immunological (CD8, PD1, PFDL1) genes and proliferation markers (proliferation score and ROR scores, MKI67, CDC20, NUF2, KIF2C, CENPF, EMP3, TYMS) were positively associated with pCR (p<.05 for all). Specifically within the gem-arm, angiogenesis genes were negatively associated with pCR (ANGPTL4: p=.05; FGFR4: p=.02; VEGFA: p=.03). In the whole collective, basal-like (83.3%) was favorable for pCR (38% vs. 20%, p=.015) compared to other subtypes (HER: 6.4%; luminal-A: 1.7%; normal: 8.7%), as was lower HER-2 score (p<.001). Proliferation was positively associated with pCR: i.e., Pam50 proliferation score, ROR scores (all p<.004), and higher Ki67 by central IHC (p<.001) -- though not MKI67 RNA expression, despite their moderate correlation. Conclusions: In early TNBC, basal-like subtype, higher Ki67 (by IHC), and lower HER-2 score were associated with chemo-sensitivity for both neoadjuvant arms. Chemo-resistance pathways differed between the two taxane-based combinations (low proliferation and immune marker gene expression for carbo, high angiogenesis for gem). The positive predictive impact of immunological genes in the nab-pac - carbo arm could influence optimal patient selection for immune-modulative therapy. Clinical trial information: NCT01815242.
Collapse
Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Aleix Prat
- Medical Oncology Department. Hospital Clinic, Barcelona, Spain
| | | | | | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Ulrike Nitz
- West German Study Group, Evangelic Hospital Bethesda, Moenchengladbach, Germany
| | | | | | | |
Collapse
|
24
|
Furlanetto J, Jackisch C, Untch M, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Wiebringhaus H, Kümmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S, von Minckwitz G. Efficacy and safety of nab-paclitaxel 125 mg/m 2 and nab-paclitaxel 150 mg/m 2 compared to paclitaxel in early high-risk breast cancer. Results from the neoadjuvant randomized GeparSepto study (GBG 69). Breast Cancer Res Treat 2017; 163:495-506. [PMID: 28315068 DOI: 10.1007/s10549-017-4200-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/13/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The GeparSepto study demonstrated that the use of nab-paclitaxel instead of paclitaxel prior to anthracycline-based chemotherapy could lead to a significantly increased pCR rate, especially in the triple negative subpopulation. We report efficacy and safety for patients treated with two different doses of nab-paclitaxel in comparison to weekly solvent-formulated paclitaxel. METHODS Patients were treated for 12 weeks with either intravenous nab-paclitaxel 150 mg/m2 (nP150) weekly, after study amendment 125 mg/m2 (nP125) weekly or solvent-based paclitaxel 80 mg/m2 (P80) weekly followed by epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 on day 1 for four 3-week cycles. RESULTS 229 patients received nP150, 377 nP125. Baseline characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for hormone receptor status, HER2 status, and Ki67. Taxane treatment was discontinued in 26.8% (nP150), 16.6% (nP125), and 13.3% of (P80) patients, respectively. Median relative total dose intensity (mRTDI) based on 125 mg/m2 for nP was 103% with nP150, 95% with nP125, 99% with P80 before and 98% with P80 after the amendment. PSN grade 3-4 was observed in 14.5% of patients with nP150, 8.1% of patients with nP125 (p = 0.018), and 2.7% of patients with P80. Overall pCR before the amendment was 33.6% after nP150 and 23.5% after P80 (OR 1.65 [95% CI 1.10-2.50]; p = 0.022); pCR after the amendment was 41.4% after nP125, and 32.4% after P80 (1.48 [95% CI 1.10-1.99]; p = 0.013). CONCLUSIONS Nab-paclitaxel 125 mg/m2 was associated with a better safety profile and compliance without compromising the efficacy compared to nab-paclitaxel 150 mg/m2.
Collapse
Affiliation(s)
- Jenny Furlanetto
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany.
| | | | | | - Andreas Schneeweiss
- National Center for Tumor Disease, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Carsten Denkert
- Institute of Pathology and German Cancer Consortium (DKTK), Charité-University Hospital, Berlin, Germany
| | | | - Sherko Kümmel
- Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - Mathias Warm
- Brustzentrum in Krankenhaus Köln-Holweide, Cologne, Germany
| | - Stefan Paepke
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Frauenheilkunde, Munich, Germany
| | | | | | | | - Jens Uwe Blohmer
- Frauenklinik an der Charité-University Hospital, Berlin, Germany
| | | | | | | | - Valentina Nekljudova
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Gunter von Minckwitz
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| |
Collapse
|
25
|
Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Abstract P5-16-03: Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-03] [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: 11/16/2022]
Abstract
Abstract
Background: The GeparSepto (NCT01583426) study showed that nab-paclitaxel (nP) increases the pathological complete response (ypT0 ypN0) rate when it replaces paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for pts with early breast cancer (BC) (Untch Lancet Oncol 2016). After a safety analysis showed a higher rate of dose reductions, treatment discontinuations as well as peripheral sensory neuropathy (PSN) with nP 150 mg/m2 w (nP150) compared to P 80mg/m2 w, dose of nP was reduced to 125 mg/m2 w (nP125). The risk-benefit ratio of nP125 was improved over nP150 (von Minckwitz SABCS 2015). We reported follow-up (FU) data on PSN occurrence and resolution.
Methods: Pts with untreated BC received P 80mg/m2 w or nP 150/125mg/m2 w followed by four cycles of E 90 mg/m2 plus C 600 mg/m2 q3w, with trastuzumab 6 mg/kg (loading (LD) dose 8 mg/kg) and pertuzumab 420 mg (LD 840 mg) q3w if HER2+. After the end of the study the protocol was amended in order to collect long-term data on PSN outcome as well as on treatment modalities. PSN will be reported according treatment and dose received on day 1.
Results: Overall 601 pts received P80; 220 pts nP150 and 385 pts nP125 on day 1. PSN grade 2-4 was observed in 18.8% (n=113/601) of pts treated with P80 and in 41.8% (n=92/220) vs 39.2% (n=151/385) with nP150 and nP125 respectively (p=0.547). Grade 3-4 PSN was reported for 2.7% (n=16/601) of pts in the P80 group and 14.5% (n=32/220) vs 8.1% (n=31/385) in the nP150 vs nP125 group respectively (p=0.018). In 31.8% (36/113), 35.9% (33/92) and 27.2% (41/151), PSN was not resolved at the end of the treatment (EOT); PSN grade 3-4 was not resolved in 37.5% (6/16), 56.3% (18/32) and 58.1% (18/31). After a median FU of 110 weeks after EOT, data on PSN status for pts with unresolved PSN grade 2-4 were available from 30, 22 and 32 pts; 26 pts did not provide update information (n=7 died, n=5 data not yet available, n=14 status unknown). For 63.3% (n=19), 40.9% (n=9) and 56.2% (n=18) of pts, PSN grade 2-4 was resolved to grade 1. Time to resolve (TTR) of PSN grade 2-4 was significantly different between nP150 and nP125 (p<0.001); no significant difference was seen between P and nP (p=0.405) [Tab.1]. After a median FU of 103 weeks after EOT, data on PSN status of pts with unresolved PSN grade 3-4 were available for 6, 14 and 14 pts. For 66.6% (n=4), 42.8% (n=6) and 50.0% (n=7) of pts PSN grade 3-4 was resolved to grade 1. TTR of PSN grade 3-4 was not significantly different neither for nP150 vs nP125 (p=0.103) nor for P vs nP (p=0.120) ) [Tab.1].
Conclusions: nP125 is associated with a lower occurrence of PSN compared to nP150 but higher PSN than P80. If PSN occurred nP125 is associated with a more rapid resolution compared to nP150. Nearly 10.7% had no resolution of PSN so far. Further FU and markers for selecting pts at risk are needed.
The trial is supported by Celgene.
Table 1. Median time to resolution (mTTR) of PSN to grade 1comparison groupsmTTR n (weeks); [95% CI]P vs nPPnP150nP125grade 2-47 [6-9]8 [6-10]grade 3-49 [4-15]17 [5-123]nP150 vs nP125 grade 2-4 13 [9-15]6 [4-9]grade 3-4 56 [11-170]17 [10-nr]abbreviations: nP, nab-paclitaxel; P, paclitaxel; nr, not reached
Citation Format: Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-03.
Collapse
Affiliation(s)
- J Furlanetto
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Jackisch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Aktas
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Denkert
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - H Wiebringhaus
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Warm
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Paepke
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Just
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J Hackmann
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Clemens
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - SD Costa
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Gerber
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Untch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Loibl
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| |
Collapse
|
26
|
Loibl S, Jackisch J, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kuemmel S, Luebbe K, Warm M, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Engels K, Nekljudova V, von Minckwitz G, Untch M. Abstract P4-21-06: Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: A subanalysis of data from the randomized phase III GeparSepto trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-06] [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
Our recent randomized, multicenter phase III GeparSepto study (Untch M et al. Lancet Oncol 2016) found that substituting nab-paclitaxel for standard solvent-based paclitaxel significantly improved the pathologic complete response (pCR) rate in patients receiving a sequential regimen of taxane, epirubicin and cyclophosphamide as neoadjuvant treatment for high-risk primary breast cancer. Patients with HER2-positive tumors (32.8%; n=396) also received a combination of pertuzumab and trastuzumab: the present analysis focuses on efficacy and safety data from these HER2+ patients treated with the dual-blockade.
Methods
Patients with histologically confirmed early breast cancer (n = 1206) received either weekly paclitaxel 80mg/m2 or weekly nab-paclitaxel 150/125mg/m2, according to randomization), followed by four cycles of epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 q3w, with concurrent trastuzumab 6 mg/kg (loading (LD) dose 8 mg/kg) and pertuzumab 420 mg (LD 840 mg) q3w for those with HER2-positive tumors. The primary endpoint was pathologic complete response (pCR), defined as ypT0 ypN0.
Results
The GeparSEPTO trial included 396/1206 (32.8%) HER2+ primary breast cancer patients. 27.0% in the HER2-positive and 34.1% in the HER2-negative group had HR-negative disease. Baseline characteristics were otherwise comparable between HER2+ and HER2- patients. Higher rates of pCR were seen in HER2+, compared to HER2- tumors (57.8% vs 22.0%). The highest overall pCR rate was observed in the HER2+/HR- cohort with 71.0%; 66.7% with Pac and 74.6% with nab-Pac. In HER2+/HR+ pCR rate was 52.9% ; 49.4% with Pac and 56.4% with nab-Pac. Using the definition ypT0/is ypN0 for pCR; pCR rates were generally higher especially in the HER2+ cohort (66.2% (ypT0/is ypN0) vs 57.8% (ypT0 ypN0)) compared to 25.2% (ypT0/is ypN0) vs 22% (ypT0 ypN0)) in patients with HER2-negative tumors. The HER2+ patients experienced a significantly higher incidence of grade 3-4 adverse events 85.4% vs 78.0% in the HER2-cohort, p=0.003); grade 3-4 hematologic AEs 74.0% (HER2+) vs 69.5% (HER2-); p=0.120 with grade 3-4 anaemia 2.5% vs 0.9%; p=0.034); any grade thrombopenia 28.5% vs 21.8%; p=0.012) and febrile neutropenia 6.3 vs 3.3%; p=0.023. Any grade 3-4 non-haematological toxicities occurred in 38.4% vs 30.1%; p=0.005), with grade 3-4 diarrhea occurring in 7.6% vs 0.9%; p<0.001 of the patients. This had no impact on compliance. LVEF decreases from baseline were uncommon (7.6%) with 2.0% (HER2+) versus 0.4% (HER2-) of patients showing decreases to <50% along with a ≥10% decrease from baseline.
Conclusion
This is the largest cohort of patients with HER2-positive early breast cancer receiving a dual HER2-targeted neoadjuvant therapy of pertuzumab and trastuzumab, together with nab-paclitaxel or paclitaxel followed by epirubicin and cyclophosphamide. HER2+ patients experienced more noteworthy toxicity. The pCR rate were higher in the HER2+ cohort receiving the dual blockade and was highest in patients with in HER+/HR- particularly if nab-paclitaxel was substituted for paclitaxel.
The trial is financially supported by Celgene and Roche.
Citation Format: Loibl S, Jackisch J, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kuemmel S, Luebbe K, Warm M, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Engels K, Nekljudova V, von Minckwitz G, Untch M. Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: A subanalysis of data from the randomized phase III GeparSepto trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-06.
Collapse
Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J Jackisch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - S Schmatloch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - B Aktas
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Denkert
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Schem
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - H Wiebringhaus
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - K Luebbe
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Warm
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Just
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J Hackmann
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Clemens
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - K Engels
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Untch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| |
Collapse
|
27
|
Gluz O, Nitz U, Liedtke C, Christgen M, Sotlar K, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, Pelz E, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Abstract P1-13-01: Comparison of 12 weeks neoadjuvant Nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple- negative breast cancer: WSG-ADAPT TN randomized phase II trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-01] [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: Pathological complete response (pCR) is associated with improved prognosis in TNBC, but optimal chemotherapy remains unclear. Use of weekly nab- paclitaxel (Nab-Pac) vs. conventional paclitaxel and also addition of carboplatinum(Carbo) to anthracycline-taxane(A/T) containing chemotherapy results in significantly higher pCR rates in TNBC with unclear impact on survival and increased toxicity.
The ADAPT study seeks to compare Carbo vs. gemcitabine(Gem) added to nab- paclitaxel as a short 12-week A-free regimen. It also assesses efficacy in early responders vs. non-responders by 3-week proliferation and/or imaging response.
Methods: ADAPT TN compares 12-week neoadjuvant regimens: Carbo vs. Gem combined with Nab-Pac and aims to identify early-response markers for pCR (yPN0 and ypT0/is). TNBC patients (centrally confirmed ER/PR <1%, HER2 neg.), cT1c- cT4c, cN0/+ were randomized to arm A (Nab-Pac 125/Gem 1000 d1,8 q3w) vs. B (Nab-Pac 125/Carbo AUC2 d1,8 q3w). Randomization was stratified by center and nodal status. The trial is powered for pCR comparison by therapy arm and by presence vs. absence of early response markers. Pre-planned interim analysis aimed to identify a dynamic biomarker, e.g. drop of 3-week Ki-67, and to validate trial assumptions.
Results: 336 patients were enrolled from 47 centers between 06/13-02/15 (n=182 ArmA: Nab-Pac/Gem and n=154 ArmB: Nab-Pac/Carbo). 90% and 95% completed therapy according to protocol respectively (n.s.). Median age was 50y. At baseline: A/B: 73% and 74%% had G3 tumors, median Ki-67 of 70% and 75%; 62.6% and 62.9%% had cT2-4c tumors, pN0 status prior to chemotherapy was confirmed in 50.5% and 50%, respectively.
pCR (ypT0/is/ypN0) was A: 28.7% and B: 45.9% (p<0.001). Total pCR (ypT0/ypN0) was A: 25.8% and B: 45.2% respectively (p <0.001).
Nab/Gem arm was associated with significantly higher frequency of dose reductions (20.6% vs. 11.9% (p=0.03), treatment related SAE's (13% vs. 5%, p=0.02), grade 3-4 infections (6.1% vs. 1.3%, p=0.04) and ALAT elevations (11.7 vs. 3.3%, p=0.01) compared to the Nab-Carbo arm.
Within the planned interim analysis (n=130: A/B: 69/61), baseline Ki-67 (Nab- Pac/Carbo arm), age>50 years, and low cellularity (<500 tumor cells and/or Ki-67≤10% in the 3-week biopsy) (Nab-Pac/Gem arm) were positively associated with pCR by logistic regression analysis (separately by therapy arm). In all patients, therapy arm itself was significant for pCR.
Validation of responder definitions for the whole study will be presented at the meeting.
Conclusions:
This is the first large randomized study comparing two short 12-week anthracycline- free regimens in unselected TNBC. Our results suggest superior efficacy and excellent toxicity of Nab-Pac/Carbo vs. Gem. Longer A/T-Carbo containing regimens render quite comparable pCR rates, thus overtreatment by 4xEC in unselected TNBC may be present in some patients. Early response criteria seem to differ according to regimen; their assessment may be impaired by substantial tumor necrosis already after the first therapy cycle.
Citation Format: Gluz O, Nitz U, Liedtke C, Christgen M, Sotlar K, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, Pelz E, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of 12 weeks neoadjuvant Nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple- negative breast cancer: WSG-ADAPT TN randomized phase II trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-01.
Collapse
Affiliation(s)
- O Gluz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - U Nitz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Liedtke
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Christgen
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - K Sotlar
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - EM Grischke
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - H Forstbauer
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Braun
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Warm
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - J Hackmann
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Uleer
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - B Aktas
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Schumacher
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - N Bangemann
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Lindner
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - S Kuemmel
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Clemens
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - J Potenberg
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - P Staib
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - A Kohls
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - E Pelz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - RE Kates
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - R Wuerstlein
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - HH Kreipe
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - N Harbeck
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| |
Collapse
|
28
|
von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. Abstract P1-14-11: nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We previously reported that nab-paclitaxel (nP) increases the pathological complete response (pCR, ypT0 ypN0) rate when it replaces solvent-based paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for patients with early breast cancer (Untch et al. SABCS 2014). Here, we report efficacy and safety of patients being treated either with 150 mg/m2 nab-paclitaxel (nP150) before an amendment or with 125 mg/m2 nab-paclitaxel (nP125) thereafter in comparison to solvent-formulated paclitaxel at 80 mg/m2 (P80).
Methods: In the GeparSepto study (NCT01583426), 1207 patients were randomized to either nP150 or P80 q1w for 12 weeks followed by 4 cycles of conventionally dosed EC (E: 90mg/m2; C: 600 mg/m2) q3w. The primary objective of the study was to compare the pCR rate (pCR, ypT0 ypN0). Patients with untreated, histologically confirmed uni- or bilateral, cT2- cT4d carcinoma, and no clinically relevant cardiovascular and other co-morbidities were included. Patients with HER2+ tumors received trastuzumab (loading dose 8mg/kg; 6 mg/kg) plus pertuzumab (loading dose 840 mg; 420 mg) q3w concomitantly to all chemotherapy cycles. After a safety analysis showed a higher rate of dose reductions and treatment discontinuations with nP150 compared to P80, weekly dose of nP was reduced to 125 mg/m2.
Results: nP was given for the majority of cycles at a dose of 150 mg/m2 to 179 patients and at a dose of 125 mg/m2 to 426 patients. Treatment characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for HER2 status (HER2-positive: nP150 22%, nP125 37% and P80 33%) and Ki67 (<20%: nP150 60%, nP125 73% and P80 69%). Taxane treatment was discontinued in 16% (nP150), 11% (nP125) and 6% (P80) of patients, respectively. Median dose per cycle (based on relative total dose intensity (RTDI)) was 129 mg/m2 with nP150, 119 mg/m2 with nP125 and 78 mg/m2 with P80, respectively. Peripheral sensory neuropathy (PNP) grade 3/4 (NCI-CTCAE v4.0) was observed in 15% with nP150, 8% with nP125 and 3% with P80, respectively. pCR was 32% with nP150, 41% with nP125 and 29% with P80 in all patients and 46% with nP150, 49% with nP125 and 26% with P80 in 277 patients with triple-negative breast cancer, respectively.
Conclusions: Risk-benefit ratio of nP125 was improved over nP150 with better drug adherence and RTDI, lower frequency of PNP but a higher pCR rate. It should therefore be considered as the preferred schedule when nP is used as neoadjuvant treatment for primary breast cancer.
The trial was financially supported by Celgene and Roche.
Citation Format: von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-11.
Collapse
Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Jakisch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Conrad
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Aktas
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Weibringhaus
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hilfrich
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Warm
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Just
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hackmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Clemens
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - SD Costa
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| |
Collapse
|
29
|
Hackmann J, Glasenapp P, Greilich A, Bayer M, Anders FB. Influence of the Nuclear Electric Quadrupolar Interaction on the Coherence Time of Hole and Electron Spins Confined in Semiconductor Quantum Dots. Phys Rev Lett 2015; 115:207401. [PMID: 26613469 DOI: 10.1103/physrevlett.115.207401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Indexed: 06/05/2023]
Abstract
The real-time spin dynamics and the spin noise spectra are calculated for p and n-charged quantum dots within an anisotropic central spin model extended by additional nuclear electric quadrupolar interactions and augmented by experimental data. Using realistic estimates for the distribution of coupling constants including an anisotropy parameter, we show that the characteristic long time scale is of the same order for electron and hole spins strongly determined by the quadrupolar interactions even though the analytical form of the spin decay differs significantly consistent with our measurements. The low frequency part of the electron spin noise spectrum is approximately 1/3 smaller than those for hole spins as a consequence of the spectral sum rule and the different spectral shapes. This is confirmed by our experimental spectra measured on both types of quantum dot ensembles in the low power limit of the probe laser.
Collapse
Affiliation(s)
- J Hackmann
- Theoretische Physik 2, Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - Ph Glasenapp
- Experimentelle Physik 2, Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - A Greilich
- Experimentelle Physik 2, Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - M Bayer
- Experimentelle Physik 2, Technische Universität Dortmund, D-44221 Dortmund, Germany
| | - F B Anders
- Theoretische Physik 2, Technische Universität Dortmund, D-44221 Dortmund, Germany
| |
Collapse
|
30
|
von Minckwitz G, Conrad B, Reimer T, Decker T, Eidtmann H, Eiermann W, Hackmann J, Möbus V, Marmé F, Potenberg J, Stickeler E, Simon E, Thomssen C, Huober J, Denkert C, Alfer J, Jackisch C, Nekljudova V, Burchardi N, Loibl S. A randomized phase 2 study comparing EC or CMF versus nab-paclitaxel plus capecitabine as adjuvant chemotherapy for nonfrail elderly patients with moderate to high-risk early breast cancer (ICE II-GBG 52). Cancer 2015; 121:3639-48. [PMID: 26111104 DOI: 10.1002/cncr.29506] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although greater than 40% of breast cancers occur in patients aged ≥65 years, these individuals are frequently undertreated. Taxane-based adjuvant chemotherapy is considered the treatment of choice but to the authors' knowledge has only limited evidence in elderly patients. METHODS Patients aged ≥65 years with a Charlson comorbidity index ≤2 and pT1/2 pN0/1 disease and either human epidermal growth factor receptor 2 (HER2)-positive, hormone receptor-negative, grade 3 (according to Common Terminology Criteria for Adverse Events [version 3.0]), high uPA/PAI-1 or any stage pT3/4 pN2/3 breast cancer were randomized to receive 4 cycles of adjuvant epirubicin and cyclophosphamide (EC) (epirubicin at a dose of 90 mg/m(2) and cyclophosphamide at a dose of 600 mg/m(2) intravenously [iv] on day 1 every 3 22 days) or 6 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) (cyclophosphamide at a dose of 500 mg/m(2), methotrexate at a dose of 40 mg/m(2), and 5-fluorouracil at a dose of 600 mg/m(2) iv on days 1 plus 8 every 29 days) versus 6 cycles of nab-paclitaxel and capecitabine (nPX) (nab-paclitaxel at a dose of 100 mg/m(2) iv on days 1, 8, and 15 every 21 days with 1 week of rest every 6 weeks plus capecitabine at a dose of 2000 mg/m(2) orally on days 1-14 every 21 days). Primary endpoints were treatment discontinuations and overall frequency of adverse events. RESULTS Thirteen of 198 patients (6.6%) discontinued EC/CMF and 69 of 193 patients (35.8%) discontinued nPX (P<.001) with 1 and 5 deaths observed during treatment, respectively. Grade 3 to 5 adverse events were more frequent among patients treated with EC/CMF (90.9%) than among those treated with nPX (64.8%) (P<.001), with hematological toxicities being more frequent with EC/CMF (88.4% vs 22.3%; P<.001), but nonhematological toxicities (hand-foot syndrome, diarrhea, mucositis, fatigue, sensory neuropathy, thromboembolisms, and metabolic disorders) being more frequent with nPX (58.5% vs 18.7%; P<.001). None of the geriatric scores (Charlson comorbidity index, Vulnerable Elders Survey [VES-13], Instrumental Activities of Daily Living [IADL], and G8) independently predicted grade 3 to 5 toxic events or treatment discontinuations. No differences in survival between the treatment groups were observed after 22.8 months. CONCLUSIONS Compared with EC/CMF, treatment with nPX led to more treatment discontinuations and nonhematological toxicities in elderly patients with moderate or high-risk breast cancer.
Collapse
Affiliation(s)
- Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany.,Department of Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Toralf Reimer
- Department Obstetrics and Gynecology, Sudstadt Clinic, Rostock, Germany
| | | | - Holger Eidtmann
- Department of Gynecology and Obstetrics, University Hospital Kiel, Kiel, Germany
| | | | - John Hackmann
- Department of Obstetrics and Gynecology, Marienhospital, Witten, Germany
| | - Volker Möbus
- Department of Obstetrics and Gynecology, Hoechst Clinic, Frankfurt, Germany
| | | | - Jochem Potenberg
- Department of Obstetrics and Gynecology, Ev. Waldkrankenhaus Hospital, Berlin, Germany
| | | | - Eike Simon
- Department of Obstetrics and Gynecology, Kreiskrankenhaus Torgau, Torgau, Germany
| | | | | | - Carsten Denkert
- Berlin Charity Hospital, Institute of Pathology, Berlin, Germany
| | - Joachim Alfer
- Institute of Pathology Kaufbeuren-Ravensburg, Germany
| | - Christian Jackisch
- Department of Gynecology Obstetrics and Gynecology, Sana Clinic, Offenbach, Germany
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Department of Gynecology Obstetrics and Gynecology, Sana Clinic, Offenbach, Germany
| | | |
Collapse
|
31
|
Gluz O, Nitz U, Christgen M, Grischke EM, Forstbauer H, Braun MW, Warm M, Uleer C, Aktas B, Schumacher C, Hackmann J, Bangemann N, Staib P, Lindner C, Kummel S, Liedtke C, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Efficacy of 12 weeks neoadjuvant nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple-negative breast cancer: WSG-ADAPT TN randomized phase II trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- Geriatric Breast Center, Evangelina Bethesda Hospital for Breast Diseases, Nordrhein-Westfalen, Germany
| | | | | | | | | | - Mathias Warm
- Kliniken der Stadt Köln - Krankenhaus Holweide, Cologne, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | | | | | | | | | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | | | | | | | | | | |
Collapse
|
32
|
Von Schumann R, Gluz O, Nitz U, Clemens M, Luebbe K, Aktas B, Just M, Noesselt T, Henschen S, Hackmann J, Lorenz-Salehi F, Freese K, Svedman C, Kates RE, Kreipe HH, Harbeck N, Liedtke C. Hormone receptor discordance between local and central pathology with RT-PCR analysis: Results from multicenter Phase III WSG-PlanB trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e11555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raquel Von Schumann
- Ev. Hospital Bethesda - Breast Center Niederrhein, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- Geriatric Breast Center, Evangelina Bethesda Hospital for Breast Diseases, Nordrhein-Westfalen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | | |
Collapse
|
33
|
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: 95] [Impact Index Per Article: 9.5] [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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Nitz U, Gluz O, Zuna I, Oberhoff C, Reimer T, Schumacher C, Hackmann J, Warm M, Uleer C, Runde V, Dünnebacke J, Belzl N, Augustin D, Kates RE, Harbeck N. Final results from the prospective phase III WSG-ARA trial: impact of adjuvant darbepoetin alfa on event-free survival in early breast cancer. Ann Oncol 2014; 25:75-80. [PMID: 24356620 DOI: 10.1093/annonc/mdt505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND WSG-ARA plus trial evaluated the effect of adjuvant darbepoetin alfa (DA) on outcome in node positive primary breast cancer (BC). PATIENTS AND METHODS One thousand two hundred thirty-four patients were randomized to chemotherapy either with DA (DA+; n = 615) or without DA (DA-; n = 619). DA (500 µg q3w) was started at hemoglobin (Hb) levels <13.0 g/dl (<12 g/dl after DA label amendment) and stopped at Hb levels ≥14.0 g/dl (12 g/dl after label amendment). Primary efficacy end point was event-free survival (EFS); secondary end points were toxicity, quality of life (QoL) and overall survival (OS). RESULTS Venous thrombosis (DA+: 3.0%, DA-: 1.0%; P = 0.013) was significantly higher for DA+, but not pulmonary embolism (0.3% in both arms). Median Hb levels were stable in DA+ (12.6 g/dl) and decreased in DA- (11.7 g/dl). Hb levels >15 g/dl were reported in 0.8% of cycles. QoL parameters did not significantly differ between arms. At 39 months, DA had no significant impact on EFS (DA+: 89.3%, DA-: 87.5%; Plog-rank = 0.55) or OS (DA+: 95.5%, DA-: 95.4%; Plog-rank = 0.77). CONCLUSIONS DA treatment did not impact EFS or OS in routine adjuvant BC treatment.
Collapse
Affiliation(s)
- U Nitz
- Breast Center Niederrhein, Evangelic Hospital Bethesda, Moenchengladbach
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Jackisch C, Wiebringhaus F, Conrad B, Weigel M, Aktas B, Wagner H, Latos K, Kohls A, Bueckner U, Hauzenberger T, Bangemann N, Hackmann J, Clemens MR, Heinrich B, Tome O, Loibl S, Nekljudova V, Von Minckwitz G. A randomized phase III trial comparing nanoparticle-based paclitaxel with solvent-based paclitaxel as part of neoadjuvant chemotherapy for patients with early breast cancer (GeparSepto): GBG 69. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS1141 Background: Anthracyclines (A) followed by taxanes (T) are standard of care for neoadjuvant therapy in breast cancer (BC). A reverse sequence of T followed by A was suggested to achieve higher pCR rates. Previous studies have shown that dual anti-HER2 blockade is superior to trastuzumab (H) alone and thus can increase the pCR rate by 20%. Nab-paclitaxel (nP) is a solvent-free formulation of P encapsulated in albumin and might also improve the pCR rate with eventually lower toxicity. Methods: The GeparSepto study (NCT01583426) will randomize 1200 patients to either nP (150 mg/m²) q1w or P (80mg/m²) q1w for 12 weeks followed by 4 cycles conventionally dosed EC (E 90mg/m², C 600 mg/m²) q3w for 4 cycles. Primary objective is to compare the pCR rate (ypT0+ ypN0). Patients with untreated, histologically confirmed cT2- cT4d BC can be included. HER2+ patients receive H (loading dose 8mg/kg; 6 mg/kg) plus pertuzumab (loading dose 840 mg; 420 mg) q3w concomitantly. Biomaterial including FFPE from core biopsy, serum, plasma and full blood is collected. HER2, ER, PgR, Ki67 and SPARC status will be centrally assessed prior to randomization for stratification. P was assumed to achieve a pCR rate of 33% which will be increased to 41% when using nP, corresponding to an odds ratio of 1.41. To investigate resistance to anti-HER2 treatment, patients with HER2+ BC are randomized prior to start of chemotherapy to receive either 6 weeks H, pertuzumab or the combination as biological window with biomaterial collection prior to start of therapy and after week 6 prior to start of chemotherapy. Results: After been approved by ethics committees and authorities recruitment started in 7/2012 in 56 sites. 293 patients were recruited (53 HER2+; 240 HER2-) by 1st Feb 2013. A first safety interim analysis is planned after 60 patients have finished therapy. Conclusions: GeparSepto investigates the efficacy of neoadjuvant nP compared to solvent-based P given weekly with a dual blockade of the HER2 receptor in HER2-pos BC. Interim safety results for nP will be presented. The window-substudy is funded within the EU-FP7 project RESPONSIFY No 278659. Clinical trial information: NCT01583426.
Collapse
Affiliation(s)
| | | | | | - Michael Weigel
- Leopoldina-Krankenhaus der Stadt Schweinfurt, Schweinfurt, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | | | | | - Andreas Kohls
- Ev. Krankenhaus Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Nitz U, Gluz O, Oberhoff C, Reimer T, Schumacher C, Hackmann J, Warm M, Uleer C, Runde V, Kuemmel S, Zuna I, Harbeck N. PD07-06: Adjuvant Chemotherapy with or without Darbepoetin alpha in Node-Positive Breast Cancer: Survival and Quality of Life Analysis from the Prospective Randomized WSG ARA Plus Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd07-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: Darbepoetin alpha (ARA) is currently used to reduce chemotherapy-associated anemia (CAA) rates in various solid tumors. A possible negative impact of ARA on patient survival has been suggested in some clinical trials. The objective of the prospective randomized phase III ARA Plus trial is to compare the survival effect of darbepoetin alpha use (ARA+/ARA-) in combination with modern standard adjuvant chemotherapy targeting guideline-recommended Hb-levels in high-risk breast cancer (BC).
Methods: ARA Plus compared 6 cycles T75A50C500 q3w or 6 cycles F500E100C500 q3w (at discretion of each center) in patients with node positive BC (aged 18–65 years). Patients were randomized to darbepoetin (ARA+) 500 μg q3w until completion of radiotherapy or to standard supportive care (ARA-). ARA was started at Hb-levels ≤13 g/dL (amendment 01/2008: Hb ≤12 g/dL) and stopped at >14 g/dL (>12 g/dL). Primary endpoint is event-free survival (EFS: relapses, death without disease evidence, second malignancy). Overall survival (OS), toxicity, Hb-levels and quality of life are secondary endpoints. Survival analysis was planned after 7 years of study duration. EFS was tested using χ2-test (α=0.05) with a statistical power of β=80% and log-rank test. Quality of life was measured using FACT questionnaires at beginning of therapy, mid, end of therapy, and at 1 year afterwards.
Results: 1234 pts (616 ARA+/618 ARA-) from 70 centres in Germany were randomized between 01/04 and 06/08. 1198 intent to treat patients (ITT) were analysed (1096 TAC; 102 CEF). Baseline characteristics were well balanced in ARA+ and ARA- arms: median age 53/53 years; tumor size 2.4/2.4cm; number of + LN 3/3; HR+ 80%/ 83.5%, G3 40.7%/36.7%. Toxicity data have been reported earlier (SABCS 2008).
At median follow up of 40 months, 168 events (81 ARA+, 83 ARA-) and 134 relapses (65 ARA+, 69 ARA-) were reported. There was no significant difference in 3-year EFS between ARA+ and ARA- arms (89.2% vs. 87.6%, p=0.97, χ2-test). 37 deaths were reported in the ARA- and 36 in the ARA+ arm. 3-year OS was 95.4% and 95.1% for ARA+ and ARA-, respectively (p=0.85). Only nodal involvement (≥4 vs. 1–3), negative HR, tumor size >2 cm and G3 were significant survival predictors by multivariate analysis. Unplanned retrospective analysis revealed better EFS for ARA+ vs. ARA- in HR- (p=0.05), and no difference in HR+ group (p=0.6). In ARA+ patients, Hb-levels were stable over the whole treatment period with rare overstimulation. In ARA- patients, Hb-levels decreased during therapy (median of all cycles ARA+/ARA-: 12.5/11.6 g/dL). There was no correlation between mean Hb-levels and survival in either study arm.
There were no significant differences in mean FACT scores changes (general, anemia, cognitive) from begin to end of therapy in either study arm. More detailed analyses are ongoing.
Conclusions: To date, the WSG ARA plus trial is the only prospectively randomized trial in early high-risk BC exclusively focusing on the impact of adjuvant ARA on patient outcome. Supportive administration of ARA appears to be safe and to have no significant survival effect when used in combination with TAC or CEF according to current guidelines.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD07-06.
Collapse
Affiliation(s)
- U Nitz
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - O Gluz
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - C Oberhoff
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - T Reimer
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - C Schumacher
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - J Hackmann
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - M Warm
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - C Uleer
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - V Runde
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - S Kuemmel
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - I Zuna
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| | - N Harbeck
- 1West German Study Group, Moenchengladbach, Germany; Bethesda Hospital, Moenchengladbach, Germany; Bethesda Hospital, Wuppertal, Germany; University Hospital Essen, Essen, Germany; Catholical Hospital Essen North, Essen, Germany; University Hospital Suedstadt, Rostock, Germany; St. Elisabeth Hospital, Cologne, Germany; Marien-Hospital Witten, Witten, Germany; University Hospital Cologne, Cologne, Germany; Krankenhaus Koeln-Holweide, Cologne, Germany; Gynecological Practice, Hildesheim, Germany; Wilhelm-Anton-Hospital Goch, Goch, Germany; Hospital Essen-Mitte, Essen, Germany
| |
Collapse
|
37
|
Büssing A, Bückner U, Enser-Weis U, Schnelle M, Schumann A, Schietzel M, Hatzmann W, Hackmann J. Modulation of chemotherapy-associated immunosuppression by intravenous application of Viscum album L. Extract (Iscador): A randomised phase II study. Eur J Integr Med 2008. [DOI: 10.1016/j.eujim.2008.08.084] [Citation(s) in RCA: 4] [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: 11/24/2022]
|
38
|
Bader W, Böhmer S, van Leeuwen P, Hackmann J, Westhof G, Hatzmann W. Does texture analysis improve breast ultrasound precision? Ultrasound Obstet Gynecol 2000; 15:311-316. [PMID: 10895451 DOI: 10.1046/j.1469-0705.2000.00046.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the possibility of distinguishing between benign and malignant breast tumors using a computer-aided evaluation of echogenicity and echostructure of ultrasound findings at certain focal points. STUDY DESIGN The ultrasound images from 89 cases of breast tumor were documented under standardized conditions using a linear array machine and 7.5 MHz transducer. In each sonographic image, the maximum area of the 'region of interest' of the tumor was marked and then subjected to consecutive statistical analysis and correlation with the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (gray level histogram, Fourier analysis, co-occurrence matrix) were applied. RESULTS Benign tumors were clearly distinguished from carcinomas in the evaluation of the co-occurrence matrix and the Fourier analysis on the basis of Wilcoxon and Student t-test (P < 0.05) but not in the gray level histogram. Using logistic regression a sensitivity of 73.8% and a specificity of 54.2% were obtained. A statistically significant difference between benign tumors and moderately differentiated together with poorly differentiated carcinomas could be demonstrated. CONCLUSION This study concludes that texture analysis appears to distinguish between benign and most malignant tumors. A computer texture analyzing system is able to improve the subjective assessment of ultrasound images of the breast but can not replace it. Where the limits of subjective assessment of a given tumor are reached, computerized texture analysis will provide additional information in the differentiation of benign from malignant findings.
Collapse
Affiliation(s)
- W Bader
- Department of Gynecology and Obstetrics, University Witten/Herdecke, Germany
| | | | | | | | | | | |
Collapse
|
39
|
Behn R, Dicken D, Hackmann J, Salito SA, Siegrist MR, Krug PA, Kjelberg I, Duval B, Joye B, Pochelon A. Ion temperature measurement of tokamak plasmas by collective Thomson scattering of D2O laser radiation. Phys Rev Lett 1989; 62:2833-2836. [PMID: 10040103 DOI: 10.1103/physrevlett.62.2833] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
40
|
Engemann R, Gassel HJ, Hackmann J, Hamelmann H. The influence of MHC subregions on the induction of suppressor cells after orthotopic rat liver transplantation. Transplant Proc 1989; 21:427-8. [PMID: 2523140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- R Engemann
- Department of General Surgery, University Hospital, Kiel, FRG
| | | | | | | |
Collapse
|
41
|
Gassel HJ, Hutchinson IV, Tellides G, Knoop M, Hackmann J, Engemann R, Morris PJ. Phenotypic characterization of T-suppressor lymphocytes induced by orthotopic rat liver transplantation. Transplant Proc 1989; 21:429-30. [PMID: 2523141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H J Gassel
- Department of General Surgery, University of Kiel, FRG
| | | | | | | | | | | | | |
Collapse
|