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Harbeck N, Fasching PA, Würstlein R, Degenhardt T, Lüftner D, Kates RE, Schumacher J, Räth P, Hoffmann O, Lorenz R, Decker T, Reinisch M, Göhler T, Staib P, Gluz O, Schinköthe T, Schmidt M. Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial. Ann Oncol 2023:S0923-7534(23)00684-1. [PMID: 37201751 DOI: 10.1016/j.annonc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations. PATIENTS AND METHODS Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration). RESULTS In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform). CONCLUSIONS PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany.
| | - P A Fasching
- University Hospital Erlangen, Obstetrics and Gynecology, Erlangen, Germany
| | - R Würstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - D Lüftner
- Immanuel Hospital Märkische Schweiz Buckow, Germany; Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Germany
| | - R E Kates
- West German Study Group, Statistics, Moenchengladbach, Germany
| | | | - P Räth
- palleos healthcare GmbH, Wiesbaden, Germany
| | - O Hoffmann
- University Hospital Essen, Breast Center, Essen, Germany
| | - R Lorenz
- Studien GbR Braunschweig, Braunschweig, Germany
| | - T Decker
- Hematology / Oncology, Ravensburg, Germany
| | - M Reinisch
- Breast Center, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - T Göhler
- Oncocenter Dresden, Dresden, Germany
| | - P Staib
- St.-Antonius Hospital gGmbH, Clinic for Hematology and Oncology, Eschweiler, Germany
| | - O Gluz
- West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany; Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | - M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Schmidt M, Lübbe K, Decker T, Thill M, Bauer L, Müller V, Link T, Furlanetto J, Reinisch M, Mundhenke C, Hoffmann O, Zahn MO, Müller L, Denkert C, van Mackelenbergh M, Fasching P, Burchardi N, Nekljudova V, Loibl S. A multicentre, randomised, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (DESIREE). ESMO Open 2022; 7:100601. [PMID: 36356410 PMCID: PMC9832733 DOI: 10.1016/j.esmoop.2022.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Stomatitis is one of the main reasons to discontinue everolimus in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC). To decrease stomatitis and subsequently early treatment discontinuations or dose reductions, the DESIREE trial investigated the use of a stepwise dose-escalation schedule of everolimus (EVE esc). PATIENTS AND METHODS DESIREE is a phase II, multicentre, randomised, double-blind, placebo-controlled trial in patients with HR+/HER2- mBC and progression/relapse after nonsteroidal aromatase inhibitor treatment. Patients were randomised to EVE esc (2.5 mg/day, week 1; 5 mg/day, week 2; 7.5 mg/day, week 3; 10 mg/day, weeks 4-24) or everolimus 10 mg/day (EVE 10mg) for 24 weeks plus exemestane. The primary endpoint was the incidence of stomatitis episodes grade ≥2 within 12 weeks of treatment. The secondary endpoints included toxicity, relative total dose intensity (RTDI) and quality of life (QoL). RESULTS A total of 160 patients were randomised and 156 started treatment (EVE esc: 80; EVE 10mg: 76). The median age of patients was 64 years (range 33-85), 56.3% patients in the EVE esc arm versus 42.1% in the EVE 10mg arm had liver metastasis (P = 0.081) and 62.5% versus 51.3% received over one metastatic therapy line (P = 0.196). Within 12 weeks, the incidence of stomatitis episodes grade ≥2 was significantly lower in the EVE esc arm compared with the EVE 10mg arm (28.8% versus 46.1%; odds ratio 0.47, 95% confidence interval 0.24-0.92; P = 0.026). Toxicity was in line with the known safety profile without new safety concerns. The median RTDI was 91.1% in the EVE esc arm versus 80.0% in the EVE 10mg arm (P = 0.329). Discontinuation rate in the first 3 weeks was 6.3% versus 15.8%, respectively (P = 0.073). QoL was comparable between the two treatment arms. CONCLUSIONS A dose-escalation schema of everolimus over 3 weeks can be successfully used to reduce the incidence of high-grade stomatitis in the first 12 weeks of treatment in patients with HR+/HER2- mBC. TRIAL REGISTRATION ClinicalTrials.govNCT02387099; https://clinicaltrials.gov/ct2/show/NCT02387099.
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Affiliation(s)
- M. Schmidt
- Universitätsmedizin Mainz, Mainz, Germany
| | - K. Lübbe
- Diakovere Henriettenstift Hannover, Hanover, Germany
| | - T. Decker
- Onkologie und Hämatologie Ravensburg, Ravensburg, Germany
| | - M. Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - L. Bauer
- GRN gGmbH Klinik Weinheim, Weinheim, Germany
| | - V. Müller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - T. Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | | | - M. Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C. Mundhenke
- Brustzentrum, Gynäkologisches Krebszentrum, Perinatalzentrum Level I, Klinikum Bayreuth, Bayreuth, Germany
| | | | - M.-O. Zahn
- MVZ Onkologische Kooperation Harz Dres./Zahn Fachärzte für Innere Medizin, Goslar, Germany
| | | | - C. Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - M. van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Kiel, Germany
| | | | | | | | - S. Loibl
- German Breast Group, Neu-Isenburg, Germany,Correspondence to: Prof. Sibylle Loibl, German Breast Group, Dornhofstr. 10, 63263 Neu-Isenburg, Germany. Tel: +49 6102 7480 335 @GBG_Forschunghttps://twitter.com/GBG_Forschung
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Reinisch M, Blohmer JU, Link T, Just M, Untch M, Stötzer O, Fasching P, Schneeweiss A, Wimberger P, Seiler S, Huober J, Thill M, Jackisch C, Rhiem K, Solbach C, Hanusch C, Denkert C, Engels K, Nekljudova V, Loibl S. 94P Patient quality of life (QoL) from the GeparX trial on the addition of denosumab (Dmab) added to two different nab-paclitaxel (nP) regimens as neoadjuvant chemotherapy (NACT) in primary breast cancer (BC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Toi M, Boyle F, Im YH, Reinisch M, Molthrop D, Jiang Z, Wei R, Sapunar F, Grimes B, Nabinger S, Johnston S. 59MO Adjuvant abemaciclib combined with endocrine therapy (ET): Efficacy results in monarchE cohort 1. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.075] [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: 11/25/2022] Open
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Jerusalem G, Prat A, Salgado R, Reinisch M, Saura C, Ruiz Borrego M, Nikolinakos P, Filian J, Ades F, Huang N, Mazzei-Abba A, Tolaney S. 92MO Neoadjuvant nivolumab (NIVO) + palbociclib (PALBO) + anastrozole (ANA) for estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) primary breast cancer (BC): CheckMate 7A8. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rugo HS, O'Shaughnessy J, Boyle F, Toi M, Broom R, Blancas I, Gumus M, Yamashita T, Im YH, Rastogi P, Zagouri F, Song C, Campone M, San Antonio B, Shahir A, Hulstijn M, Brown J, Zimmermann A, Wei R, Johnston S, Reinisch M, Tolaney SM. Adjuvant Abemaciclib Combined with Endocrine Therapy for High Risk Early Breast Cancer: Safety and Patient-Reported Outcomes From the monarchE Study. Ann Oncol 2022; 33:616-627. [PMID: 35337972 DOI: 10.1016/j.annonc.2022.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high risk, early breast cancer demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PRO) are presented. PATIENTS AND METHODS The safety population included all patients who received at least one dose of study treatment (n=5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality-of-life, ET symptoms, fatigue, and side effect burden were assessed. RESULTS The addition of abemaciclib to ET resulted in higher incidence of Grade≥3 AEs (49.7% vs 16.3% with ET alone), predominantly laboratory cytopenias (e.g., neutropenia [19.6%]) without clinical complications. Abemaciclib-treated patients experienced more serious adverse events (SAEs; 13.3% vs 7.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to Grade1/2 AEs (66.8%). AEs were managed with comedications (e.g., antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (Grade1/2: 77%); Grade2/3 events were highest in the first month (20.5%), most short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTE) were higher with abemaciclib+ET (2.5%) vs ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen vs AIs (4.3% vs 1.8%). PROs were similar between arms, including being 'bothered by side effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported "a little bit" or "somewhat". CONCLUSION In patients with high risk EBC, adjuvant abemaciclib+ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.
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Affiliation(s)
- H S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA.
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas TX, USA
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney; University of Sydney, Sydney, Australia
| | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | - R Broom
- Auckland City Hospital, Auckland, New Zealand
| | - I Blancas
- Hospital Universitario Clínico San Cecilio, Granada, Spain; Medicine Department. University of Granada, Spain
| | - M Gumus
- Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | | | - Y-H Im
- Division of Hematology/Medical Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - F Zagouri
- National and Kapodistrian University of Athens, Department of Clinical Therapeutics, School of Medicine, Athens, Greece
| | - C Song
- Fujian Medical University Union Hospital, Fujian, China
| | - M Campone
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes / Saint-Herblain, France
| | | | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | - M Hulstijn
- Eli Lilly and Company, Indianapolis, USA
| | - J Brown
- Eli Lilly and Company, Indianapolis, USA
| | | | - Ran Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Johnston
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Reinisch
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
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Marmé F, Hanusch C, Furlanetto J, Denkert C, Link T, Untch M, Blohmer JU, Jackisch C, Reinisch M, Rhiem K, Schneeweiss A, Solbach C, Schöllhorn L, Fasching P, Rey J, Loibl S. 199TiP Phase III post-neoadjuvant study evaluating sacituzumab govitecan (SG), an antibody drug conjugate in primary HER2-negative breast cancer patients with high relapse risk after standard neoadjuvant treatment: SASCIA. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Vlachou E, Kümmel S, Künzel N, Breit E, Schindowski D, Pankert K, Hentsch S, Hanf V, Weber D, Graßhoff ST, Müller C, Lucke W, Deuschle P, Engellandt K, Rüland A, Dall P, Harrach H, Bruzas S, Chiari O, Reinisch M. 201TiP Evaluation of the feasibility of ultrasound-guided clipping of suspicious intramammary lesions in primary breast cancer patients receiving neoadjuvant therapy (Ultra3Detect). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.482] [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: 11/25/2022] Open
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Miles D, Gligorov J, André F, Cameron D, Schneeweiss A, Barrios C, Xu B, Wardley A, Kaen D, Andrade L, Semiglazov V, Reinisch M, Patel S, Patre M, Morales L, Patel SL, Kaul M, Barata T, O'Shaughnessy J. Primary results from IMpassion131, a double-blind, placebo-controlled, randomised phase III trial of first-line paclitaxel with or without atezolizumab for unresectable locally advanced/metastatic triple-negative breast cancer. Ann Oncol 2021; 32:994-1004. [PMID: 34219000 DOI: 10.1016/j.annonc.2021.05.801] [Citation(s) in RCA: 324] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-bound-paclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumab-paclitaxel in aTNBC. PATIENTS AND METHODS Eligible patients [no prior systemic therapy or ≥12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m2 (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression ≥1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint. RESULTS Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P = 0.20; median PFS 6.0 months with atezolizumab-paclitaxel versus 5.7 months with placebo-paclitaxel]. In the PD-L1-positive population, atezolizumab-paclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placebo-paclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumab-paclitaxel versus 28.3 months with placebo-paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug. CONCLUSION Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. CLINICALTRIALS.GOV: NCT03125902.
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Affiliation(s)
- D Miles
- Mount Vernon Cancer Centre, Northwood, UK.
| | - J Gligorov
- Medical Oncology Department, Institut Universitaire de Cancérologie Assistance Publique-Hôpitaux de Paris-Sorbonne Université, Paris, France
| | - F André
- Department of Medical Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - D Cameron
- University of Edinburgh, Edinburgh, UK
| | - A Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - C Barrios
- Latin American Cooperative Oncology Group, Porto Alegre RS, Brazil
| | - B Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - A Wardley
- National Institute for Health Research Manchester Clinical Research Facility at The Christie NHS Foundation Trust, Manchester, UK; Outreach Research & Innovation Group, Manchester, UK
| | - D Kaen
- Centro Oncológico Riojano Integral and Universidad Nacional de La Rioja, La Rioja, Argentina
| | - L Andrade
- Clinical Oncology, Santa Casa de Misericórdia da Bahia, Salvador, Brazil
| | - V Semiglazov
- NN Petrov Research Institute of Oncology, St. Petersburg, Russia
| | | | - S Patel
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Patre
- Global Product Development Medical Affairs Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - L Morales
- Global Product Development Medical Affairs Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - S L Patel
- Patient-Centered Outcomes Research, Genentech, Inc., South San Francisco, USA
| | - M Kaul
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - T Barata
- Pharma Development Biostatistics Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, USA
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Paepke S, Thill M, Peisker U, Ohlinger R, Gruber I, Malter W, Kümmel S, Hahn M, Kühn T, Reinisch M, Stachs A, Reimer T. One size fits all? Novel pulse biopsy platform offers improved needle control, high tissue yield and multiple needle options – pre-clinical results. Breast 2021. [DOI: 10.1016/s0960-9776(21)00172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Rugo H, O’Shaughnessy J, Song C, Broom R, Gumus M, Yamashita T, San Antonio B, Shahir A, Zimmermann A, Zagouri F, Reinisch M. Safety outcomes from monarchE: Phase 3 study of abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER-2-, node-positive, high risk, early breast cancer. Breast 2021. [DOI: 10.1016/s0960-9776(21)00101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bruzas S, Kümmel S, Harbeck N, Schmid P, Cortés J, Seiberling C, Chiari O, Harrach H, Ataseven B, Dyson M, Traut E, Theuerkauf I, Gebauer D, Gluz O, Reinisch M. 172P Gene expression in early breast cancer (EBC) patients (pts) with relapse despite pathologic complete response (pCR): An intra- and interindividual (matched control) analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reinisch M, Untch M, Reimer T, Mahlberg R, Aydogdu M, Hitschold T, Jackisch C, Marmé F, Lück HJ, Ladda E, Schmatloch S, Schmidt M, Klare P, Sinn B, Stickeler E, Seiler S, Rey J, Klutinus N, Möbus V, Loibl S. 86P Patients (pts) preference for different administration methods of trastuzumab (T) in pts with HER2+ early breast cancer (BC) treated within the GAIN-2 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.026] [Citation(s) in RCA: 1] [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: 11/28/2022] Open
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Reinisch M, Heil J, Rüland A, Seiberling C, Harrach H, Schindowski D, Lubitz J, Ankel C, Graßhoff ST, Deuschle P, Hanf V, Holtschmidt J, Traut E, Kuehn T, Kuemmel S. Prospective, multicenter registry trial to evaluate the clinical feasibility of targeted axillary dissection (TAD) in patients (pts) with breast cancer (BC) and core biopsy proven axillary involvement (cN+). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Seiler S, Schmatloch S, Reinisch M, Neunhöffer T, Schmidt M, Bechtner C, Marmé F, Wagner M, Möbus V, Reimer T, Kleine-Tebbe A, Sinn B, Stickeler E, Untch M, Janni W, Seither F, Loibl S. Abstract P1-17-07: Cancer management and outcome of very young non-pregnant patients with breast cancer diagnosed at 40 years or younger– GBG 29. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-07] [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
Breast cancer diagnosed in young women who are 40 years (yrs) or younger is a relatively rare disease. However, it represents the most common cause of cancer-related deaths in this age-group. Furthermore, young age at diagnosis is associated with an increased risk of recurrence and worse survival. To date, general concepts concerning oncological cancer management should be driven by clinicopathological tumor characteristics and should adhere to standardized protocols for patients in general, but little is known about the oncological cancer treatment and outcome of this very young women in today's clinical practice.
Patients and Methods
The breast cancer in pregnancy registry study (BCP/GBG29/BIG 03-02) is a multicenter, international, observational study. BCP was established to investigate the oncological management and outcome of breast cancer in pregnancy. Since 2014 non-pregnant patients who are 40 yrs or younger are eligible if diagnosed with histological confirmed invasive breast cancer, independent of the type of treatment as control cohort. All patients received oncological treatment according to local standards. In this study the following endpoints will be analyzed descriptively for the young non-pregnant women cohort: breast cancer staging at diagnosis, biological characteristics of breast cancer at diagnosis, diagnostic procedures, treatment modalities, toxicity, pathological complete response after neoadjuvant chemotherapy, disease-free survival and overall survival.
Results
From February 2014 until June 2018, 969 non-pregnant patients ≤40 yrs have been registered. The median age at diagnosis was 35 yrs (range 19-40). Overall, 90.1% of patients had a stage T1-2 at diagnosis and 67.1% of patients had negative lymph nodes. 86.7% of tumors were invasive ductal carcinomas and 4.1% lobular carcinomas. Grading (G) 3 was reported in 55.5%. 26.6% of tumors were luminal A-like (ER- and/or PgR-positive, HER2-negative, G1-2), 40.0% luminal B-like (ER- and/or PgR-positive, HER2-negative, G3 or ER- and/or PgR-positive, HER2-positive, any G), 7.7% HER2 positive non-luminal-like, and 25.7% triple negative breast cancers. 3.8% of young non-pregnant patients had metastatic disease at primary diagnosis.
Conclusion
This registry comprises a large cohort of young non-pregnant patients with breast cancer diagnosed at the age of 40 yrs or younger and provides important data about a modern breast cancer treatment as well as oncological outcome in this setting of young women. Further results including oncological management, toxicity, and survival will be presented at the meeting.
Citation Format: Seiler S, Schmatloch S, Reinisch M, Neunhöffer T, Schmidt M, Bechtner C, Marmé F, Wagner M, Möbus V, Reimer T, Kleine-Tebbe A, Sinn B, Stickeler E, Untch M, Janni W, Seither F, Loibl S. Cancer management and outcome of very young non-pregnant patients with breast cancer diagnosed at 40 years or younger– GBG 29 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-07.
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Affiliation(s)
- S Seiler
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - S Schmatloch
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - M Reinisch
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - T Neunhöffer
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - M Schmidt
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - C Bechtner
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - F Marmé
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - M Wagner
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - V Möbus
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - T Reimer
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - A Kleine-Tebbe
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - B Sinn
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - E Stickeler
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - W Janni
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - F Seither
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Brustzentrum, Elisabeth Krankenhaus, Kassel, Germany; Brustzentrum, Kliniken Essen-Mitte, Essen, Germany; HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; Universitätsmedizin Mainz, Mainz, Germany; Brustzentrum, Klinikum Memmingen, Memmingen, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Siloah St. Trudpert Klinikum, Pforzheim, Germany; Klinikum für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany; Brustzentrum, DRK Kliniken, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Freiburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm, Germany
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Müller V, Park-Simon TW, Huober J, Schmidt M, Weide R, Reinisch M, Fehm T, Salat C, Loibl S, Mundhenke C, Winer E. A randomized study of tucatinib (ONT-380) vs. placebo in combination with capecitabine and trastuzumab in patients with pretreated HER2-pos. metastatic breast cancer: HER2CLIMB. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- V Müller
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - TW Park-Simon
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - J Huober
- Universitäts-Frauenklinik, Ulm, Deutschland
| | - M Schmidt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - R Weide
- Praxisklinik für Hämatologie und Onkologie, Koblenz, Deutschland
| | - M Reinisch
- Kliniken Essen Mitte, Senologie, Essen, Deutschland
| | - T Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - C Salat
- Hope – Onkologisches Zentrum Rotkreuzklinikum, München, Deutschland
| | - S Loibl
- German Breast Group, Neu Isenburg, Deutschland
| | - C Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum SH – Campus Kiel, Kiel, Deutschland
| | - E Winer
- Dana-Farber Cancer Institute, Boston, Vereinigte Staaten von Amerika
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Reinisch M, Seiler S, Hauzenberger T, Schmatloch S, Strittmatter HJ, Zahm DM, Thode C, Jackisch C, Strik D, Moebus V, Reimer T, Sinn B, Stickeler E, Marme F, Janni W, Kamischke A, Rudlowski C, Nekljudova V, von Minckwitz G, Loibl S. Final analysis of the Male-GBG54 study: A prospective, randomised multi-centre phase II study evaluating endocrine treatment with either tamoxifen +/- gonadotropin releasing hormone analogue (GnRHa) or an aromatase inhibitor + GnRHa in male breast cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Witzel ID, Laakmann E, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Zahm D, Blohmer J, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Müller V, Loibl S. Abstract P1-17-01: Development of brain metastases in breast cancer patients treated in the neoadjuvant trials Geparquinto and Geparsixto. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The incidence of brain metastases (BM) in breast cancer patients is rising and has become a major clinical challenge. So far, the incidence of BM after modern neoadjuvant treatment is not clear.
Materials and Methods: In Geparquinto, patients with untreated HER2-positive breast cancer (n=615) received either lapatinib or trastuzumab, patients with HER2 negative breast cancer (n=1925) received bevacizumab in addition to an anthracycline and taxane-containing regimen and those not responding paclitaxel and everolimus (n=32). In Geparsixto, patients with HER2-positive tumors (n=273) received trastuzumab and lapatinib and patients with triple-negative tumors (n=315) received bevacizumab in addition to chemotherapy. We analyzed clinical factors associated with the occurrence of BM as first site of metastatic relapse after neoadjuvant treatment in both trials (n=3160).
Results: After a median follow-up of 61 months, 108 (3%) of a total of 3160 patients developed BM as first site of recurrence and 411 (13%) patients had distant metastases outside the brain. Brain metastases as first site of recurrence occurred later than other metastases (3--year-relapse free-rate 96.7% for patients who developed BM and 89.5% for patients who developed metastases outside the brain). Regarding subtypes of the primary tumor, 1% of luminal A (11/954), 2% of luminal B (7/381), 4% of HER2 positive (34/809) and 6% of triple-negative patients (56/1008) developed BM as first site of recurrence. In multivariate analysis, risk factors for the development of BM were larger tumor size (cT3-4; HR 1.9, 95%-CI 1.3-2.8, p=0.0022), node positive disease (HR 2.8, 95% CI 1.8-4.4, p<0.0001), no pCR after neoadjuvant chemotherapy (HR 2.7, 95% CI 1.6-4.7, p=0.0003) and HER2 positive (HR 3.8, 95% CI 1.9-7.8, p=0.0002) or triple-negative subtype (HR 8.1, 95% CI 4.2 – 15.8, p< 0.0001). Breast cancer subtype remained the most relevant risk factor for BM. Patients who developed BM were more often HER2 positive or triple-negative tumors compared with patients who developed metastases outside the brain (HER2 positive subtype 32 vs. 19%, triple-negative subtype 52 vs. 40%, p< 0.001).
Conclusion: Especially patients with HER2-positive and triple negative tumors are at risk of developing BM despite active systemic treatment. A better understanding of the underlying mechanisms is required in order to develop potential preventive strategies.
Citation Format: Witzel ID, Laakmann E, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Zahm D, Blohmer J, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Müller V, Loibl S. Development of brain metastases in breast cancer patients treated in the neoadjuvant trials Geparquinto and Geparsixto [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-01.
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Affiliation(s)
- ID Witzel
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - E Laakmann
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - PA Fasching
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Rezai
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Schem
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Solbach
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - H Tesch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - P Klare
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - A Schneeweiss
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - D Zahm
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - J Blohmer
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - B Ingold-Heppner
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - J Huober
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Hanusch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Jackisch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Reinisch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Untch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - G von Minckwitz
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - V Müller
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - S Loibl
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
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Möbus V, Mahlberg R, Janni W, Tomé O, Marmé F, Forstbauer H, Reimer T, von der Assen A, Reinisch M, Lorenz R, Schmatloch S, Schmidt M, Sinn B, Klutinus N, Stickeler E, Untch M, Seiler S, Burchardi N, von Minckwitz G, Loibl S. Abstract P5-20-09: Pharmacokinetic results of a subcutaneous injection of trastuzumab into the thigh versus into the abdominal wall in patients with HER2-positive primary breast cancer (BC) treated within the neo-/adjuvant GAIN-2 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-09] [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: 11/16/2022]
Abstract
Abstract
Background
A new subcutaneous (s.c.) formulation of trastuzumab became available in 2013 based on equivalent efficacy, pharmacokinetic (PK) profile and safety with the standard intravenous (i.v.) administration, where the s.c. trastuzumab was administered only into the thigh. As an s.c. injection into the abdominal wall (abdw) might be more convenient for patients (pts) and health care professionals, the PK profile of s.c. trastuzumab injected into the thigh vs the abdw in pts with HER2+ early BC needs to be evaluated.
Methods
GAIN-2 study compared two intense dose-dense (idd) anthracycline/taxane containing regimens. After completion of the anthracycline and i.v. trastuzumab given concurrently with taxanes, HER2+ BC pts were randomized in a 1:1 ratio to continue adjuvant s.c. trastuzumab 600mg fixed dose injected every 3 weeks either into the thigh or the abdw. Randomization was stratified according to CT arm [(iddEnPC) vs tailored dd CT (dtEC-dtD)] and age (≤50 vs >50). Pts in the EnPC arm received 14 and in the dtEC-dtD arm 15 cycles of s.c. trastuzumab.
For the PK profile of s.c. trastuzumab serum samples collected before cycle 7, on days 2, 4, 8, 15 and 21 of cycle 7 are evaluated. With a total sample size of 30 (15 per group), the simulated 90% two-sided CI for the area under the plasma concentration (AUC0-last) will be (0.79-1.27) and for the peak drug concentration (Cmax) will be (0.77-1.30). Allowing for a dropout rate of 15%, 18 pts per group will be included in the PK analysis.
The primary objective was to assess the PK profile of s.c. trastuzumab injected into the thigh vs the abdw. The secondary objectives included safety and tolerability.
Results
The per-protocol (pp) set consists of 30 pts (17 in the thigh group and 13 in the abdw group). Baseline characteristics were well balanced between the groups. The log-transformed Geometric Least Square Means (GLSM) for Cmax were 11.77 and 11.52 in the thigh and the abdw group, respectively. The geo-mean ratio (on the original scale) for Cmax was 1.29 (90% CI 1.05-1.58). The log-transformed GLSM for AUC0-last were 14.54 and 14.28 in the thigh and the abdw group, respectively. The geo-mean ratio for AUC0-last was 1.29 (90% CI 1.02-1.63).
Overall 29 pts (96.7%) reported any grade and 5 pts (16.7%) high grade adverse events (AEs). The incidence of any grade AEs was similar between the two groups. The most common AEs were anemia (70.6% for the thigh vs 61.5% for the abdw group, p=0.705), leukopenia (80.0% for both groups, p=1.000) and fatigue (47.1% for the thigh vs 76.9% for the abdw group, p=0.141). 6 serious AEs were reported (2 in the thigh vs 4 in the abdw group). The final PK results of s.c. trastuzumab will be presented at the meeting.
Conclusions
Bioavailability of s.c. trastuzumab as reflected by peak and total exposure measured in cycle 7 was approx. 30% higher if administered into the thigh than into the abdw in pts with HER2+ primary BC treated after dose-dense CT plus i.v. trastuzumab. However, no increased toxicity was observed. Study limitations were that no cross-over design was used and number of pts satisfying criteria for pp-set were different in the arms.
Citation Format: Möbus V, Mahlberg R, Janni W, Tomé O, Marmé F, Forstbauer H, Reimer T, von der Assen A, Reinisch M, Lorenz R, Schmatloch S, Schmidt M, Sinn B, Klutinus N, Stickeler E, Untch M, Seiler S, Burchardi N, von Minckwitz G, Loibl S. Pharmacokinetic results of a subcutaneous injection of trastuzumab into the thigh versus into the abdominal wall in patients with HER2-positive primary breast cancer (BC) treated within the neo-/adjuvant GAIN-2 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-09.
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Affiliation(s)
- V Möbus
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - R Mahlberg
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - W Janni
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - O Tomé
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - F Marmé
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - H Forstbauer
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - T Reimer
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - A von der Assen
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Reinisch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - R Lorenz
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Schmatloch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Schmidt
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - B Sinn
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - N Klutinus
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - E Stickeler
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Untch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Seiler
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - N Burchardi
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - G von Minckwitz
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Loibl
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
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Furlanetto J, Eiermann W, Marmé F, Reimer T, Reinisch M, Schmatloch S, Stickeler E, Thomssen C, Untch M, Denkert C, von Minckwitz G, Lederer B, Nekljudova V, Weber K, Loibl S, Möbus V. Higher rate of severe toxicities in obese patients receiving dose-dense (dd) chemotherapy according to unadjusted body surface area: results of the prospectively randomized GAIN study. Ann Oncol 2016; 27:2053-2059. [DOI: 10.1093/annonc/mdw315] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/28/2016] [Indexed: 12/14/2022] Open
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Furlanetto J, Eiermann W, Marmé F, Reimer T, Reinisch M, Schmatloch S, Stickeler E, Thomssen C, Untch M, Denkert C, von Minckwitz G, Nekljudova V, Loibl S, Möbus V. Abstract P1-13-04: Higher rate of severe toxicities in obese patients receiving dose-dense chemotherapy according to unadjusted body mass index – Results of the prospectively randomized GAIN study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-04] [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: In routine clinical practice chemotherapy (CT) doses are frequently capped at a body surface area (BSA) of 2.0 m2 or adjusted to an ideal weight (i.e. [body length in cm - 10%] + 40% [current weight-ideal weight]) for obese patients (BMI>30 according to WHO) due to safety reasons. There are no data on CT dosing within intense dose-dense regimen for obese patients. Therefore, a retrospective analysis of the GAIN study population has been conducted.
Methods: Between August 2004 and July 2008 a total of 3023 patients were enrolled in the GAIN study, a randomized phase III adjuvant trial, comparing two types of dose-dense regimen. Patients were randomized to intense dose-dense ETC (Epirubicin 150 mg/m2, Paclitaxel 225 mg/m2, Cyclophosphamide 2500-2000 mg/m2, i.v. q15 for 3 cycles) or EC followed by T plus capecitabine (X) (EC-TX) (E 112.5 mg/m2 + C 600 mg/m2, i.v. q15 for 4 cycles followed by T 67.5 mg/m2 i.v. q8 for 10 weeks + X: 2000 mg/m2 p. o. day 1-14, q22 for 4 cycles). An adjustment of CT dose to an ideal weight for obese patients was implemented by a protocol amendment. Yet some patients received a dose adjustment by capping at 2.0 m2. We retrospectively evaluated a total of 543 patients with a BMI>30. Data on BSA and dose adjustment were collected from case report forms. Toxicities were compared between patients who received CT according to an unadjusted or adjusted BSA using the 2-sided exact test of Fisher. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method and the log-rank test.
Results: Overall, 18.0% (n=543) of patients in the GAIN study were obese: 30.9% (n=168) of them received CT according to an unadjusted BSA. For the remainder BSA was adjusted to ideal weight or was capped at 2.0 m2 (69.1%; n=375). A total of 14.5% (n=24) of obese patients receiving full dose of chemotherapy vs 6.4% (n=24) of obese patients with an adjusted BSA experienced febrile neutropenia (p=0.005) and 9.6% (n=16) vs 2.9% (n=11) high grade thrombopenia (p=0.002). Overall, 16.7% (n=28) vs 10.1% (n=38) had a thromboembolic event (p=0.034), which was high grade in 12.5% (n=21) vs 6.4% (n=24), respectively (p=0.027) and 3.0% (n=5) vs 0.3% (n=1) experienced high grade hot flushes (p=0.012). The only significant differences in favor of the non-adjusted group were for dizziness (4.2% [n=7] vs 10.7% [n=40]; p=0.013), diarrhea (18.5% [n=31] vs 26.9% [n=101]; p=0.039) and an increase in serum creatinine (6.8% [n=11] vs 14.0% [n=52]; p=0.019). No differences in DFS and OS were observed between the two groups (5year DFS 81.9% [CI 74.9%-87.2%] vs 80.8% [76.3%-84.6%]; p=0.850; 5year OS 86.4% [79.9%-90.9%] vs 88.3% [84.4%-91.3%]; p=0.491).
Conclusion: This analysis of patients treated with a dose-dense regimen showed that obese patients who received CT according to their real BSA have a higher risk of severe toxicities, in particular of febrile neutropenia, high grade thrombopenia and high grade thromboembolic events. Therefore, a dose adjustment of intense dose-dense CT should be performed for obese patients to avoid life-threatening complications.
Citation Format: Furlanetto J, Eiermann W, Marmé F, Reimer T, Reinisch M, Schmatloch S, Stickeler E, Thomssen C, Untch M, Denkert C, von Minckwitz G, Nekljudova V, Loibl S, Möbus V. Higher rate of severe toxicities in obese patients receiving dose-dense chemotherapy according to unadjusted body mass index – Results of the prospectively randomized GAIN study. [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 P1-13-04.
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Affiliation(s)
- J Furlanetto
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - W Eiermann
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - F Marmé
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - T Reimer
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - M Reinisch
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - S Schmatloch
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - E Stickeler
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - C Thomssen
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
| | - V Möbus
- German Breast Group, Neu-Isenburg, Germany; Inter-disciplinary Oncological Center, München, Germany; University Hospital Heidelberg, Heidelberg, Germany; Klinikum Südstadt Rostock, Rostock, Germany; Kliniken Essen-Mitte, Essen, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; University Hospital Freiburg, Freiburg, Germany; Universitiy Hospital Halle, Halle an der Saale, Germany; Helios Klinikum Berlin Buch, Berlin, Germany; Charite University Berlin, Berlin, Germany; Klinikum Frankfurt -Hoechst, Frankfurt, Germany
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Kestlmeier R, Reinisch M, Trappe AE. [Thoracic intervertebral disk displacement: a rare differential diagnosis of segmental irritation--guidelines for use of chiropractic therapy]. Zentralbl Neurochir 2000; 60:121-4. [PMID: 10726334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Thoracic disc herniations rarely occur; they vary with respect to the clinical symptomatic and do not always lead to neurological deficit. A patient is being reported on with first symptoms of unspecific back pain. The patient has been frequently treated within 12 months (at regular intervals) exclusively by chiropractic manipulation without a considerable success. It is the objective of this case report that in persistent and therapy resistant back pain without obvious neurological deficite beside native radiographs further diagnostic investigation (MRI) is indicated. Concerning chiropractic manipulations (mobilisation techniques with impulse) this paper recommends testing maneuvers, the consideration of contraindications (structural lesions, neurological deficite) and emphasizes the use of atraumatic manipulation techniques.
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Affiliation(s)
- R Kestlmeier
- Neurochirurgische Klinik und Poliklinik, Technischen Universität München
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Riel KA, Reinisch M, Kersting-Sommerhoff B, Hof N, Merl T. 0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint: a prospective arthroscopically controlled clinical study. Knee Surg Sports Traumatol Arthrosc 1999; 7:37-41. [PMID: 10024961 DOI: 10.1007/s001670050118] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 244 patients. A dedicated system for MRI of limbs and peripheral joints--the 0.2-T Artoscan (Esaote, Italy)--was used for imaging knee joint lesions. T1-weighted spin-echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of the femoropatellar joint were acquired. Paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments and medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 h after imaging, the sensitivity, specificity, and accuracy were respectively 93%, 97%, and 95% for tears of the medial meniscus; 82%, 96%, and 93% for tears of the lateral meniscus; 100%, 100%, and 100% for tears of the posterior cruciate ligament; 98%, 98%, and 97% for tears of the anterior cruciate ligament; and 72%, 100%, and 92% for full-thickness articular cartilage lesions. The examination can be performed within 30-45 min at lower cost than diagnostic arthroscopy. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
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Affiliation(s)
- K A Riel
- Abteilung und Poliklinik für Sportorthopädie, Technische Universität München, Germany
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Riel KA, Kersting-Sommerhoff B, Reinisch M, Ottl G, Golder W, Lenz M, Hof N, Gerhardt P, Hipp E. [Prospective comparison of ARTOSCAN-MRI and arthroscopy in knee injuries]. Z Orthop Ihre Grenzgeb 1996; 134:430-4. [PMID: 8967143 DOI: 10.1055/s-2008-1037433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 276 patients. A "dedicated system" for MRI of limbs and peripheral joints--the 0,2 Tesla ARTOSCAN (ESAOTE, Italy)--was used for imaging knee joint lesions. T1-weighted spin echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of bone and the femoropatellar joint were acquired. If necessary paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments, medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 hours after imaging, the sensitivity, specificity, and accuracy were respectively, 91, 92 and 91 per cent for tears of the medial meniscus; 80, 96, and 92 per cent for tears of the posterior meniscus; 100, 100, and 100 per cent for tears of the posterior cruciate ligament; 93, 98, and 99 per cent for tears of the anterior cruciate ligament; and 73, 100, and 92 per cent for full-thickness articular cartilage lesions. The examination can be performed within 30 to 45 minutes at a cost that is lower than that of diagnostic arthroscopy. ARTOSCAN imaging is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
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Affiliation(s)
- K A Riel
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München
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Reinisch M, Schaff P, Hauser W, Rosemeyer B. [Treadmill versus field trial. Movement analysis and pressure distribution in the athletic shoe]. Sportverletz Sportschaden 1991; 5:60-73. [PMID: 1925926 DOI: 10.1055/s-2007-993563] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our current knowledge on interactions between runner and runningshoe is mainly based on treadmill measurements. In order to reveal stress load and adaptation on playing surfaces it was necessary to develop a combined measuring device out of 3-D video motion analysis and portable pressure measurement system. By means of a motor driven cart moving parallel to the subject with comparable position of cameras to the treadmill test it was possible to set up an identical trial for track and field. 12 subjects (male, age 24-32, size 9) were tested at a speed of 2.8 m/s. The varying conditions were treadmill and grass and two different constructed running shoes. 200 cycles and over 1000 steps were analyzed. The quantitative analysis of 37 parameters describing the contact phase was performed using the wilcoxon test for paired samples.-A qualitative comparison of running styles was introduced by using angle-angle-diagrams (knee and ankle by 3-D data) similar to those first described for 2-D by P.R. Cavanagh in 1973. It showed a huge interindividual variability under same conditions. Comparing the angle-angle-diagrams for the four different running conditions it was possible to classify them into three characteristic groups: non-adaptors, surface-adaptors and shoe-adaptors. Comparing track and field to treadmill measurements significant differences were found for the knee at impact: On treadmill the initial knee angle was 4.6 degrees more extended at a 13% higher angle velocity and a 30% higher angle deceleration (sig. p less than 0.05). A 7.3% higher impulse was found on grass at a 5.9% higher step length. No difference in maximum pressure was found. These results show that adaptation is performed mainly by the knee. Changing the motion pattern the knee seems to be capable of homogenizing the different stress loads to the foot. Comparing the running shoes significant differences were found in the motion of the ankle: a controversial behaviour was found to be on treadmill and grass. The pressure data revealed significant differences for the treadmill test to be in the heel area, for grass in the arch area. This points to an--up to now--unknown importance of the arch on unplain surfaces that are obviously influenced by the construction of the shoe and are not accessible by treadmill tests. The described different behaviour of shoes in treadmill and track and field tests points out the reduced validity of single treadmill tests.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- M Reinisch
- Institut für biomechanische Analysen im Sport und interdisziplinäre Studien (BASiS), TUV-PS, München
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Sixtová E, Nevarilová A, Hrabĕtová I, Reinisch M, Krcmárová H, Rajlichová J. [Parotitis epidemica in recent years (author's transl)]. Cas Lek Cesk 1976; 115:363-6. [PMID: 1260810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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