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Fuchs M, Jacob AS, Kaul H, Kobe C, Kuhnert G, Pabst T, Greil R, Bröckelmann PJ, Topp MS, Just M, Hertenstein B, Soekler M, Vogelhuber M, Zijlstra JM, Keller UB, Krause SW, Dührsen U, Meissner J, Viardot A, Eich HT, Baues C, Diehl V, Rosenwald A, Buehnen I, von Tresckow B, Dietlein M, Borchmann P, Engert A, Eichenauer DA. Follow-up of the GHSG HD16 trial of PET-guided treatment in early-stage favorable Hodgkin lymphoma. Leukemia 2024; 38:160-167. [PMID: 37845285 PMCID: PMC10776396 DOI: 10.1038/s41375-023-02064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
The primary analysis of the GHSG HD16 trial indicated a significant loss of tumor control with PET-guided omission of radiotherapy (RT) in patients with early-stage favorable Hodgkin lymphoma (HL). This analysis reports long-term outcomes. Overall, 1150 patients aged 18-75 years with newly diagnosed early-stage favorable HL were randomized between standard combined-modality treatment (CMT) (2x ABVD followed by PET/CT [PET-2] and 20 Gy involved-field RT) and PET-2-guided treatment omitting RT in case of PET-2 negativity (Deauville score [DS] < 3). The study aimed at excluding inferiority of PET-2-guided treatment and assessing the prognostic impact of PET-2 in patients receiving CMT. At a median follow-up of 64 months, PET-2-negative patients had a 5-year progression-free survival (PFS) of 94.2% after CMT (n = 328) and 86.7% after ABVD alone (n = 300; HR = 2.05 [1.20-3.51]; p = 0.0072). 5-year OS was 98.3% and 98.8%, respectively (p = 0.14); 4/12 documented deaths were caused by second primary malignancies and only one by HL. Among patients assigned to CMT, 5-year PFS was better in PET-2-negative (n = 353; 94.0%) than in PET-2-positive patients (n = 340; 90.3%; p = 0.012). The difference was more pronounced when using DS4 as cut-off (DS 1-3: n = 571; 94.0% vs. DS ≥ 4: n = 122; 83.6%; p < 0.0001). Taken together, CMT should be considered standard treatment for early-stage favorable HL irrespective of the PET-2-result.
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Grants
- Sanofi-Genzyme, Takeda
- Employment/leadership position (University Hospital of Cologne, Head of the GHSG Trial Coordination Centre), honorarium (Celgene, BMS, Takeda, Affimed, Lukon, Janssen)
- Takeda Medical Research Foundation
- Bristol-Myers Squibb Company | Bristol-Myers Squibb Canada (BMS Canada)
- BeiGene, MSD Stemline
- Gilead Sciences (Gilead)
- Miltenyi Biotec
- Novartis
- Roche (F. Hoffmann-La Roche Ltd)
- Amgen (Amgen Inc.)
- Pfizer (Pfizer Inc.)
- Merck & Co., Inc. | Merck Sharp and Dohme (Merck Sharp & Dohme)
- AbbVie (AbbVie Inc.)
- AstraZeneca
- allogene, Cerus, incyte, IQVIA, Noscendo, Pentixapharm,
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Affiliation(s)
- Michael Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Anne Sophie Jacob
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Helen Kaul
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | | | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Richard Greil
- IIIrd Medical Department, Paracelcus Medical University and Salzburg Cancer Research Institute, Salzburg, Austria
- Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie), Salzburg, Austria
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marianne Just
- Dres. med. Just/Düwel/Riesenberg/Steinke/Schäfer, Studiengesellschaft, Bielefeld, Germany
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen Mitte, Bremen, Germany
| | - Martin Soekler
- Onkology, Spital Thun, Switzerland, formerly University of Tübingen, Tübingen, Germany
| | - Martin Vogelhuber
- Medizinische Klinik III, Universitätsklinik Regensburg, Regensburg, Germany
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Ulrich Bernd Keller
- Department of Internal Medicine III, Klinikum "Rechts der Isar", Munich, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, Uniklinikum Erlangen, Erlangen, Germany
| | - Ulrich Dührsen
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Hans-Theodor Eich
- Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany
| | - Christian Baues
- Department of Radiotherapy, University of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius Maximilian University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Ina Buehnen
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
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Link T, Blohmer JU, Schmitt WD, Kuhlmann JD, Just M, Untch M, Stotzer O, Fasching PA, Thill M, Reinisch M, Schneeweiss A, Wimberger P, Seiler S, Huober J, Jackisch C, Rhiem K, Hanusch C, Sinn BV, Nekljudova V, Loibl S, Denkert C. RANK Expression as an Independent Predictor for Response to Neoadjuvant Chemotherapy in Luminal-Like Breast Cancer: A Translational Insight from the GeparX Trial. Clin Cancer Res 2023; 29:4606-4612. [PMID: 37725572 DOI: 10.1158/1078-0432.ccr-23-1801] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The GeparX study investigated whether denosumab as add-on treatment to nab-paclitaxel-based neoadjuvant chemotherapy (NACT) with two different schedules (125 mg/m² weekly vs. day 1, 8 every 22 days) may increase pathologic complete response (pCR) rate. The addition of denosumab to NACT did not improve pCR rates as recently published. In this study, we investigated whether receptor activator of nuclear factor-kappa B (RANK) expression, as part of the denosumab target pathway: (i) may retrospectively identify a subgroup of patients with additional clinical benefit of denosumab or (ii) may predict response to nab-paclitaxel NACT. EXPERIMENTAL DESIGN RANK protein was IHC-stained on pre-therapeutic core biopsies from patients of the GeparX study (n = 667) with the antibody RANK/Envision System HRP (DAB) and was analyzed for the percentage of membranous RANK tumor cell staining (>5% RANKhigh vs. ≤5% RANKlow). RESULTS We could not identify any patient subgroup with differential response under denosumab add-on treatment in patients with RANKhigh expression [139/667, 20.8%; OR, 0.86; 95% confidence interval (CI), 0.44-1.68; P = 0.667] or RANKlow expression (528/667 (79.2%) OR, 1.10; 95% CI, 0.78-1.56; P = 0.589; Pinteraction = 0.528). However, the pCR rate was higher in the RANKhigh subgroup compared with RANKlow (50% vs. 39%; OR, 1.52; 95% CI, 1.04-2.21; P = 0.037). RANK expression constituted an independent predictor of response to NACT frequently in patients with luminal-like subtype (HR+/HER2-; OR, 2.98; 95% CI, 1.30-6.79; P = 0.010). No predictive value of RANK expression among the different nab-paclitaxel regimens was observed. CONCLUSION We report RANK expression to be an independent predictive biomarker for response to NACT in patients with luminal-like breast cancer.
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Affiliation(s)
- Theresa Link
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens-Uwe Blohmer
- National Center for Tumour Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Wolfgang D Schmitt
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Dominik Kuhlmann
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | | | - Oliver Stotzer
- Gemeinschaftspraxis Hämatologie/Intern. Onkologie, München, Germany
| | | | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Mattea Reinisch
- National Center for Tumour Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jens Huober
- Kantonsspital St. Gallen, Brustzentrum, Departement Interdisziplinäre medizinische Dienste, St. Gallen, Switzerland
| | | | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Germany Universität Köln, Zentrum familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | - Bruno V Sinn
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
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Schmidt M, Nitz U, Reimer T, Schmatloch S, Graf H, Just M, Stickeler E, Untch M, Runnebaum I, Belau A, Huober J, Jackisch C, Hofmann M, Krocker J, Nekljudova V, Loibl S. Adjuvant capecitabine versus nihil in older patients with node-positive/high-risk node-negative early breast cancer receiving ibandronate - The ICE randomized clinical trial. Eur J Cancer 2023; 194:113324. [PMID: 37797387 DOI: 10.1016/j.ejca.2023.113324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023]
Abstract
AIM OF THE STUDY Evaluation of the impact of a de-escaleted chemotherapy regimen consisting of capecitabine (Cap) on invasive disease-free survival (iDFS) in patients ≥65 years with node-positive/high-risk node-negative early breast cancer (BC) receiving ibandronate (Ib). METHODS ICE (Ib with or without Cap in Elderly patients with early breast cancer) was a multicentre phase 3 clinical trial with a 2020 update of long-term follow-up for overall survival enroling node-positive/high-risk node-negative patients ≥65 years with early BC. Patients were randomised to Cap 2000 mg/m² day 1-14 q3w for 6 cycles plus Ib (50 mg p.o. daily or alternatively 6 mg intravenous q4w) or Ib alone for 2 years. Endocrine therapy was recommended for hormone receptor (HR)-positive patients. The primary endpoint was iDFS analysed using Cox proportional hazards regression and log-rank analysis. RESULTS 1358 (96.4%) of 1409 randomised patients started treatment. 564 (83.4%) completed 6 cycles of Cap. 513 (77.7%) and 516 (78.8%) completed Ib in the Cap+Ib and Ib alone arm, respectively. Median age was 71 (range 64-88) years, 1099 (81%) were HR-positive, 705 (51.9%) node-negative. At a median follow-up of 61.3 months, 5-year iDFS was 78.8% for Cap+Ib versus 75.0% for Ib alone (p = 0.80). Effects were independent of age, nodal, and HR status. The addition of Cap caused significantly higher skin and gastrointestinal toxicity. CONCLUSIONS The adjuvant combination of Cap+Ib did not show significantly better iDFS than Ib alone in node-positive/high-risk node-negative older BC patients, of whom HR-positive patients were also treated with endocrine therapy. TRIAL REGISTRATION Study in elderly patients with early breast cancer (ICE), NCT00196859, https://clinicaltrials.gov/ct2/show/NCT00196859?term=NCT00196859.
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Affiliation(s)
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany
| | - Toralf Reimer
- Klinikum Südstadt, Universitäts-Frauenklinik, Rostock, Germany
| | | | - Heiko Graf
- HELIOS Klinikum Meiningen GmbH, Meiningen, Germany
| | | | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik Aachen, Germany
| | | | - Ingo Runnebaum
- Universitätsklinikum Jena, Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Germany
| | | | - Jens Huober
- Universitätsklinikum Ulm, Germany; Kantonsspital St.Gallen, Brustzentrum, Departement Interdisziplinäre medizinische Dienste, St. Gallen, Switzerland
| | | | - Manfred Hofmann
- Vinzenz-von-Paul-Kliniken, Marienhospital, Stuttgart, Germany
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Eichenauer DA, Bühnen I, Baues C, Kobe C, Kaul H, Greil R, Moccia A, Zijlstra JM, Hertenstein B, Topp MS, Just M, von Tresckow B, Eich HT, Fuchs M, Dietlein M, Hartmann S, Engert A, Borchmann P. Interim PET-guided treatment for early-stage NLPHL: a subgroup analysis of the randomized GHSG HD16 and HD17 studies. Blood 2023; 142:553-560. [PMID: 37257195 DOI: 10.1182/blood.2023019939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The optimal first-line treatment for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) diagnosed in early stages is largely undefined. We, therefore, analyzed 100 NLPHL patients treated in the randomized HD16 (early-stage favorable; n = 85) and HD17 (early-stage unfavorable; n = 15) studies. These studies investigated the omission of consolidation radiotherapy (RT) in patients with a negative interim positron emission tomography (iPET) (ie, Deauville score <3) after chemotherapy (HD16: 2× doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]; HD17: 2× escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPP] plus 2× ABVD). Patients with NLPHL treated in the HD16 and HD17 studies had 5-year progression-free survival (PFS) rates of 90.3% and 92.9%, respectively. Thus, the 5-year PFS did not differ significantly from that of patients with classical Hodgkin lymphoma treated within the same studies (HD16: P = .88; HD17: P = .50). Patients with early-stage favorable NLPHL who had a negative iPET after 2× ABVD and did not undergo consolidation RT tended to have a worse 5-year PFS than patients with a negative iPET who received consolidation RT (83% vs 100%; P = .05). There were 10 cases of NLPHL recurrence. However, no NLPHL patient died during follow-up. Hence, the 5-year overall survival rate was 100%. Taken together, contemporary Hodgkin lymphoma-directed treatment approaches result in excellent outcomes for patients with newly diagnosed early-stage NLPHL and, thus, represent valid treatment options. In early-stage favorable NLPHL, consolidation RT appears necessary after 2× ABVD to achieve the optimal disease control irrespective of the iPET result.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Christian Baues
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Richard Greil
- Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austrian Group for Medical Tumor Therapy, Paracelsus Medical University, Salzburg, Austria
| | - Alden Moccia
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Joseé M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen-Mitte, Bremen, Germany
| | - Max S Topp
- Second Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, German Cancer Consortium (DKTK partner site Essen), Essen, Germany
| | - Hans-Theodor Eich
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- German Hodgkin Study Group, University Hospital Cologne, Cologne, Germany
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5
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Gluz O, Nitz UA, Christgen M, Kuemmel S, Holtschmidt J, Schumacher J, Hartkopf A, Potenberg J, Lüedtke-Heckenkamp K, Just M, Schem C, von Schumann R, Kolberg-Liedtke C, Eulenburg CZ, Schinköthe T, Graeser M, Wuerstlein R, Kates RE, Kreipe HH, Harbeck N. Efficacy of Endocrine Therapy Plus Trastuzumab and Pertuzumab vs De-escalated Chemotherapy in Patients with Hormone Receptor-Positive/ERBB2-Positive Early Breast Cancer: The Neoadjuvant WSG-TP-II Randomized Clinical Trial. JAMA Oncol 2023:2804892. [PMID: 37166817 PMCID: PMC10176180 DOI: 10.1001/jamaoncol.2023.0646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Importance Combination of chemotherapy with (dual) ERBB2 blockade is considered standard in hormone receptor (HR)-positive/ERBB2-positive early breast cancer (EBC). Despite some promising data on endocrine therapy (ET) combination with dual ERBB2 blockade in HR-positive/ERBB2-positive BC, to our knowledge, no prospective comparison of neoadjuvant chemotherapy vs ET plus ERBB2 blockade in particular with focus on molecular markers has yet been performed. Objective To determine whether neoadjuvant de-escalated chemotherapy is superior to endocrine therapy, both in combination with pertuzumab and trastuzumab, in a highly heterogeneous HR-positive/ERBB2-positive EBC. Design, Setting, and Participants This prospective, multicenter, neoadjuvant randomized clinical trial allocated 207 patients with centrally confirmed estrogen receptor-positive and/or progesterone receptor-positive (>1%) HR-positive/ERBB2-positive EBC to 12 weeks of standard ET (n = 100) vs paclitaxel (n = 107) plus trastuzumab and pertuzumab. A total of 186 patients were required to detect a statistically significant difference in pathological complete response (pCR) (assumptions: 19% absolute difference in pCR; power, ≥80%; 1-sided Fisher exact test, 2.5% significance level). Interventions Standard ET (aromatase inhibitor or tamoxifen) or paclitaxel, 80 mg/m2, weekly plus trastuzumab and pertuzumab every 21 days. Main Outcomes and Measures The primary end point was pCR (ypT0/is, ypN0). Secondary end points included safety, translational research, and health-related quality of life. Omission of further chemotherapy was allowed in patients with pCR. PAM50 analysis was performed on baseline tumor biopsies. Results Of the 207 patients included (median [range] age, 53 [25-83] years), 121 (58%) had cT2 to cT4 tumors, and 58 (28%) had clinically node-positive EBC. The pCR rate in the ET plus trastuzumab and pertuzumab arm was 23.7% (95% CI, 15.7%-33.4%) vs 56.4% (95% CI, 46.2%-66.3%) in the paclitaxel plus trastuzumab and pertuzumab arm (odds ratio, 0.24; 95% CI, 0.12-0.46; P < .001). Both immunohistochemical ERBB2 score of 3 or higher and ERBB2-enriched subtype were independent predictors for pCR in both arms. Paclitaxel was superior to ET only in the first through third quartiles but not in the highest ERBB2 quartile by messenger RNA. In contrast with the paclitaxel plus trastuzumab and pertuzumab arm, no decrease in health-related quality of life after 12 weeks was observed in the ET plus trastuzumab and pertuzumab arm. Conclusions and Relevance The WSG-TP-II randomized clinical trial is, to our knowledge, the first prospective trial comparing 2 neoadjuvant de-escalation treatments in HR-positive/ERBB2-positive EBC and demonstrated an excellent pCR rate after 12 weeks of paclitaxel plus trastuzumab and pertuzumab that was clearly superior to the pCR rate after ET plus trastuzumab and pertuzumab. Trial Registration ClinicalTrials.gov Identifier: NCT03272477.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- University Clinics Cologne, Cologne, Germany
| | - Ulrike A Nitz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Mönchengladbach, Germany
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Holtschmidt
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Breast Center, St Elisabeth-Krankenhaus Köln-Hohenlind, Cologne, Germany
| | | | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, Tüebingen University Hospital, Tüebingen, Germany
| | | | | | | | | | | | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Women's Clinic, University Clinics Essen, Essen, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Mönchengladbach, Germany
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Timo Schinköthe
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
- CANKADO Service GmbH, Kirchheim bei München, Germany
| | - Monika Graeser
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
| | | | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
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6
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Janni W, Fehm T, Müller V, Schochter F, De Gregorio A, Decker T, Hartkopf A, Just M, Sagasser J, Schmidt M, Wimberger P, Banys-Paluchowski M, Fasching PA, Rack B, Riethdorf S, Schneeweiss A, Wallwiener D, Meier-Stiegen F, Krawczyk N, Hoffmann O, Blohmer JU, Niederacher D, Neubauer H, Pantel K, Friedl TW, Huober J. Abstract PD18-07: Omission of chemotherapy in the treatment of HER2-positive and hormone-receptor positive metastatic breast cancer – interim results from the randomized phase 3 DETECT V trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd18-07] [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: 03/06/2023]
Abstract
Abstract
Background: Metastatic breast cancer (MBC) is an incurable disease and both the improvement of survival and maintenance of quality of life (QoL) are equally important aims of treatment planning. In patients with HER2-positive MBC, taxane-based chemotherapy in combination with dual HER2 targeted therapy with trastuzumab (T) and pertuzumab (P) is the standard of care first line therapy. However, adverse events are well-known side effects of any cytostatic treatment and can seriously impact the patients’ QoL. In addition, in HER2-positive MBC activated estrogen receptor (ER) signaling is associated with primary or secondary resistance. Thus, for patients with HER2-positive and hormone-receptor (HR) positive MBC, the synergistic combination of dual HER2-targeted therapy plus endocrine therapy might offer a better treatment option compared to cytotoxic chemotherapy-based treatments. Methods: Between 9/2015 and 11/2022, the multicenter phase III DETECT V trial randomized patients with HER2-positive and HR-positive (i.e. ER positive and/or progesterone-receptor positive) MBC in the 1st-3rd line setting 1:1 to receive T and P combined with either endocrine therapy or chemotherapy followed by maintenance therapy with T, P and endocrine therapy. Chemotherapy and the endocrine agents could be chosen from a variety of available regimens according to physicians’ choice. Based on emerging data strongly suggesting an additional benefit of CDK4/6 inhibitors, an amendment came into effect in January 2019 with the addition of ribociclib to both treatment arms after 124 patients had been randomized. The primary objective of DETECT V is to compare tolerability between the chemotherapy-free and chemotherapy-containing treatment arm; secondary objectives comprise the comparison of PFS, OS and safety. Here we report results of an unplanned interim analysis with data cut off June 22th 2022. Results: The results reported here are based on 153 patients for whom end of study was documented at the time of data cut off for this interim analysis (120 patients randomized before and 33 patients randomized after the addition of ribociclib; 115 patients in the 1st line setting; 77 and 76 patients in the chemotherapy-free and chemotherapy-containing arm, respectively). Overall survival (OS) and progression-free survival (PFS) did not differ between patients receiving chemotherapy-free and chemotherapy-containing treatment (median OS not yet reached vs. 37.2 months, hazard ratio 0.87, 95% CI 0.51 – 1.50, p = 0.63; median PFS 15.6 vs. 14.9 months, hazard ratio 0.98, 95% CI 0.64 – 1.52, p = 0.93). Study treatment was terminated prematurely significantly less often in the chemotherapy-free treatment arm (43.9% vs. 72.2%, p = 0.001). Furthermore, tolerability was better for the chemotherapy-free treatment as there were less adverse events (AEs) of any grade (585 vs. 793; 70 vs. 71 patients affected), less AEs grade 3 or higher (66 vs. 90; 33 vs. 48 patients affected) and less serious adverse events (45 vs. 52; 28 vs. 29 patients affected) reported in the chemotherapy-free treatment arm as compared to the chemotherapy-containing treatment arm. Conclusion: These preliminary results suggest that chemotherapy-free treatment for patients with triple-positive MBC might be an effective and well tolerated option.
Citation Format: Wolfgang Janni, Tanja Fehm, Volkmar Müller, Fabienne Schochter, Amelie De Gregorio, Thomas Decker, Andreas Hartkopf, Marianne Just, Jacqueline Sagasser, Marcus Schmidt, Pauline Wimberger, Maggie Banys-Paluchowski, Peter A. Fasching, Brigitte Rack, Sabine Riethdorf, Andreas Schneeweiss, Diethelm Wallwiener, Franziska Meier-Stiegen, Natalia Krawczyk, Oliver Hoffmann, Jens-Uwe Blohmer, Dieter Niederacher, Hans Neubauer, Klaus Pantel, Thomas W. Friedl, Jens Huober. Omission of chemotherapy in the treatment of HER2-positive and hormone-receptor positive metastatic breast cancer – interim results from the randomized phase 3 DETECT V trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-07.
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Affiliation(s)
- Wolfgang Janni
- 1Department Gynecology and Obstetrics, University of Ulm, Germany
| | - Tanja Fehm
- 2University Hospital Düsseldorf, Düsseldorf, Germany
| | - Volkmar Müller
- 3Department of Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fabienne Schochter
- 4Department of Obstetrics and Gynecology, University Hospital Ulm, Germany
| | - Amelie De Gregorio
- 5Department of Obstetrics and Gynecology, University Hospital Ulm, Germany
| | | | - Andreas Hartkopf
- 7Department of Obstetrics and Gynecology, University Hospital Ulm, Germany
| | - Marianne Just
- 8Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Jacqueline Sagasser
- 9Department of Obstetrics and Gynecology, University Hospital of Augsburg, Augsburg, Germany
| | - Marcus Schmidt
- 10Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Pauline Wimberger
- 11Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Sachsen, Germany
| | | | - Peter A. Fasching
- 13Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Brigitte Rack
- 14Department of Obstetrics and Gynecology, University Hospital Ulm, Germany
| | - Sabine Riethdorf
- 15Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Schneeweiss
- 16National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Diethelm Wallwiener
- 17Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Meier-Stiegen
- 18Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Natalia Krawczyk
- 19Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | - Dieter Niederacher
- 22Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans Neubauer
- 23Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klaus Pantel
- 24Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas W. Friedl
- 25Department of Obstetrics and Gynecology, University Hospital Ulm, Germany
| | - Jens Huober
- 26Kantonsspital St.Gallen, Brustzentrum, Departement Interdisziplinäre medizinische Dienste, St. Gallen, Switzerland
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7
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Harbeck N, Nitz UA, Christgen M, Kümmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Forstbauer H, Grischke EM, Scheffen I, Malter W, von Schumann R, Just M, Zu Eulenburg C, Biehl C, Kolberg-Liedtke C, Deurloo R, de Haas S, Jóźwiak K, Hauptmann M, Kates R, Graeser M, Wuerstlein R, Kreipe HH, Gluz O. De-Escalated Neoadjuvant Trastuzumab-Emtansine With or Without Endocrine Therapy Versus Trastuzumab With Endocrine Therapy in HR+/HER2+ Early Breast Cancer: 5-Year Survival in the WSG-ADAPT-TP Trial. J Clin Oncol 2023:JCO2201816. [PMID: 36809046 DOI: 10.1200/jco.22.01816] [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: 02/23/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy is standard of care in human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC), irrespective of the hormone receptor status. Trastuzumab-emtansine (T-DM1), antibody-drug conjugate, is highly effective in HER2+ EBC; however, no survival data are available for de-escalated antibody-drug conjugate-based neoadjuvant therapy without conventional chemotherapy. PATIENTS AND METHODS In the WSG-ADAPT-TP (ClinicalTrials.gov identifier: NCT01779206) phase II trial, 375 centrally reviewed patients with hormone receptor-positive (HR+)/HER2+ EBC (clinical stage I-III) were randomly assigned to 12 weeks of T-DM1 with or without endocrine therapy (ET) or trastuzumab + ET once every 3 weeks (ratio 1:1:1). Adjuvant chemotherapy (ACT) omission was allowed in patients with pathologic complete response (pCR). In this study, we report the secondary survival end points and biomarker analysis. Patients who received at least one dose of study treatment were analyzed. Survival was analyzed using the Kaplan-Meier method, two-sided log-rank statistics, and Cox regression models stratified for nodal and menopausal status. P values < .05 were considered statistically significant. RESULTS T-DM1, T-DM1 + ET, and trastuzumab + ET induced similar 5-year invasive disease-free survival (iDFS; 88.9%, 85.3%, 84.6%; Plog-rank = .608) and overall survival rates (97.2%, 96.4%, 96.3%; Plog-rank = .534). Patients with pCR versus non-pCR had improved 5-year iDFS rates (92.7% v 82.7%; hazard ratio, 0.40; 95% CI, 0.18 to 0.85). Among the 117 patients with pCR, 41 did not receive ACT; 5-year iDFS rates were similar in those with (93.0%; 95% CI, 84.0 to 97.0) and without ACT (92.1%; 95% CI, 77.5 to 97.4; Plog-rank = .848). Translational research revealed that tumors with PIK3CA wild type, high immune marker expression, and luminal-A tumors (by PAM50) had an excellent prognosis with de-escalated anti-HER2 therapy. CONCLUSION The WSG-ADAPT-TP trial demonstrated that pCR after 12 weeks of chemotherapy-free de-escalated neoadjuvant therapy was associated with excellent survival in HR+/HER2+ EBC without further ACT. Despite higher pCR rates for T-DM1 ± ET versus trastuzumab + ET, all trial arms had similar outcomes because of mandatory standard chemotherapy after non-pCR. WSG-ADAPT-TP demonstrated that such de-escalation trials in HER2+ EBC are feasible and safe for patients. Patient selection on the basis of biomarkers or molecular subtypes may increase the efficacy of systemic chemotherapy-free HER2-targeted approaches.
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Affiliation(s)
- Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Ulrike A Nitz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | | | - Sherko Kümmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | | | | | - Joke Tio
- Department of Gynecology, University Hospital Münster, Münster, Germany
| | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Iris Scheffen
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Breast Center, University Hospital, Cologne, Germany
| | | | | | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Claudia Biehl
- Westphalian Brest Center Dortmund, Dortmund, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Women's Clinic, University Clinics Essen, Essen, Germany
| | | | | | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
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8
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Wimberger P, Blohmer JU, Krabisch P, Link T, Just M, Sinn BV, Simon E, Solbach C, Fehm T, Denkert C, Kühn C, Rhiem K, Tesch H, Kümmel S, Petzold A, Stötzer O, Meisel C, Kuhlmann JD, Nekljudova V, Loibl S. The effect of denosumab on disseminated tumor cells (DTCs) of breast cancer patients with neoadjuvant treatment: a GeparX translational substudy. Breast Cancer Res 2023; 25:32. [PMID: 36978142 PMCID: PMC10045108 DOI: 10.1186/s13058-023-01619-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/11/2023] [Indexed: 03/30/2023] Open
Abstract
Background Disseminated tumor cells (DTCs) in the bone marrow are observed in about 40% at primary diagnosis of breast cancer and predict poor survival. While anti-resorptive therapy with bisphosphonates was shown to eradicate minimal residue disease in the bone marrow, the effect of denosumab on DTCs, particularly in the neoadjuvant setting, is largely unknown. The recent GeparX clinical trial reported that denosumab, applied as an add-on treatment to nab-paclitaxel based neoadjuvant chemotherapy (NACT), did not improve the patient’s pathologic complete response (pCR) rate. Herein, we analyzed the predictive value of DTCs for the response to NACT and interrogated whether neoadjuvant denosumab treatment may eradicate DTCs in the bone marrow.
Methods A total of 167 patients from the GeparX trial were analyzed for DTCs at baseline by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. Initially DTC-positive patients were re-analyzed for DTCs after NACT ± denosumab.
Results At baseline, DTCs were observed in 43/167 patients (25.7%) in the total cohort, however their presence did not predict response to nab-paclitaxel based NACT (pCR rates: 37.1% in DTC-negative vs. 32.6% DTC-positive; p = 0.713). Regarding breast cancer subtypes, the presence of DTCs at baseline was numerically associated with response to NACT in TNBC patients (pCR rates: 40.0% in DTC-positive vs. 66.7% in DTC-negative patients; p = 0.16). Overall, denosumab treatment did not significantly increase the given DTC-eradication rate of NACT (NACT: 69.6% DTC-eradication vs. NACT + denosumab: 77.8% DTC-eradication; p = 0.726). In TNBC patients with pCR, a numerical but statistically non-significant increase of DTC-eradication after NACT + denosumab was observed (NACT: 75% DTC-eradication vs. NACT + denosumab: 100% DTC-eradication; p = 1.00).
Conclusion This is the first study worldwide, demonstrating that neoadjuvant add-on denosumab over a short-term period of 24 months does not increase the DTC-eradication rate in breast cancer patients treated with NACT. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-023-01619-2.
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Affiliation(s)
- Pauline Wimberger
- grid.4488.00000 0001 2111 7257Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- grid.461742.20000 0000 8855 0365National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens-Uwe Blohmer
- grid.6363.00000 0001 2218 4662Gynäkologie mit Brustzentrum, Charité-Univesitätsmedizin Berlin, Berlin, Germany
| | - Petra Krabisch
- grid.459629.50000 0004 0389 4214Klinikum Chemnitz, Chemnitz, Germany
| | - Theresa Link
- grid.4488.00000 0001 2111 7257Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- grid.461742.20000 0000 8855 0365National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Bruno Valentin Sinn
- grid.6363.00000 0001 2218 4662Department of Pathology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Eike Simon
- Kreiskrankenhaus Torgau, Torgau, Germany
| | - Christine Solbach
- grid.411088.40000 0004 0578 8220Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Tanja Fehm
- grid.411327.20000 0001 2176 9917Universität Düsseldorf, Düsseldorf, Germany
| | - Carsten Denkert
- grid.10253.350000 0004 1936 9756Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | | | - Kerstin Rhiem
- grid.411097.a0000 0000 8852 305XUniversität Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | - Sherko Kümmel
- grid.461714.10000 0001 0006 4176Kliniken Essen-Mitte Evang. Huyssen-Stiftung, Essen, Germany
| | - Andrea Petzold
- grid.4488.00000 0001 2111 7257Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- grid.461742.20000 0000 8855 0365National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Stötzer
- Gemeinschaftspraxis Hämatologie/Intern. Onkologie, München, Germany
| | - Cornelia Meisel
- grid.4488.00000 0001 2111 7257Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- grid.461742.20000 0000 8855 0365National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Dominik Kuhlmann
- grid.4488.00000 0001 2111 7257Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- grid.461742.20000 0000 8855 0365National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Sibylle Loibl
- grid.434440.30000 0004 0457 2954German Breast Group, Neu-Isenburg, Germany
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9
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Harbeck N, Gluz O, Christgen M, Braun M, Thill M, Wimberger P, Luedtke-Heckenkamp K, Graeser M, Hilpert F, Bjelic-Radisic V, Krauss K, Warm M, Zaiss MR, Hartkopf AD, Just M, Kreipe HH, Nitz U, zu Eulenburg C, Wuerstlein R, Kuemmel S. Adjuvant dynamic marker-adjusted personalized therapy comparing endocrine therapy plus ribociclib versus chemotherapy in intermediate-risk HR+/HER2- early breast cancer: ADAPTcycle. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS609 Background: The WSG ADAPT trial program focusses on individualization of (neo)-adjuvant decision-making in EBC in a subtype-specific manner. Clinical feasibility of the WSG ADAPT trial goals - early response assessment and subtype-specific therapy tailoring to those patients (pts) who are most likely to benefit - has recently been confirmed by the 5-years survival data of the ADAPT HR+/HER2- clinical trial. Methods: WSG-ADAPTcycle is a prospective, multi-center, interventional, two-arm, (neo)adjuvant, non-blinded, randomized, controlled phase III trial (NCT04055493) investigating whether treatment with the CDK4/6 inhibitor ribociclib (600mg/day) together with ET is superior to standard-chemotherapy (CT) in intermediate-risk HR+/HER2- EBC. Definition of intermediate-risk is either based on Oncotype DX and endocrine responder status (measured by Ki67-response after 2-4 weeks of induction endocrine therapy (ET)) or on low-intermediate baseline Ki67 and high estrogen receptor (ER)/progesterone receptor (PR)-expression (Dowsett et al. NPJ Breast Cancer 2020). Co-primary endpoints are DFS and dDFS. It is planned to screen 5600 pts and to randomize 1670 pts (1002 to ribociclib + ET; 668 to standard CT followed by ET). Study start was in July 2019 (88 sites, enrollment period 42 months) and until date of submission, 3079 pts have been screened and 811 randomized (490 ribociclib / 321 CT). Pre-/postmenopausal pts with histologically confirmed invasive HR+/HER2- EBC with high clinical risk (cT2-4 or Ki-67 20% or G3 or cN+) are eligible if they fulfil the ADAPT intermediate-risk criteria: Recurrence Score (RS) ≤25 plus several risk factors and poor ET responder, RS >25 and ET-responder in p/cN0-1 pts, or RS ≤25 with c/pN2-3 in ET-responder. Direct randomization of premenopausal patients (irrespective of ET-response) with c/pN0 and RS 16-25 or c/pN1 with RS 0-25 is allowed according to investigator´s decision; however, based on the ADAPT results, ET+ovarian function suppression alone is strongly recommended in ET-responders. Treatment duration is 2 years for the ribociclib + aromatase inhibitor (AI) (premenopausal: AI + GnRH)-arm and 16-24 weeks for the CT-arm; neoadjuvant or adjuvant treatment is allowed. The minimum 5-year follow-up phase includes standard adjuvant ET. ePROs are collected using CANKADO; ECG monitoring is performed using a novel eHealth method. Translational analyses: Tumor tissue will be collected prior to ET, after at least 3 weeks of ET, if residual tumor is diagnosed (neoadjuvant treatment), and at recurrence, to identify potential resistance markers. Exploratory tissue biomarker research will be conducted to assess alterations in molecular markers. In addition, ctDNA/ctRNA from optional blood samples will be assessed for mutations and gene expression relevant for HR+/HER2- EBC. Clinical trial information: NCT04055493.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU and West German Study Group, Munich, Germany
| | - Oleg Gluz
- West German Study Group and Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany and University Hospital Cologne, Cologne, Germany
| | | | - Michael Braun
- Interdisciplinary Breast Center, Rotkreuz-Clinics Munich, Munich, Germany
| | - Marc Thill
- Breast Center, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden, Dresden, Germany
| | | | - Monika Graeser
- Breast Center Niederrhein, Ev. Bethesda Hospital and Department of Gynecology, University Medical Center Hamburg and West German Study Group, Mönchengladbach, Germany
| | - Felix Hilpert
- Breast Center Hamburg International, Hospital Jerusalem, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, University Witten-Herdecke, Wuppertal, Germany
| | - Katja Krauss
- Breast Center, Dept. Obstetrics & Gynecology, RWTH Aachen, Aachen, Germany
| | - Mathias Warm
- Breast Center Cologne-Holweide, Municipal Hospital Holweide, Cologne, Germany
| | | | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, University of Tuebingen and University of Ulm, Tuebingen and Ulm, Germany
| | - Marianne Just
- Oncological Specialist Practice Bielefeld, Bielefeld, Germany
| | | | - Ulrike Nitz
- West German Study Group/Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Rachel Wuerstlein
- Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, West German Study Group, Munich, Germany
| | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany and Clinics Essen-Mitte, Breast Center, Essen, Germany and Women’s Clinic, Charité Berlin, Berlin, Germany, Essen, Germany
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10
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Blohmer JU, Link T, Reinisch M, Just M, Untch M, Stötzer O, Fasching PA, Schneeweiss A, Wimberger P, Seiler S, Huober J, Thill M, Jackisch C, Rhiem K, Solbach C, Hanusch C, Seither F, Denkert C, Engels K, Nekljudova V, Loibl S. Effect of Denosumab Added to 2 Different nab-Paclitaxel Regimens as Neoadjuvant Therapy in Patients With Primary Breast Cancer: The GeparX 2 × 2 Randomized Clinical Trial. JAMA Oncol 2022; 8:1010-1018. [PMID: 35588050 DOI: 10.1001/jamaoncol.2022.1059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Adjuvant denosumab might improve disease-free survival in hormone receptor (HR)-positive primary breast cancer (BC). The optimal neoadjuvant nab-paclitaxel schedule in terms of efficacy and safety is unclear. Objective To determine whether adding denosumab to anthracycline/taxane-containing neoadjuvant chemotherapy (NACT) increases the pathological complete response (pCR) rate and which nab-paclitaxel schedule is more effective in the NACT setting. Design, Setting, and Participants The GeparX was a multicenter, prospective, open-label, phase 2b, 2 × 2 randomized clinical trial conducted by GBG and AGO-B at 38 German sites between February 2017 and March 2019. The analysis data set was locked September 4, 2020; analysis was completed November 13, 2020. Patients had unilateral or bilateral primary BC, stage cT2-cT4a-d or cT1c, with either clinically node-positive or pathologically node-positive or HR-negative disease, or Ki-67 proliferation index greater than 20%, or ERBB2 (formerly HER2)-positive BC. Interventions Patients were randomized to receive or not receive denosumab, 120 mg subcutaneously every 4 weeks for 6 cycles, and either nab-paclitaxel, 125 mg/m2 weekly for 12 weeks or days 1 and 8 every 3 weeks for 4 cycles (8 doses), followed by 4 cycles of epirubicin/cyclophosphamide, 90/600 mg/m2 (every 2 weeks or every 3 weeks). Carboplatin was given in triple-negative BC (TNBC), and trastuzumab biosimilar ABP980 plus pertuzumab was given in ERBB2-positive BC (ERBB2-positive substudy). Main Outcomes and Measures The primary outcome was pCR rates between arms for each randomization. Results A total of 780 female (n = 779) and male (n = 1) patients (median [range] age, 49.0 [22-80] years) were randomized to the 4 treatment groups. The pCR (ypT0 ypN0) rate was 41.0% (90% CI, 37%-45%) with denosumab vs 42.8% (90% CI, 39%-47%) (P = .58) without denosumab, irrespective of BC subtype. Nab-paclitaxel weekly resulted in a significantly (significance level of α = .10) higher pCR rate of 44.9% (90% CI, 41%-49%) vs 39.0% (90% CI, 35%-43%) (P = .06) with nab-paclitaxel days 1 and 8 every 3 weeks. The pCR rates for nab-paclitaxel schedules in subgroups were only significantly different for TNBC (60.4% vs 50.0%; P = .06). Grade 3 to 4 toxic effects did not differ with or without denosumab. Nonhematologic toxic effects of grade 3 to 4 were higher with nab-paclitaxel weekly (33.7% vs 24.1%; P = .004). Conclusions and Relevance In this randomized clinical trial, denosumab added to anthracycline/taxane-based NACT did not improve pCR rates. Nab-paclitaxel at a dosage of 125 mg/m2 weekly significantly increased the pCR rate compared with the days 1 and 8, every-3-weeks schedule overall and in TNBC, but generated higher toxicity. Trial Registration ClinicalTrials.gov Identifier: NCT02682693.
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Affiliation(s)
| | - Theresa Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | | | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | | | - Oliver Stötzer
- Gemeinschaftspraxis Hämatologie/Intern. Onkologie, München, Germany
| | | | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | | | - Jens Huober
- Universitätsklinikum Ulm, Ulm, Germany.,Breast Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | | | - Kerstin Rhiem
- Universität Köln, Zentrum familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | | | | | - Carsten Denkert
- Institut für Pathologie, Universität Marburg, Marburg, Germany
| | - Knut Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss, Germany
| | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Bethanien Krankenhaus Frankfurt, Frankfurt, Germany.,Goethe Universität Frankfurt, Frankfurt, Germany
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11
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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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12
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Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke EM, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N, von Schumann R, Kuhn W, Polata S, Bielecki W, Meyer R, Just M, Kraudelt S, Siggelkow W, Wortelmann H, Kleine-Tebbe A, Leitzen L, Kirchhof H, Krabisch P, Hackmann J, Depenbusch R, Gnauert K, Staib P, Lehnert A, Hoffmann O, Briest S, Lindner C, Heyl V, Bauer L, Uleer C, Mohrmann S, Viehstaedt N, Malter W, Link T, Buendgen N, Tio J. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23:625-635. [DOI: 10.1016/s1470-2045(22)00159-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
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13
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Denkert C, Seither F, Schneeweiss A, Link T, Blohmer JU, Just M, Wimberger P, Forberger A, Tesch H, Jackisch C, Schmatloch S, Reinisch M, Solomayer EF, Schmitt WD, Hanusch C, Fasching PA, Lübbe K, Solbach C, Huober J, Rhiem K, Marmé F, Reimer T, Schmidt M, Sinn BV, Janni W, Stickeler E, Michel L, Stötzer O, Hahnen E, Furlanetto J, Seiler S, Nekljudova V, Untch M, Loibl S. Clinical and molecular characteristics of HER2-low-positive breast cancer: pooled analysis of individual patient data from four prospective, neoadjuvant clinical trials. Lancet Oncol 2021; 22:1151-1161. [PMID: 34252375 DOI: 10.1016/s1470-2045(21)00301-6] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The development of anti-HER2 antibody-drug conjugates opens new therapeutic options for patients with breast cancer, including patients with low expression of HER2. To characterise this new breast cancer subtype, we have compared the clinical and molecular characteristics of HER2-low-positive and HER2-zero breast cancer, including response to neoadjuvant chemotherapy and prognosis. METHODS In this pooled analysis of individual patient data, we evaluated a cohort of 2310 patients with HER2-non-amplified primary breast cancer that were treated with neoadjuvant combination chemotherapy in four prospective neoadjuvant clinical trials (GeparSepto, NCT01583426; GeparOcto, NCT02125344; GeparX, NCT02682693; Gain-2 neoadjuvant, NCT01690702) between July 30, 2012, and March 20, 2019. Central HER2 testing was done prospectively before random assignment of participants in all trials. HER2-low-positive status was defined as immunohistochemistry (IHC) 1+ or IHC2+/in-situ hybridisation negative and HER2-zero was defined as IHC0, based on the American Society of Clinical Oncology/College of American Pathologists guidelines. Disease-free survival and overall survival data were available for 1694 patients (from all trials except GeparX) with a median follow-up of 46·6 months (IQR 35·0-52·3). Bivariable and multivariable logistic regression models and Cox-proportional hazards models were performed based on a predefined statistical analysis plan for analysis of the endpoints pathological complete response, disease-free survival, and overall survival. FINDINGS A total of 1098 (47·5%) of 2310 tumours were HER2-low-positive and 1212 (52·5%) were HER2-zero. 703 (64·0%) of 1098 patients with HER2-low-positive tumours were hormone receptor positive, compared with 445 (36·7%) of 1212 patients with HER2-zero tumours (p<0.0001). HER2-low-positive tumours had a significantly lower pathological complete response rate than HER2-zero tumours (321 [29·2%] of 1098 vs 473 [39·0%] of 1212, p=0·0002). Pathological complete response was also significantly lower in HER2-low-positive tumours versus HER2-zero tumours in the hormone receptor-positive subgroup (123 [17·5%] of 703 vs 105 [23·6%] of 445, p=0·024), but not in the hormone receptor-negative subgroup (198 [50·1%] of 395 vs 368 [48·0%] of 767, p=0·21). Patients with HER2-low-positive tumours had significantly longer survival than did patients with HER2-zero tumours (3-year disease-free survival: 83·4% [95% CI 80·5-85·9] vs 76·1% [72·9-79·0]; stratified log-rank test p=0·0084; 3-year overall survival: 91·6% [84·9-93·4] vs 85·8% [83·0-88·1]; stratified log-rank test p=0·0016). Survival differences were also seen in patients with hormone receptor-negative tumours (3-year disease-free survival: 84·5% [95% CI 79·5-88·3] vs 74·4% [70·2-78.0]; stratified log-rank test p=0·0076; 3-year overall survival: 90·2% [86·0-93·2] vs 84·3% [80·7-87·3], stratified log-rank test p=0·016), but not in patients with hormone receptor-positive tumours (3-year disease-free survival 82·8% [79·1-85·9] vs 79·3% [73·9-83·7]; stratified log-rank test p=0·39; 3-year overall survival 92·3% [89·6-94·4] vs 88·4% [83·8-91·8]; stratified log-rank test p=0·13). INTERPRETATION Our results show that HER2-low-positive tumours can be identified as new subgroup of breast cancer by standardised IHC, distinct from HER2-zero tumours. HER2-low-positive tumours have a specific biology and show differences in response to therapy and prognosis, which is particularly relevant in therapy-resistant, hormone receptor-negative tumours. Our results provide a basis for a better understanding of the biology of breast cancer subtypes and the refinement of future diagnostic and therapeutic strategies. FUNDING German Cancer Aid (Deutsche Krebshilfe).
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Affiliation(s)
- Carsten Denkert
- Institute of Pathology, Philipps-Universität Marburg and University Hospital of Giessen and Marburg, Marburg, Germany; German Breast Group, Neu-Isenburg, Germany.
| | | | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Theresa Link
- Department of Gynecology and Obstetrics, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jens-Uwe Blohmer
- Breast Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Almuth Forberger
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Hans Tesch
- Onkologie Bethanien Krankenhaus Frankfurt, Frankfurt, Germany
| | | | | | - Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen Mitte, Essen, Germany
| | | | - Wolfgang D Schmitt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Claus Hanusch
- Frauenklinik München, Rotkreuzklinikum München, München, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Kristina Lübbe
- DIAKOVERE Henriettenstift Gynäkologie, Hannover, Germany
| | - Christine Solbach
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frederik Marmé
- Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsfrauenklinik Mannheim, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Universitätsmedizin Mainz, Mainz, Germany
| | - Bruno V Sinn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Elmar Stickeler
- Clinics for Gynaecology and Obstetrica, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Laura Michel
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | | | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | | | | | - Michael Untch
- Breast Cancer Center, Department of Gynecology and Obstetrics, Helios-Klinikum Berlin Buch, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany; Goethe University of Frankfurt, Frankfurt, Germany
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14
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Graeser M, Schrading S, Gluz O, Strobel K, Würstlein R, Kümmel S, Schumacher C, Grischke E, Forstbauer H, Braun M, Christgen M, Adams J, Nitzsche H, Just M, Fischer HH, Aktas B, Potenberg J, von Schumann R, Kolberg‐Liedtke C, Harbeck N, Kuhl CK, Nitz U. Early response by MR imaging and ultrasound as predictor of pathologic complete response to 12-week neoadjuvant therapy for different early breast cancer subtypes: Combined analysis from the WSG ADAPT subtrials. Int J Cancer 2021; 148:2614-2627. [PMID: 33533487 PMCID: PMC8048810 DOI: 10.1002/ijc.33495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
We evaluated the role of early response after 3 weeks of neoadjuvant treatment (NAT) assessed by ultrasound (US), magnetic resonance imaging (MRI) and Ki-67 dynamics for prediction of pathologic complete response (pCR) in different early breast cancer subtypes. Patients with HR+/HER2+, HR-/HER2- and HR-/HER2+ tumors enrolled into three neoadjuvant WSG ADAPT subtrials underwent US, MRI and Ki-67 assessment at diagnosis and after 3 weeks of NAT. Early response was defined as complete or partial response (US, MRI) and ≥30% proliferation decrease or <500 invasive tumor cells (Ki-67). Predictive values and area under the receiver operating characteristic (AUC) curves for prediction of pCR (ypT0/is ypN0) after 12-week NAT were calculated. Two hundred twenty-six had MRI and 401 US; 107 underwent both MRI and US. All three methods yielded a similar AUC in HR+/HER2+ (0.66-0.67) and HR-/HER2- tumors (0.53-0.63), while MRI and Ki-67 performed better than US in HR-/HER2+ tumors (0.83 and 0.79 vs 0.56). Adding MRI+/-Ki-67 increased AUC of US in HR-/HER2+ tumors to 0.64 to 0.75. MRI and Ki-67 demonstrated highest sensitivity in HR-/HER2- (0.8-1) and HR-/HER2+ tumors (1, both). Negative predictive value was similar for all methods in HR+/HER2+ (0.71-0.74) and HR-/HER2- tumors (0.85-1), while it was higher for MRI and Ki-67 compared to US in HR-/HER2+ subtype (1 vs 0.5). Early response assessed by US, MRI and Ki-67 is a strong predictor for pCR after 12-week NAT. Strength of pCR prediction varies according to tumor subtype. Adding MRI+/-Ki-67 to US did not improve pCR prediction in majority of our patients.
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Affiliation(s)
- Monika Graeser
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- Department of GynecologyUniversity Medical Center HamburgHamburgGermany
| | - Simone Schrading
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Oleg Gluz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- University Hospital CologneCologneGermany
| | - Kevin Strobel
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Rachel Würstlein
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Sherko Kümmel
- West German Study GroupMoenchengladbachGermany
- Breast UnitKliniken Essen‐MitteEssenGermany
- University Hospital Charité, Humboldt University BerlinBerlinGermany
| | | | | | | | - Michael Braun
- Department of GynecologyBreast Center, Red Cross Hospital MunichMunichGermany
| | | | | | - Henrik Nitzsche
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
| | | | | | - Bahriye Aktas
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
- Department of GynecologyUniversity Hospital LeipzigLeipzigGermany
| | | | | | - Cornelia Kolberg‐Liedtke
- University Hospital Charité, Humboldt University BerlinBerlinGermany
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
| | - Nadia Harbeck
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Christiane K. Kuhl
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Ulrike Nitz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
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15
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Christgen M, Harbeck N, Gluz O, Raap M, Christgen H, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Krabisch P, Just M, Graeser M, Baehner R, Wuerstlein R, Nitz U, Kates R, Kreipe H. Differential impact of prognostic parameters in hormone receptor-positive lobular early breast cancer in the WSG PlanB trial. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30531-1] [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: 11/27/2022]
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Harbeck N, Nitz U, Christgen M, Kuemmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Malter W, Forstbauer H, von Schumann R, Just M, Jóźwiak K, Hauptmann M, Kates R, Gräser M, Wuerstlein R, Kreipe H. LBA14 De-escalated neoadjuvant T-DM1 with or without endocrine therapy (ET) vs trastuzumab+ET in early HR+/HER2+ breast cancer (BC): ADAPT-TP survival results. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2242] [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: 10/23/2022] Open
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17
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Link T, Blohmer JU, Just M, Untch M, Stötzer O, Fasching P, Schneeweiss A, Wimberger P, Seiler S, Huober J, Schmitt W, Jackisch C, Rhiem K, Hanusch C, Denkert C, Sinn B, Engels K, Nekljudova V, Loibl S. 168MO GeparX: Denosumab (Dmab) as add-on to different regimen of nab-paclitaxel (nP)-anthracycline based neoadjuvant chemotherapy (NACT) in early breast cancer (BC): Subgroup analyses by RANK expression and HR status. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.290] [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: 10/23/2022] Open
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18
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Christgen M, Gluz O, Harbeck N, Kates RE, Raap M, Christgen H, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Krabisch P, Just M, Augustin D, Graeser M, Baehner F, Wuerstlein R, Nitz U, Kreipe H. Differential impact of prognostic parameters in hormone receptor-positive lobular breast cancer. Cancer 2020; 126:4847-4858. [PMID: 32780421 DOI: 10.1002/cncr.33104] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Invasive lobular breast cancer (BC) is the second most common BC subtype. Prognostic parameters (tumor classification, lymph node status, histologic grade, Oncotype DX recurrence score [RS], progesterone receptor status, and Ki67 index) were retrospectively studied in a large, prospective clinical trial encompassing 2585 patients who had hormone receptor-positive early BC (the West German Study Group PlanB trial). METHODS BCs were centrally reviewed and classified as lobular (n = 353; 14%) or nonlobular (n = 2232; 86%). The median follow-up was 60 months. Five-year disease-free survival (DFS) estimates were obtained using the Kaplan-Meier method. Prognostic parameters were evaluated using Cox proportional hazard models. RESULTS Lobular BC was associated with higher tumor classification, higher lymph node status, lower histologic grade, lower Ki67 index, and low or intermediate RS. The prevalence of high RS (RS range, 26-100) was 3-fold lower in patients who had lobular BC compared with those who had nonlobular BC (8% vs 24%; P < .001). However, 5-year DFS estimates for lobular and nonlobular BC were similar (92.1% and 92.3%, respectively; P = .673). In multivariate analyses, prognostic parameters for DFS in lobular BC included grade 3 (hazard ratio, 5.06; 95% CI, 1.91-13.39) and a pathologic lymph node status (pN) of pN3 (hazard ratio, 12.16; 95% CI, 3.87-38.24), but not RS. By contrast, prognostic parameters in nonlobular BC included grade 3 (hazard ratio, 1.65; 95% CI, 1.11-2.44), pN3 (hazard ratio, 3.68; 95% CI, 1.60-8.46), and high RS (hazard ratio, 2.49; 95% CI, 1.69-3.68). CONCLUSIONS Lobular BC is associated with low and intermediate RS, although 5-year DFS is similar to that of nonlobular BC. The effect of the RS in lobular BC appears to be distinct from that in nonlobular BC. For risk assessment, the RS needs to be complemented by clinicopathologic parameters for therapy decision making.
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Affiliation(s)
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Evangelical Hospital Bethesda, Lower Rhine Breast Center, Moenchengladbach, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, Comprehensive Cancer Center Munich, University Hospital of the Ludwig Maximillian University of Munich, Munich, Germany
| | | | - Mieke Raap
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Michael Clemens
- Department of Oncology, Motherhouse of the Sisters of Mercy of St Charles Borromeo Clinics, Trier, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Benno Nuding
- Department of Gynecology and Obstetrics, Evangelical Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig, Leipzig, Germany
| | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany.,Breast Center, Essen-Mitte Clinics, Essen, Germany
| | - Toralf Reimer
- Department of Gynecology and Obstetrics, Suedstadt Clinics, Rostock, Germany
| | - Andrea Stefek
- Altmark Breast Center, Johanniter Clinics Stendal, Stendal, Germany
| | | | | | | | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Evangelical Hospital Bethesda, Lower Rhine Breast Center, Moenchengladbach, Germany
| | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, Comprehensive Cancer Center Munich, University Hospital of the Ludwig Maximillian University of Munich, Munich, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Evangelical Hospital Bethesda, Lower Rhine Breast Center, Moenchengladbach, Germany
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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19
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Wimberger P, Blohmer JU, Krabisch P, Link T, Just M, Sinn BV, Simon E, Solbach C, Fehm TN, Denkert C, Kühn C, Rhiem K, Tesch H, Kümmel S, Petzold A, Stoetzer OJ, Meisel C, Kuhlmann JD, Nekljudova V, Loibl S. Influence of denosumab on disseminated tumor cells (DTC) in the bone marrow of breast cancer (BC) patients with neoadjuvant treatment: A GeparX translational substudy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
580 Background: DTCs in the bone marrow are observed in up to 30% at primary diagnosis of BC and their presence is an independent prognostic factor for reduced survival. It was shown that antiresorptive therapy eradicates DTCs and improves prognosis in DTC-positive BC patients (pts). In the GeparX phase III prospective randomized trial, denosumab (a monoclonal IgG2-anti-RANKL-antibody) was investigated as add-on treatment to neoadjuvant chemotherapy (NACT) with two different nab-paclitaxel schedules in early high-risk primary BC. In a translational substudy, we analyzed for the first time the influence of short-term denosumab treatment (24 weeks) on the presence of DTCs. Methods: A total of 167 pts from the GeparX trial were analyzed for DTCs at baseline by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. Initially DTC-positive pts were re-analyzed for DTCs after NACT±Denosumab. Results: Overall, 60/167 pts (35.9%) treated with NACT±Denosumab had a pathological complete response (pCR; 55.4% in TNBC, 43.3% in HER2+, 15.3% in HR+/HER2-). At baseline, 43/167 pts (25.7%) were DTC-positive and 41 of those were available for re-analysis of DTCs after NACT±Denosumab. DTC eradication was observed in 77.8% after NACT+Denosumab and in 69.6% after NACT alone (p = 0.726). Due to the limited number of pts eligible for DTC-re-analysis after NACT, a subtype specific analysis for the effect of denosumab was not possible. There was no significant association between pCR and i) the presence of DTCs at baseline (37.1% DTC-negative vs 32.6% positive, p = 0.71) or ii) the eradication of DTCs after NACT±Denosumab (36.7% vs 27.3%, p = 0.72). Notably, in TNBC, we observed a tendency that DTC-positivity at baseline or DTC-persistence after NACT could be associated with reduced pCR rate (40.0% in DTC-positive vs. 66.7% in DTC-negative pts, p = 0.16; 25% in DTC-persistent pts vs. 50% in DTC-eradicated pts, p = 0.59). Conclusions: Denosumab in addition to NACT does not improve pCR, but the suspected effect of denosumab on DTC eradication should be further analyzed in TNBC. Key words: GeparX trial, denosumab, disseminated tumor cells, bone marrow, neoadjuvant chemotherapy. Funding: GeparX and DTC substudy were financially supported by Amgen and Celgene. Clinical trial information: NCT02682693 .
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Affiliation(s)
- Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Petra Krabisch
- NOGGO and Department of Gynecology and Obstetrics, Klinikum Chemnitz, Chemnitz, Germany
| | | | | | - Bruno Valentin Sinn
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eike Simon
- Kreiskrankenhaus Torgau, Torgau, Germany
| | | | | | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg, Marburg, Germany
| | | | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Hans Tesch
- Hämatologisch-Onkologische Gemeinschaftspraxis Bethanien, Frankfurt, Germany
| | - Sherko Kümmel
- Kliniken Essen-Mitte Evang, Huyssens-Stiftung, Essen, Germany
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20
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Harbeck N, Gluz O, Christgen M, Graeser M, Hilpert F, Krauss K, Thill M, Warm M, Müller V, Braun MW, Just M, Kreipe HH, Nitz U, Kates RE, Schinkoethe T, Wuerstlein R, Kuemmel S. ADAPTcycle: Adjuvant dynamic marker-adjusted personalized therapy (ADAPT) comparing endocrine therapy plus ribociclib versus chemotherapy in intermediate-risk HR+/HER2- early breast cancer (EBC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS601 Background: The WSG ADAPT trial program represents the concept of individualization of (neo)-adjuvant decision-making in EBC in a subtype-specific manner. The first WSG ADAPT umbrella trial aimed to establish early predictive molecular surrogate markers for response after a short 3-week induction treatment. The goals of the WSG ADAPT trial program are early response assessment and subtype-specific therapy tailoring to those patients who are most likely to benefit. Methods: WSG-ADAPTcycle is a prospective, multi-center, interventional, two-arm, open-label, (neo)adjuvant, non-blinded, randomized, controlled phase III trial (NCT04055493). It investigates whether patients (pts.) with HR+/HER2- EBC identified during screening as intermediate risk (based on Oncotype DX and response to 3 weeks of preoperative endocrine therapy [ET]) derive additional benefit from 2 years of the CDK4/6 inhibitor ribociclib combined with ET compared to chemotherapy (CT) (followed by standard ET). Co-primary endpoints are disease-free survival (DFS) and distant DFS. It is planned to screen 5600 pts and to randomize 1670 pts in a 3:2 ratio (ribociclib + ET/CT). Study start was in July 2019 (80 sites, enrollment period 36 months) and until date of submission, 180 pts. have been screened and 40 randomized. Pts with HR+/HER2- EBC with clinically enhanced risk (cT2-4 or Ki67 20% or G3 or cN+) are eligible if they fulfill the ADAPT intermediate-risk group criteria: either Recurrence Score (RS) ≤25 and Ki67postendocrine>10%, RS >25 and Ki67postendocrine<10% in p/cN0-1 pts, or RS ≤25 and Ki67postendocrine<10% in c/pN2-3 pts. Treatment duration is 2 years for the ribociclib + ET (premenopausal: AI + GnRH) arm and 16-24 weeks for the CT arm; treatment is possible either in the neoadjuvant (ET + ribociclib duration 16 – 32 weeks) or adjuvant setting. ePROs are collected using CANKADO; ECG monitoring is performed using a novel cardiology-supported CANKADO-based eHealth method. Translational analyses: Exploratory tissue biomarker research will be conducted to assess alterations in molecular markers. In addition, ctDNA/ctRNA from optional blood samples will be assessed for mutations and gene expression. Conclusions: ADAPTcycle seeks to evaluate whether endocrine-based therapy with ET and a CDK 4/6 inhibitor is superior to CT followed by ET in patients with luminal EBC who may be undertreated with ET alone (based on either lack of endocrine responsiveness or high tumor burden). Clinical trial information: 2018-003749-40 .
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU and West German Study Group, Munich, Germany
| | - Oleg Gluz
- Breast Center Niederrhein, University Clinics Cologne and West German Study Group, Moenchengladbach, Germany
| | | | - Monika Graeser
- Breast Center Niederrhein, Ev. Bethesda Hospital and West German Study Group, Mönchengladbach, Germany
| | - Felix Hilpert
- Breast Center Hamburg International, Hospital Jerusalem, Hamburg, Germany
| | - Katja Krauss
- Breast Center, Dept. Obstetrics & Gynecology, RWTH Aachen, Aachen, Germany
| | - Marc Thill
- Breast Center, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Mathias Warm
- Breast Center Cologne-Holweide, Municipal Hospital Holweide, Cologne, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Marianne Just
- Oncological Specialist Practice Bielefeld, Bielefeld, Germany
| | | | - Ulrike Nitz
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU and West German Study Group, Moenchengladbach, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU and West German Study Group, Munich, Germany
| | - Sherko Kuemmel
- Breast Center, Ev. Clinics Essen-Mitte and West German Study Group, Essen, Germany
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21
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Gluz O, Nitz U, Christgen M, Kuemmel S, Holtschmidt J, Priel J, Hartkopf A, Potenberg J, Luedtke-Heckenkamp K, Just M, Wuelfing P, von Schumann R, Graeser M, Wuerstlein R, Kates RE, Kreipe HH, Harbeck N. De-escalated chemotherapy versus endocrine therapy plus pertuzumab+ trastuzumab for HR+/HER2+ early breast cancer (BC): First efficacy results from the neoadjuvant WSG-TP-II study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
515 Background: HR+/HER2+ breast cancer (BC) is a distinct entity associated with better prognosis compared to HR-/HER2+ BC. However, combination of chemotherapy (CT) with (dual) anti-HER2 blockade is standard in HER2+ early BC (EBC), irrespective of HR-status. Despite of some promising data on combination of endocrine therapy (ET) with dual anti-HER2 blockade in EBC and metastatic HR+/HER2+ BC, no prospective comparison of neoadjuvant CT vs. ET + dual HER2-blockade has yet been performed. Methods: In the prospective WSG TP-II phase II-trial (NCT03272477; Sponsor: Palleos GmbH, Wiesbaden, Germany), 207 patients (pts) (257 screened; 40 centers) with centrally confirmed HR+/HER2+ EBC were randomized to 12 weeks of standard ET (n=100) vs. paclitaxel 80 mg/m2 weekly (n=107) +trastuzumab+pertuzumab q3w for all pts. Primary endpoint was pCR (ypT0/is/ypN0). Secondary endpoints include safety, disease-free and overall survival, translational research, and quality of life (QoL). Omission of further CT was allowed in all pts with pCR; dual HER2-blockade was administered in the adjuvant setting in all pts. Results: Baseline characteristics were well balanced between the arms. Median age was 53 years; 58% had cT2-4, 28% had cN+; 43% had G3 tumors. pCR data were available in 198 pts (ET: n=96; Pac: n=102). pCR was observed in 24% (95% CI: 16-34%) with ET+T+P vs. 57% (95% CI:47-67%) with Pac+T+P (OR 0.24, 95% CI: 0-0.46, p<0.001). In multivariable logistic regression analysis and corresponding sensitivity analysis (bootstrap/subsample inclusion frequencies and lasso regression) including study arm, BMI, menopausal, cT, and cN status, histological grade, HER2-status, Ki67, ER, PR as continuous variables, only study arm and HER2 3+ status were significantly associated with pCR. Neoadjuvant treatment was well tolerated in both study arms and completed per protocol in 93/92 (ET+P+T/Pac+P+T) patients. Only 9/13 SAEs (ET+P+T/Pac+P+T) were reported during neoadjuvant therapy. PAM50 and QoL analysis are ongoing. Conclusions: WSG TP-II is the first randomized prospective trial comparing two neoadjuvant de-escalation treatments in HR+/HER2+ EBC. The excellent pCR rate of 57% after only 12 weeks of Pac+P+T was clearly superior to the still promising 24% pCR rate in pts treated by ET+P+T. In both arms, treatment efficacy was most pronounced in HER2 3+ tumors. Survival results need to be awaited before definite recommendations for a de-escalated regimen in HR+/HER2+ EBC can be made. Clinical trial information: 2016-005157-21 .
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Affiliation(s)
- Oleg Gluz
- Breast Center Niederrhein, University Clinics Cologne and West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group/Breast Center Niederrhein, Moenchengladbach, Germany
| | | | | | | | - Jan Priel
- Palleos Healthcare GmbH, Wiesbaden, Germany
| | | | | | | | | | - Pia Wuelfing
- Mammazentrum Hamburg – Brustklinik am Krankenhaus Jerusalem, Hamburg, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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22
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Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kümmel S, Warm M, Fasching PA, Just M, Hanusch C, Hackmann J, Blohmer JU, Rhiem K, Schmitt WD, Furlanetto J, Gerber B, Huober J, Nekljudova V, von Minckwitz G, Loibl S. NAB-Paclitaxel Improves Disease-Free Survival in Early Breast Cancer: GBG 69–GeparSepto. J Clin Oncol 2019; 37:2226-2234. [DOI: 10.1200/jco.18.01842] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The GeparSepto trial demonstrated that weekly nanoparticle albumin-bound (NAB)–paclitaxel significantly improves the pathologic complete remission rate compared with weekly solvent-based (sb) paclitaxel followed by epirubicin plus cyclophosphamide as neoadjuvant treatment in patients with primary breast cancer (BC). Here, we report data on long-term outcomes. METHODS Patients with histologically confirmed primary BC were randomly assigned in a 1:1 ratio to 12 times weekly NAB-paclitaxel 150 mg/m2 (after study amendment, 125 mg/m2) or weekly sb-paclitaxel 80 mg/m2 followed in both arms by four times epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks. Patients with human epidermal growth factor receptor 2 (HER2)-positive BC received dual antibody treatment with trastuzumab (8 mg/kg loading dose followed by 6 mg/kg every 3 weeks) and pertuzumab (840 mg loading dose followed by 420 mg every 3 weeks) concurrently to chemotherapy and continued for 1 year. RESULTS A total of 1,206 patients started treatment, 606 with NAB-paclitaxel and 600 with sb-paclitaxel. After a median follow-up of 49.6 months (range, 0.5 to 64.0 months), 243 invasive disease–free survival (iDFS) events were reported (143 in the sb-paclitaxel and 100 in the NAB-paclitaxel arm). At 4 years, overall patients treated with NAB-paclitaxel had a significantly better iDFS compared with sb-paclitaxel (84.0% v 76.3%; hazard ratio, 0.66; 95% CI, 0.51 to 0.86; P = .002), whereas overall survival did not significantly differ between the two treatment arms (89.7% v 87.2%, respectively; hazard ratio, 0.82; 95% CI, 0.59 to 1.16; P = .260). Long-term follow-up of the treatment-related peripheral sensory neuropathy (PSN) showed a significant decrease of the median time to resolve PSN after NAB-paclitaxel 125 mg/m2 compared with NAB-paclitaxel 150 mg/m2. CONCLUSION The significantly higher pathologic complete response rate with NAB-paclitaxel translated into a significantly improved iDFS in patients with early BC as compared with sb-paclitaxel. PSN improved much faster under NAB-paclitaxel 125 mg/m2 compared with NAB-paclitaxel 150 mg/m2.
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Affiliation(s)
| | | | | | | | - Bahriye Aktas
- Klinik und Poliklinik für Frauenheilkunde Leipzig, Leipzig, Germany
| | | | | | | | - Sherko Kümmel
- Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - Mathias Warm
- Brustzentrum im Krankenhaus Köln-Holweide, Cologne, Germany
| | | | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
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23
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Denkert C, Link T, Jank P, Just M, Hanusch C, Brasch F, van Mackelenbergh M, Küster W, Marme F, Karn T, Müller V, Kümmel S, Nekljudova V, Loibl S, Blohmer JU. Comparison of an automated cartridge-based system for mRNA assessment with central immunohistochemistry in the neoadjuvant GeparX trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3075 Background: Hormone receptors, HER2 and Ki-67 are prognostic values typically determined for breast cancer (BC) outcome and prediction of therapy response. A RT-qPCR based system, the Xpert Breast Cancer STRAT4, can be used to classify BC tissues regarding their hormone receptor status, HER2 and proliferation via Ki-67. We compared mRNA expression analysis of ER, PR, HER2, and Ki-67 by this automated in-vitro diagnostic platform (GeneXpert) (GX) with central immunohistochemistry (IHC) in a large clinical trial cohort. Methods: BC patients from the prospective GBG neoadjuvant trial GeparX (NCT02682693) (still recruiting) were included in this biomarker project. We used formalin-fixed paraffin embedded (FFPE) pretherapeutical core biopsies with a tumor content > 10%. One 4 µm FFPE tissue section was first processed with the Xpert FFPE Lysis Kit, the sample lysate was placed in the STRAT4 cartridge system and then tested on the GX system in which the purification, amplification and real-time detection took place within two hours automatically. Results: A total of 503 (99%) of the 509 samples had a valid measurement of all four genes. 258 samples (51.3%) of the cohort were classified in central pathology as ER positive, 196 (39%) as PR positive and 78 (15.5%) as HER2-positive, and 421 samples (83.7%) were Ki-67-high ( > 20%). The simple kappa coefficient was for ER = 0.7938, PR = 0.6540, HER2 = 0.8172 and Ki-67 = 0.3655. This indicates, that the measurements for ER, PR and HER2 showed a high correlation between both methods, whereas the measurement of Ki-67 does not. The accuracy between the STRAT4 and IHC was 89.7% for ER, 83.3% for PR, 94.6% for HER2 and 86.7% for Ki-67. According to molecular subgroups, highest accuracy regarding Ki-67, was determined in TNBC (96.2%; luminal: 81.1%; HER2-positive: 76.9%). Conclusions: Our results show a high concordance between standardized central IHC and automated mRNA expression analysis for the most important BC biomarkers ER, PR and HER2. For the proliferation marker Ki-67, the concordance is slightly lower. The STRAT4 assay might offer additional option to conventional methods for BC biomarker assessment, in particular in settings where IHC is not feasible. To determine the clinical validity, additional outcome analyses are necessary. Clinical trial information: NCT02682693.
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Affiliation(s)
- Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Paul Jank
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Frank Brasch
- Klinikum Bielefeld, Bielefeld, Bielefeld, Germany
| | | | - Willi Küster
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Marme
- University of Heidelberg, National Center for Tumor Disease/Department of Gynecology, Heidelberg, Germany
| | - Thomas Karn
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Sherko Kümmel
- Kliniken Essen-Mitte Evang, Huyssens-Stiftung, Essen, Germany
| | | | - Sibylle Loibl
- German Breast Group (GBG) and Centre for Haematology and Oncology Bethanien, Frankfurt, Neu-Isenburg, Germany
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24
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Janning M, Müller V, Vettorazzi E, Cubas-Cordova M, Gensch V, Ben-Batalla I, Zu Eulenburg C, Schem C, Fasching PA, Schnappauf B, Karn T, Fehm T, Just M, Kühn T, Holms F, Overkamp F, Krabisch P, Rack B, Denkert C, Untch M, Tesch H, Rezai M, Kittel K, Pantel K, Bokemeyer C, Loibl S, von Minckwitz G, Loges S. Evaluation of soluble carbonic anhydrase IX as predictive marker for efficacy of bevacizumab: A biomarker analysis from the geparquinto phase III neoadjuvant breast cancer trial. Int J Cancer 2019; 145:857-868. [PMID: 30694523 DOI: 10.1002/ijc.32163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/19/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
We analyzed the predictive potential of pretreatment soluble carbonic anhydrase IX levels (sCAIX) for the efficacy of bevacizumab in the phase III neoadjuvant GeparQuinto trial. sCAIX was determined by enzyme-linked immunosorbent assay (ELISA). Correlations between sCAIX and pathological complete response (pCR), disease-free and overall survival (DFS, OS) were assessed with logistic and Cox proportional hazard regression models using bootstrapping for robust estimates and internal validation. 1,160 HER2-negative patient sera were analyzed, of whom 577 received bevacizumab. Patients with low pretreatment sCAIX had decreased pCR rates (12.1 vs. 20.1%, p = 0.012) and poorer DFS (adjusted 5-year DFS 71.4 vs. 80.5 months, p = 0.010) compared to patients with high sCAIX when treated with neoadjuvant chemotherapy (NCT). For patients with low sCAIX, pCR rates significantly improved upon addition of bevacizumab to NCT (12.1 vs. 20.4%; p = 0.017), which was not the case in patients with high sCAIX (20.1% for NCT vs. 17.0% for NCT-B, p = 0.913). When analyzing DFS we found that bevacizumab improved 5-year DFS for patients with low sCAIX numerically but not significantly (71.4 vs. 78.5 months; log rank 0.234). In contrast, addition of bevacizumab worsened 5-year DFS for patients with high sCAIX (81 vs. 73.6 months, log-rank 0.025). By assessing sCAIX levels we identified a patient cohort in breast cancer that is potentially undertreated with NCT alone. Bevacizumab improved pCR rates in this group, suggesting sCAIX is a predictive biomarker for bevacizumab with regards to treatment response. Our data also show that bevacizumab is not beneficial in patients with high sCAIX.
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Affiliation(s)
- Melanie Janning
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Clinic and Policlinic for Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miguel Cubas-Cordova
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria Gensch
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Ben-Batalla
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Zu Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Schem
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Benjamin Schnappauf
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Düsseldorf, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Frank Holms
- Department of Gynecology and Obstetrics, St. Barbara Kliniken Heessen, Hamm, Germany
| | | | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz, Germany
| | - Brigitte Rack
- Department of Obstetrics and Gynecology, Campus Innenstadt, University Hospital Munich, Germany
| | - Carsten Denkert
- Department of Pathology, Charité Berlin Campus Mitte and German Cancer Consortium (DKTK), Berlin, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Hans Tesch
- Centre for Hematology and Oncology, Frankfurt, Germany
| | - Mahdi Rezai
- Centre for Breast Cancer, Luisenkrankenhaus Düsseldorf, Germany
| | | | - Klaus Pantel
- Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Sonja Loges
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nitz U, Gluz O, Christgen M, Kates RE, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Lorenz-Salehi F, Krabisch P, Just M, Augustin D, Liedtke C, Chao C, Shak S, Wuerstlein R, Kreipe HH, Harbeck N. Correction to: Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat 2019; 175:265-266. [PMID: 30632020 PMCID: PMC6491403 DOI: 10.1007/s10549-018-05105-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ulrike Nitz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.
| | - Matthias Christgen
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Ronald E Kates
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Michael Clemens
- Department of Oncology, Clinics Mutterhaus der Borromäerinnen, Feldstraße 16, 54290, Trier, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Center, University Clinics Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Benno Nuding
- Department of Gynecology and Obstetrics, Evangelical Hospital, Ferrenbergstraße 24, 51465, Bergisch Gladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sherko Kuemmel
- Clinics Essen-Mitte, Breast Centre, Henricistraße 92, 45136, Essen, Germany
| | - Toralf Reimer
- Department of Gynecology and Obstetrics, Clinics Suedstadt, Südring 81, 18059, Rostock, Germany
| | - Andrea Stefek
- Johanniter Clinics Stendal, Breast Center Altmark, Bahnhofstraße 24 - 26, 39576, Stendal, Germany
| | - Fatemeh Lorenz-Salehi
- Department of Gynecology, Dr. Horst-Schmidt Clinics, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany
| | - Petra Krabisch
- Klinikum ChemnitzFlemmingstraße 2, 09116, Chemnitz, Germany
| | - Marianne Just
- Oncological Practice, Teutoburger Str. 60 33604, Bielefeld, Germany
| | - Doris Augustin
- Breast Centre Ostbayern, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Cornelia Liedtke
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
- Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Nadia Harbeck
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
- Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
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Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kümmel S, Rhiem K, Warm M, Fasching P, Just M, Hanusch C, Hackmann J, Blohmer JU, Furlanetto J, Nekljudova V, von Minckwitz G, Loibl S. Impact of nab-paclitaxel dose reduction on survival of the randomized phase III GeparSepto trial comparing neoadjuvant chemotherapy of weekly nab-paclitaxel (nP) with solvent-based paclitaxel (P) followed by anthracycline/cyclophosphamide for patients with early breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kummel S, Wimberger P, Von Minckwitz G, Nekljudova V, Denkert C, Just M, Hanusch C, Stoetzer OJ, Huober JB, Hofmann M, Jackisch C, Blohmer JU, Vladimirova V, Schneeweiss A, Untch M, Loibl S. Investigating denosumab as an add-on neoadjuvant treatment for RANK/L-positive or RANK/L-negative primary breast cancer and two different nab-paclitaxel schedules: 2x2 factorial design (GeparX)—An iterim safety analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Carsten Denkert
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Oliver J Stoetzer
- Medizinisches Zentrum für Hämatologie und Onkologie, München, Germany
| | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Manfred Hofmann
- Klinik für Gynäkologie und Geburtshilfe, Marienhospital, Stuttgart, Germany
| | | | | | | | - Andreas Schneeweiss
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
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Loibl S, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Wiebringhaus H, Kümmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Dan Costa S, Gerber B, Engels K, Nekljudova V, von Minckwitz G, Untch M. Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: a subanalysis of data from the randomized phase III GeparSepto trial. Ann Oncol 2017; 28:497-504. [PMID: 27831502 DOI: 10.1093/annonc/mdw610] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The neoadjuvant phase III GeparSepto study showed that substituting nab-paclitaxel for standard solvent-based paclitaxel significantly improved the pathologic complete response (pCR) rate achieved with a sequential neoadjuvant chemotherapy regimen of paclitaxel, epirubicin, and cyclophosphamide for high-risk primary breast cancer. Recent trials demonstrated that in HER2+ breast cancer pCR can be increased by using pertuzumab in addition to trastuzumab and chemotherapy. The present analysis focuses on efficacy and safety data from the subset of patients with HER2+ tumors from the GeparSepto trial (n = 396) in comparison to the HER2- cohort. Patients and methods Patients with histologically confirmed breast cancer (n = 1206) received four cycles of weekly paclitaxel [either solvent-based (Pac) or nab-paclitaxel (nab-Pac), according to randomization] followed by 4 cycles of epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 q3w, with concurrent trastuzumab and pertuzumab q3w for those with HER2+ tumors. The primary endpoint was pCR defined as ypT0 ypN0. Results Higher rates of pCR were achieved in HER2+ than in HER2- tumors (57.8% versus 22.0%, P < 0.0001), with the highest rate in the HER2+/HR- cohort (71.0%; 66.7% Pac, 74.6% nab-Pac). In HER2+/HR+ tumors, the pCR rate was 52.9% (49.7% Pac, 56.4% nab-Pac). Grade ≥3 toxic effects were significantly more common in HER2+ than in HER2- patients, with grade 3-4 diarrhea in 7.6% versus 0.9% (P < 0.001) and febrile neutropenia in 6.3% versus 3.3% (P = 0.023) of patients. Left ventricular ejection fraction decreases from baseline were uncommon, with 2.0% versus 0.4% of patients showing decreases to <50% along with a ≥10% decrease from baseline. Conclusion In HER2+ early breast cancer, a dual HER2-targeted combination of pertuzumab and trastuzumab, together with taxane-epirubicin-cyclophosphamide neoadjuvant chemotherapy, achieved high rates of pCR.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, , Germany
| | - C Jackisch
- Department of Obstetrics & Gynecology, Sana Klinikum, Offenbach, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, , Germany
| | - S Schmatloch
- Breast Cancer Center, Elisabeth Krankenhausx, Weinbergstraße 7, Kassel, Germany
| | - B Aktas
- Department of Gynecology & Obstetrics, University Women's Hospital Essen, Essen, Germany
| | - C Denkert
- Department of Pathology, University Hospital Charité, Berlin, Germany
| | - H Wiebringhaus
- Gynecology, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
| | - S Kümmel
- Breast Unit, Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - M Warm
- Breast Unit, Brustzentrum im Krankenhaus Köln-Holweide, Köln, Germany
| | - S Paepke
- Women's Clinic, Klinikum Rechts der Isar der TU München, Klinik und Poliklinik für Frauenheilkunde, München, Germany
| | - M Just
- Oncology, Onkologische Schwerpunktpraxis Bielefeld, Germany
| | - C Hanusch
- Women's Clinic, Klinikum zum Roten Kreuz, München, Germany
| | - J Hackmann
- Breast Unit, Marien Hospital Witten, Witten, Germany
| | - J-U Blohmer
- Women's Clinic, Klinik für Gynäkologie am Campus Charité Mitte, Berlin, Germany
| | - M Clemens
- Women's Clinic, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - S Dan Costa
- Department of Gynecology, Universitäts-Frauenklinik, Magdeburg, Germany
| | - B Gerber
- Women's Clinic, Universitäts-Frauenklinik, Rostock, Germany
| | - K Engels
- Department of Pathology, Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Germany
| | | | | | - M Untch
- Department of Gynecology and Obstetrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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Al-Batran SE, Zvirbule Z, Lordick F, Thuss-Patience P, Just M, Bitzer M, Brass V, Krilova A, Maurus D, Türeci Ö, Sahin U. Phase 1 Study of IMAB362 with immunomodulation in patients with advanced gastric cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nitz U, Gluz O, Christgen M, Kates RE, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Lorenz-Salehi F, Krabisch P, Just M, Augustin D, Liedtke C, Chao C, Shak S, Wuerstlein R, Kreipe HH, Harbeck N. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat 2017; 165:573-583. [PMID: 28664507 PMCID: PMC6336763 DOI: 10.1007/s10549-017-4358-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [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: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023]
Abstract
Background The prospective phase 3 PlanB trial used the Oncotype DX® Recurrence Score® (RS) to define a genomically low-risk subset of clinically high-risk pN0-1 early breast cancer (EBC) patients for treatment with adjuvant endocrine therapy (ET) alone. Here, we report five-year data evaluating the prognostic value of RS, Ki-67, and other traditional clinicopathological parameters. Methods A central tumour bank was prospectively established within PlanB. Following an early amendment, hormone receptor (HR)+ , pN0-1 RS ≤ 11 patients were recommended to omit chemotherapy. Patients with RS ≥ 12, pN2-3, or HR-negative/HER2-negative disease were randomised to anthracycline-containing or anthracycline-free chemotherapy. Primary endpoint: disease-free survival (DFS). PlanB Clinicaltrials.gov identifier: NCT01049425. Findings From 2009 to 2011, PlanB enrolled 3198 patients (central tumour bank, n = 3073) with the median age of 56 years, 41.1% pN+, and 32.5% grade 3 EBC. Chemotherapy was omitted in 348/404 (86.1%) eligible RS ≤ 11 patients. After 55 months of median follow-up, five-year DFS in ET-treated RS ≤ 11 patients was 94% (in both pN0 and pN1) versus 94% (RS 12–25) and 84% (RS > 25) in chemotherapy-treated patients (p < 0.001); five-year overall survival (OS) was 99 versus 97% and 93%, respectively (p < 0.001). Nodal status, central/local grade, tumour size, continuous Ki-67, progesterone receptor (PR), IHC4, and RS were univariate prognostic factors for DFS. In a multivariate analysis including all univariate prognostic markers, only pN2-3, central and local grade 3, tumour size >2 cm, and RS, but not IHC4 or Ki-67 were independent adverse factors. If RS was excluded, IHC4 or both Ki-67 and PR entered the model. The impact of RS was particularly pronounced in patients with intermediate Ki-67 (>10%, <40%) tumours. Interpretation The excellent five-year outcomes in clinically high-risk, genomically low-risk (RS ≤ 11) pN0-1 patients without adjuvant chemotherapy support using RS with standardised pathology for treatment decisions in HR+ HER2-negative EBC. Ki-67 has the potential to support patient selection for genomic testing.
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Affiliation(s)
- Ulrike Nitz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany. .,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.
| | - Matthias Christgen
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Ronald E Kates
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Michael Clemens
- Department of Oncology, Clinics Mutterhaus der Borromäerinnen, Feldstraße 16, 54290, Trier, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Center, University Clinics Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Benno Nuding
- Department of Gynecology and Obstetrics, Evangelical Hospital, Ferrenbergstraße 24, 51465, Bergisch Gladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sherko Kuemmel
- Clinics Essen-Mitte, Breast Centre, Henricistraße 92, 45136, Essen, Germany
| | - Toralf Reimer
- Department of Gynecology and Obstetrics, Clinics Suedstadt, Südring 81, 18059, Rostock, Germany
| | - Andrea Stefek
- Johanniter Clinics Stendal, Breast Center Altmark, Bahnhofstraße 24 - 26, 39576, Stendal, Germany
| | - Fatemeh Lorenz-Salehi
- Department of Gynecology, Dr. Horst-Schmidt Clinics, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany
| | - Petra Krabisch
- Klinikum ChemnitzFlemmingstraße 2, 09116, Chemnitz, Germany
| | - Marianne Just
- Oncological Practice, Teutoburger Str. 60 33604, Bielefeld, Germany
| | - Doris Augustin
- Breast Centre Ostbayern, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Cornelia Liedtke
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Nadia Harbeck
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
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Furlanetto J, Jackisch C, Untch M, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Wiebringhaus H, Kümmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S, von Minckwitz G. Efficacy and safety of nab-paclitaxel 125 mg/m 2 and nab-paclitaxel 150 mg/m 2 compared to paclitaxel in early high-risk breast cancer. Results from the neoadjuvant randomized GeparSepto study (GBG 69). Breast Cancer Res Treat 2017; 163:495-506. [PMID: 28315068 DOI: 10.1007/s10549-017-4200-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/13/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The GeparSepto study demonstrated that the use of nab-paclitaxel instead of paclitaxel prior to anthracycline-based chemotherapy could lead to a significantly increased pCR rate, especially in the triple negative subpopulation. We report efficacy and safety for patients treated with two different doses of nab-paclitaxel in comparison to weekly solvent-formulated paclitaxel. METHODS Patients were treated for 12 weeks with either intravenous nab-paclitaxel 150 mg/m2 (nP150) weekly, after study amendment 125 mg/m2 (nP125) weekly or solvent-based paclitaxel 80 mg/m2 (P80) weekly followed by epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 on day 1 for four 3-week cycles. RESULTS 229 patients received nP150, 377 nP125. Baseline characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for hormone receptor status, HER2 status, and Ki67. Taxane treatment was discontinued in 26.8% (nP150), 16.6% (nP125), and 13.3% of (P80) patients, respectively. Median relative total dose intensity (mRTDI) based on 125 mg/m2 for nP was 103% with nP150, 95% with nP125, 99% with P80 before and 98% with P80 after the amendment. PSN grade 3-4 was observed in 14.5% of patients with nP150, 8.1% of patients with nP125 (p = 0.018), and 2.7% of patients with P80. Overall pCR before the amendment was 33.6% after nP150 and 23.5% after P80 (OR 1.65 [95% CI 1.10-2.50]; p = 0.022); pCR after the amendment was 41.4% after nP125, and 32.4% after P80 (1.48 [95% CI 1.10-1.99]; p = 0.013). CONCLUSIONS Nab-paclitaxel 125 mg/m2 was associated with a better safety profile and compliance without compromising the efficacy compared to nab-paclitaxel 150 mg/m2.
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Affiliation(s)
- Jenny Furlanetto
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany.
| | | | | | - Andreas Schneeweiss
- National Center for Tumor Disease, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Carsten Denkert
- Institute of Pathology and German Cancer Consortium (DKTK), Charité-University Hospital, Berlin, Germany
| | | | - Sherko Kümmel
- Interdisziplinäres Brustzentrum an den Kliniken Essen-Mitte, Essen, Germany
| | - Mathias Warm
- Brustzentrum in Krankenhaus Köln-Holweide, Cologne, Germany
| | - Stefan Paepke
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Frauenheilkunde, Munich, Germany
| | | | | | | | - Jens Uwe Blohmer
- Frauenklinik an der Charité-University Hospital, Berlin, Germany
| | | | | | | | - Valentina Nekljudova
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Gunter von Minckwitz
- German Breast Group, GBG Forschungs GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
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Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Abstract P5-16-03: Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The GeparSepto (NCT01583426) study showed that nab-paclitaxel (nP) increases the pathological complete response (ypT0 ypN0) rate when it replaces paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for pts with early breast cancer (BC) (Untch Lancet Oncol 2016). After a safety analysis showed a higher rate of dose reductions, treatment discontinuations as well as peripheral sensory neuropathy (PSN) with nP 150 mg/m2 w (nP150) compared to P 80mg/m2 w, dose of nP was reduced to 125 mg/m2 w (nP125). The risk-benefit ratio of nP125 was improved over nP150 (von Minckwitz SABCS 2015). We reported follow-up (FU) data on PSN occurrence and resolution.
Methods: Pts with untreated BC received P 80mg/m2 w or nP 150/125mg/m2 w followed by four cycles of E 90 mg/m2 plus C 600 mg/m2 q3w, with trastuzumab 6 mg/kg (loading (LD) dose 8 mg/kg) and pertuzumab 420 mg (LD 840 mg) q3w if HER2+. After the end of the study the protocol was amended in order to collect long-term data on PSN outcome as well as on treatment modalities. PSN will be reported according treatment and dose received on day 1.
Results: Overall 601 pts received P80; 220 pts nP150 and 385 pts nP125 on day 1. PSN grade 2-4 was observed in 18.8% (n=113/601) of pts treated with P80 and in 41.8% (n=92/220) vs 39.2% (n=151/385) with nP150 and nP125 respectively (p=0.547). Grade 3-4 PSN was reported for 2.7% (n=16/601) of pts in the P80 group and 14.5% (n=32/220) vs 8.1% (n=31/385) in the nP150 vs nP125 group respectively (p=0.018). In 31.8% (36/113), 35.9% (33/92) and 27.2% (41/151), PSN was not resolved at the end of the treatment (EOT); PSN grade 3-4 was not resolved in 37.5% (6/16), 56.3% (18/32) and 58.1% (18/31). After a median FU of 110 weeks after EOT, data on PSN status for pts with unresolved PSN grade 2-4 were available from 30, 22 and 32 pts; 26 pts did not provide update information (n=7 died, n=5 data not yet available, n=14 status unknown). For 63.3% (n=19), 40.9% (n=9) and 56.2% (n=18) of pts, PSN grade 2-4 was resolved to grade 1. Time to resolve (TTR) of PSN grade 2-4 was significantly different between nP150 and nP125 (p<0.001); no significant difference was seen between P and nP (p=0.405) [Tab.1]. After a median FU of 103 weeks after EOT, data on PSN status of pts with unresolved PSN grade 3-4 were available for 6, 14 and 14 pts. For 66.6% (n=4), 42.8% (n=6) and 50.0% (n=7) of pts PSN grade 3-4 was resolved to grade 1. TTR of PSN grade 3-4 was not significantly different neither for nP150 vs nP125 (p=0.103) nor for P vs nP (p=0.120) ) [Tab.1].
Conclusions: nP125 is associated with a lower occurrence of PSN compared to nP150 but higher PSN than P80. If PSN occurred nP125 is associated with a more rapid resolution compared to nP150. Nearly 10.7% had no resolution of PSN so far. Further FU and markers for selecting pts at risk are needed.
The trial is supported by Celgene.
Table 1. Median time to resolution (mTTR) of PSN to grade 1comparison groupsmTTR n (weeks); [95% CI]P vs nPPnP150nP125grade 2-47 [6-9]8 [6-10]grade 3-49 [4-15]17 [5-123]nP150 vs nP125 grade 2-4 13 [9-15]6 [4-9]grade 3-4 56 [11-170]17 [10-nr]abbreviations: nP, nab-paclitaxel; P, paclitaxel; nr, not reached
Citation Format: Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-03.
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Affiliation(s)
- J Furlanetto
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Jackisch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Aktas
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Denkert
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - H Wiebringhaus
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Warm
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Paepke
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Just
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J Hackmann
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Clemens
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - SD Costa
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Gerber
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Untch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Loibl
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
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Loibl S, Jackisch J, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kuemmel S, Luebbe K, Warm M, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Engels K, Nekljudova V, von Minckwitz G, Untch M. Abstract P4-21-06: Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: A subanalysis of data from the randomized phase III GeparSepto trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Our recent randomized, multicenter phase III GeparSepto study (Untch M et al. Lancet Oncol 2016) found that substituting nab-paclitaxel for standard solvent-based paclitaxel significantly improved the pathologic complete response (pCR) rate in patients receiving a sequential regimen of taxane, epirubicin and cyclophosphamide as neoadjuvant treatment for high-risk primary breast cancer. Patients with HER2-positive tumors (32.8%; n=396) also received a combination of pertuzumab and trastuzumab: the present analysis focuses on efficacy and safety data from these HER2+ patients treated with the dual-blockade.
Methods
Patients with histologically confirmed early breast cancer (n = 1206) received either weekly paclitaxel 80mg/m2 or weekly nab-paclitaxel 150/125mg/m2, according to randomization), followed by four cycles of epirubicin 90 mg/m2 plus cyclophosphamide 600 mg/m2 q3w, with concurrent trastuzumab 6 mg/kg (loading (LD) dose 8 mg/kg) and pertuzumab 420 mg (LD 840 mg) q3w for those with HER2-positive tumors. The primary endpoint was pathologic complete response (pCR), defined as ypT0 ypN0.
Results
The GeparSEPTO trial included 396/1206 (32.8%) HER2+ primary breast cancer patients. 27.0% in the HER2-positive and 34.1% in the HER2-negative group had HR-negative disease. Baseline characteristics were otherwise comparable between HER2+ and HER2- patients. Higher rates of pCR were seen in HER2+, compared to HER2- tumors (57.8% vs 22.0%). The highest overall pCR rate was observed in the HER2+/HR- cohort with 71.0%; 66.7% with Pac and 74.6% with nab-Pac. In HER2+/HR+ pCR rate was 52.9% ; 49.4% with Pac and 56.4% with nab-Pac. Using the definition ypT0/is ypN0 for pCR; pCR rates were generally higher especially in the HER2+ cohort (66.2% (ypT0/is ypN0) vs 57.8% (ypT0 ypN0)) compared to 25.2% (ypT0/is ypN0) vs 22% (ypT0 ypN0)) in patients with HER2-negative tumors. The HER2+ patients experienced a significantly higher incidence of grade 3-4 adverse events 85.4% vs 78.0% in the HER2-cohort, p=0.003); grade 3-4 hematologic AEs 74.0% (HER2+) vs 69.5% (HER2-); p=0.120 with grade 3-4 anaemia 2.5% vs 0.9%; p=0.034); any grade thrombopenia 28.5% vs 21.8%; p=0.012) and febrile neutropenia 6.3 vs 3.3%; p=0.023. Any grade 3-4 non-haematological toxicities occurred in 38.4% vs 30.1%; p=0.005), with grade 3-4 diarrhea occurring in 7.6% vs 0.9%; p<0.001 of the patients. This had no impact on compliance. LVEF decreases from baseline were uncommon (7.6%) with 2.0% (HER2+) versus 0.4% (HER2-) of patients showing decreases to <50% along with a ≥10% decrease from baseline.
Conclusion
This is the largest cohort of patients with HER2-positive early breast cancer receiving a dual HER2-targeted neoadjuvant therapy of pertuzumab and trastuzumab, together with nab-paclitaxel or paclitaxel followed by epirubicin and cyclophosphamide. HER2+ patients experienced more noteworthy toxicity. The pCR rate were higher in the HER2+ cohort receiving the dual blockade and was highest in patients with in HER+/HR- particularly if nab-paclitaxel was substituted for paclitaxel.
The trial is financially supported by Celgene and Roche.
Citation Format: Loibl S, Jackisch J, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kuemmel S, Luebbe K, Warm M, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Engels K, Nekljudova V, von Minckwitz G, Untch M. Dual HER2-blockade with pertuzumab and trastuzumab in HER2-positive early breast cancer: A subanalysis of data from the randomized phase III GeparSepto trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-06.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J Jackisch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - S Schmatloch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - B Aktas
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Denkert
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Schem
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - H Wiebringhaus
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - K Luebbe
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Warm
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Just
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J Hackmann
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Clemens
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - K Engels
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
| | - M Untch
- German Breast Group, Neu-Isenburg; Sana Kliniken Offenbach; Universitätsklinikum Heidelberg; Elisabeth-Krankenhaus Kassel; Universitätsklinikum Essen; Charite Berlin; Universitätsklinikum Schleswig-Holstein; St. Barbara Klinik Heessen Hamm; Kliniken Essen-Mitte, Essen; Diakovere Henriettenstift Hannover; Kliniken der Stadt Köln GmbH; Onkologische Schwerpunkpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen, Trier; Klinikum Südstadt Rostock; Pathologiezentrum Neuss; Helios Kliniken Berlin Buch
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Degenhardt T, Kreipe HH, Gluz O, Kates RE, Liedtke C, Kraemer S, Clemens MR, Nuding B, Reimer T, Aktas B, Kuemmel S, Just M, Lorenz-Salehi F, Uleer C, Stefek A, Heyl V, Würstlein R, Nitz U, Christgen M, Harbeck N. Androgenrezeptor (AR) und Forkhead BoxA1 (FOXA1) als Prognosefaktoren beim frühen HER2-negativen Mammakarzinom – eine translationale Substudie im Rahmen der prospektiven Phase-III-WSG-Plan B Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593241] [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: 10/20/2022] Open
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Grischke EM, Nusch A, Marschner N, Abenhardt W, Wilke J, Decker T, Just M, Kümmel S, Kurbacher C, Marmé F, Overkamp F, Xuan F, Miller M, Janni W. Ribociclib + letrozole for postmenopausal women with hormone receptor-positive (HR+), HER2-negative advanced breast cancer (ABC) who received no prior therapy for advanced disease. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592812] [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: 10/20/2022] Open
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Degenhardt T, Kreipe HH, Gluz O, Kates RE, Liedtke C, Kraemer S, Clemens MR, Nuding B, Reimer T, Aktas B, Kummel S, Just M, Lorenz-Salehi F, Uleer C, Stefek A, Heyl V, Wuerstlein R, Nitz U, Harbeck N, Christgen M. Prognostic impact of androgen receptor (AR) and forkhead box A1 (FOXA1) in early HER2-negative primary breast cancer: A translational substudy of the prospective phase III WSG-PlanB-trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tom Degenhardt
- University of Munich, Klinikum GroBhadern, Munich, Germany
| | | | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | | | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | - Stefan Kraemer
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | | | - Benno Nuding
- Department of Obstetrics & Gynecology, Protestant Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | | | | | | | | | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | - Ulrike Nitz
- Geriatric Breast Center, Evangelina Bethesda Hospital for Breast Diseases, Nordrhein-Westfalen, Germany
| | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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Gluz O, Nitz U, Christgen M, Kates RE, Clemens M, Kraemer S, Nuding B, Reimer T, Aktas B, Kümmel S, Just M, Stefek A, Lorenz-Salehi F, Krabisch P, Liedtke C, Svedman C, Shak S, Wuerstlein R, Kreipe HH, Harbeck N. Prognostic impact of 21 Gene Recurrence Score, IHC4, and central grade in high-risk HR+/HER2- early breast cancer (EBC): 5-year results of the prospective Phase III WSG PlanB trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group; Evangelic Hospital Bethesda, Moenchengladbach, Germany
| | | | | | | | - Stefan Kraemer
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Benno Nuding
- Department of Obstetrics & Gynecology, Protestant Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | | | - Sherko Kümmel
- Department of Senology / Breast Care Center, Kliniken Essen Mitte, Essen, Germany
| | | | | | | | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz, Chemnitz, Germany
| | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | | | | | | | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
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Just M. Eine interdisziplinäre Herausforderung: Tuberkulose – ein Fall für Drei. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1578921] [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: 10/22/2022]
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Gluz O, Nitz UA, Christgen M, Kates RE, Shak S, Clemens M, Kraemer S, Aktas B, Kuemmel S, Reimer T, Kusche M, Heyl V, Lorenz-Salehi F, Just M, Hofmann D, Degenhardt T, Liedtke C, Svedman C, Wuerstlein R, Kreipe HH, Harbeck N. West German Study Group Phase III PlanB Trial: First Prospective Outcome Data for the 21-Gene Recurrence Score Assay and Concordance of Prognostic Markers by Central and Local Pathology Assessment. J Clin Oncol 2016; 34:2341-9. [PMID: 26926676 DOI: 10.1200/jco.2015.63.5383] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The 21-gene Recurrence Score (RS) assay is a validated prognostic/predictive tool in early hormone receptor-positive breast cancer (BC); however, only a few prospective outcome results have been available so far. In the phase III PlanB trial, RS was prospectively used to define a subset of patients who received only endocrine therapy. We present 3-year outcome data and concordance analysis (among biomarkers/RS). PATIENTS AND METHODS Central tumor bank was established prospectively from PlanB (intermediate and high-risk, locally human epidermal growth factor receptor 2-negative BC). After an early amendment, HR-positive, pN0-1 patients with RS ≤ 11 were recommended to omit chemotherapy. RESULTS From 2009 to 2011, PlanB enrolled 3,198 patients with a median age of 56 years; 41.1% had node-positive and 32.5% grade 3 disease. In 348 patients (15.3%), chemotherapy was omitted based on RS ≤ 11. After 35 months median follow-up, 3-year disease-free survival in patients with RS ≤ 11 and endocrine therapy alone was 98% versus 92% and 98% in RS > 25 and RS 12 to 25 in chemotherapy-treated patients, respectively. Nodal status, central and local grade, the Ki-67 protein encoded by the MKI67 gene, estrogen receptor, progesterone receptor, tumor size, and RS were univariate prognostic factors for disease-free survival; only nodal status, both central and local grade, and RS were independent multivariate factors. Histologic grade was discordant between central and local laboratories in 44%. RS was positively but moderately correlated with the Ki-67 protein encoded by the MKI67 gene and grade and negatively correlated with progesterone receptor and estrogen receptor. CONCLUSION In this prospective trial, patients with enhanced clinical risk and omitted chemotherapy on the basis of RS ≤ 11 had excellent 3-year survival. The substantial discordance observed between traditional prognostic markers and RS emphasizes the need for standardized assessment and supports the potential integration of standardized, well-validated genomic assays such as RS with clinicopathologic prognostic factors for chemotherapy indication in early hormone receptor-positive BC.
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Affiliation(s)
- Oleg Gluz
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA.
| | - Ulrike A Nitz
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Matthias Christgen
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Ronald E Kates
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Steven Shak
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Michael Clemens
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Stefan Kraemer
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Bahriye Aktas
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Sherko Kuemmel
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Toralf Reimer
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Manfred Kusche
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Volker Heyl
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Fatemeh Lorenz-Salehi
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Marianne Just
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Daniel Hofmann
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Tom Degenhardt
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Cornelia Liedtke
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Christer Svedman
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Rachel Wuerstlein
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Hans H Kreipe
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
| | - Nadia Harbeck
- Oleg Gluz, Ulrike A. Nitz, Ronald E. Kates, Daniel Hofmann, Cornelia Liedtke, Rachel Wuerstlein, and Nadia Harbeck, West German Study Group; Oleg Gluz and Ulrike A. Nitz, Evangelical Hospital Bethesda, Moenchengladbach; Matthias Christgen and Hans H. Kreipe, Medical School Hannover, Hannover; Michael Clemens, Mutterhaus der Borromäerinnen, Trier; Stefan Kraemer, University Clinics Cologne, Cologne; Bahriye Aktas, University Clinics Essen; Sherko Kuemmel, Clinics Essen-Mitte, Essen; Toralf Reimer, Clinics Suedstadt, Rostock; Manfred Kusche, Marienhospital Aachen, Aachen; Volker Heyl, Asklepios Paulinen Clinics; Fatemeh Lorenz-Salehi, Dr Horst-Schmidt Clinics, Wiesbaden; Marianne Just, Oncologic Practice, Bielefeld; Tom Degenhardt, Rachel Wuerstlein, and Nadia Harbeck, University of Munich, Munich; Cornelia Liedtke, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany; and Steven Shak and Christer Svedman, Genomic Health, Redwood City, CA
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von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. Abstract P1-14-11: nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We previously reported that nab-paclitaxel (nP) increases the pathological complete response (pCR, ypT0 ypN0) rate when it replaces solvent-based paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for patients with early breast cancer (Untch et al. SABCS 2014). Here, we report efficacy and safety of patients being treated either with 150 mg/m2 nab-paclitaxel (nP150) before an amendment or with 125 mg/m2 nab-paclitaxel (nP125) thereafter in comparison to solvent-formulated paclitaxel at 80 mg/m2 (P80).
Methods: In the GeparSepto study (NCT01583426), 1207 patients were randomized to either nP150 or P80 q1w for 12 weeks followed by 4 cycles of conventionally dosed EC (E: 90mg/m2; C: 600 mg/m2) q3w. The primary objective of the study was to compare the pCR rate (pCR, ypT0 ypN0). Patients with untreated, histologically confirmed uni- or bilateral, cT2- cT4d carcinoma, and no clinically relevant cardiovascular and other co-morbidities were included. Patients with HER2+ tumors received trastuzumab (loading dose 8mg/kg; 6 mg/kg) plus pertuzumab (loading dose 840 mg; 420 mg) q3w concomitantly to all chemotherapy cycles. After a safety analysis showed a higher rate of dose reductions and treatment discontinuations with nP150 compared to P80, weekly dose of nP was reduced to 125 mg/m2.
Results: nP was given for the majority of cycles at a dose of 150 mg/m2 to 179 patients and at a dose of 125 mg/m2 to 426 patients. Treatment characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for HER2 status (HER2-positive: nP150 22%, nP125 37% and P80 33%) and Ki67 (<20%: nP150 60%, nP125 73% and P80 69%). Taxane treatment was discontinued in 16% (nP150), 11% (nP125) and 6% (P80) of patients, respectively. Median dose per cycle (based on relative total dose intensity (RTDI)) was 129 mg/m2 with nP150, 119 mg/m2 with nP125 and 78 mg/m2 with P80, respectively. Peripheral sensory neuropathy (PNP) grade 3/4 (NCI-CTCAE v4.0) was observed in 15% with nP150, 8% with nP125 and 3% with P80, respectively. pCR was 32% with nP150, 41% with nP125 and 29% with P80 in all patients and 46% with nP150, 49% with nP125 and 26% with P80 in 277 patients with triple-negative breast cancer, respectively.
Conclusions: Risk-benefit ratio of nP125 was improved over nP150 with better drug adherence and RTDI, lower frequency of PNP but a higher pCR rate. It should therefore be considered as the preferred schedule when nP is used as neoadjuvant treatment for primary breast cancer.
The trial was financially supported by Celgene and Roche.
Citation Format: von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-11.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Jakisch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Conrad
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Aktas
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Weibringhaus
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hilfrich
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Warm
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Just
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hackmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Clemens
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - SD Costa
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
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Gluz O, Nitz U, Kreipe H, Christgen M, Kates R, Hofmann D, Shak S, Clemens M, Kraemer S, Aktas B, Kuemmel S, Reimer T, Kusche M, Heyl V, Lorenz-Salehi F, Just M, Liedtke C, Wuerstlein R, Harbeck N. 1937 Clinical impact of risk classification by central/local grade or luminal-like subtype vs. Oncotype DX®: First prospective survival results from the WSG phase III planB trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30886-3] [Citation(s) in RCA: 5] [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: 11/25/2022]
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Harbeck N, Gluz O, Christgen M, Braun MW, Kummel S, Potenberg J, Aktas B, Schumacher C, Forstbauer H, Augustin D, Kraemer S, Just M, Tio J, Kleine-Tebbe A, Liedtke C, Kates RE, Hofmann D, Wuerstlein R, Kreipe HH, Nitz U. Efficacy of 12-weeks of neoadjuvant TDM1 with or without endocrine therapy in HER2-positive hormone-receptor-positive early breast cancer: WSG-ADAPT HER2+/HR+ phase II trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | | | | | | | - Jochem Potenberg
- Department of Hematology, Waldkrankenhaus Spandau, Berlin, Germany
| | | | | | | | | | - Stefan Kraemer
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | | | - Joke Tio
- University Clinics Münster, Münster, Germany
| | | | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | | | | | | | | | - Ulrike Nitz
- Geriatric Breast Center, Evangelina Bethesda Hospital for Breast Diseases, Nordrhein-Westfalen, Germany
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Sahin U, Al-Batran SE, Hozaeel W, Zvirbule Z, Freiberg-Richter J, Lordick F, Just M, Bitzer M, Thuss-Patience PC, Krilova A, Brass V, Mueller C, Daalman E, Tureci O. IMAB362 plus zoledronic acid (ZA) and interleukin-2 (IL-2) in patients (pts) with advanced gastroesophageal cancer (GEC): Clinical activity and safety data from the PILOT phase I trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Wael Hozaeel
- Frankfurt A.M. Nordwest Krankenhaus GMBH, Frankfurt Am Main, Germany
| | | | | | | | | | | | - Peter C. Thuss-Patience
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Med Klinik m. S. Hämatologie, Onkologie u. Tumorimmunologie, Berlin, Germany
| | - Anna Krilova
- Piejuras Hospital, Oncology Clinic, Liepaja, Latvia
| | - Volker Brass
- University Hospital Freiburg, Clinic of Internal Medicine II, Gastroenterology and Hepatology, Freiburg, Germany
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Von Schumann R, Gluz O, Nitz U, Clemens M, Luebbe K, Aktas B, Just M, Noesselt T, Henschen S, Hackmann J, Lorenz-Salehi F, Freese K, Svedman C, Kates RE, Kreipe HH, Harbeck N, Liedtke C. Hormone receptor discordance between local and central pathology with RT-PCR analysis: Results from multicenter Phase III WSG-PlanB trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e11555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raquel Von Schumann
- Ev. Hospital Bethesda - Breast Center Niederrhein, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- Geriatric Breast Center, Evangelina Bethesda Hospital for Breast Diseases, Nordrhein-Westfalen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
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Abstract
With the use of the protease inhibitor from bovine organs--Trasylol-- as a model, we studied the pinocytic transport of peptides in the kidney. Rats were injected with the 125I-labeled peptide and killed at different times thereafter. Kidney homogenates were subfractionated by differential and sucrose gradient centrifugation. Radioactivity was measured in the fractions in order to study the time-dependent fixation of the peptide to different cell organelles. With short survival periods, the protease inhibitor is recovered in the brush-border fraction, with longer periods, a shift towards the lysosome fraction takes place. Thus, the renal transport of the protease inhibitor consists of three steps: binding to the brush border, incorporation in micropinocytic vesicles and transport in phagolysosomes.
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Issa-Nummer Y, Darb-Esfahani S, Loibl S, Kunz G, Nekljudova V, Schrader I, Sinn BV, Ulmer HU, Kronenwett R, Just M, Kühn T, Diebold K, Untch M, Holms F, Blohmer JU, Habeck JO, Dietel M, Overkamp F, Krabisch P, von Minckwitz G, Denkert C. Prospective validation of immunological infiltrate for prediction of response to neoadjuvant chemotherapy in HER2-negative breast cancer--a substudy of the neoadjuvant GeparQuinto trial. PLoS One 2013; 8:e79775. [PMID: 24312450 PMCID: PMC3846472 DOI: 10.1371/journal.pone.0079775] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/04/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction We have recently described an increased lymphocytic infiltration rate in breast carcinoma tissue is a significant response predictor for anthracycline/taxane-based neoadjuvant chemotherapy (NACT). The aim of this study was to prospectively validate the tumor-associated lymphocyte infiltrate as predictive marker for response to anthracycline/taxane-based NACT. Patients and Methods The immunological infiltrate was prospectively evaluated in a total of 313 core biopsies from HER2 negative patients of the multicenter PREDICT study, a substudy of the neoadjuvant GeparQuinto study. Intratumoral lymphocytes (iTuLy), stromal lymphocytes (strLy) as well as lymphocyte-predominant breast cancer (LPBC) were evaluated by histopathological assessment. Pathological complete response (pCR) rates were analyzed and compared between the defined subgroups using the exact test of Fisher. Results Patients with lymphocyte-predominant breast cancer (LPBC) had a significantly increased pCR rate of 36.6%, compared to non-LPBC patients (14.3%, p<0.001). LPBC and stromal lymphocytes were significantly independent predictors for pCR in multivariate analysis (LPBC: OR 2.7, p = 0.003, strLy: OR 1.2, p = 0.01). The amount of intratumoral lymphocytes was significantly predictive for pCR in univariate (OR 1.2, p = 0.01) but not in multivariate logistic regression analysis (OR 1.2, p = 0.11). Conclusion Confirming previous investigations of our group, we have prospectively validated in an independent cohort that an increased immunological infiltrate in breast tumor tissue is predictive for response to anthracycline/taxane-based NACT. Patients with LPBC and increased stromal lymphocyte infiltration have significantly increased pCR rates. The lymphocytic infiltrate is a promising additional parameter for histopathological evaluation of breast cancer core biopsies.
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Affiliation(s)
| | | | | | - Georg Kunz
- Department of Gynecology and Obstetrics, St. Johannes Hospital, Dortmund, Germany
| | | | | | | | | | | | | | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Kurt Diebold
- Gemeinschaftspraxis für Pathologie Hamm, Hamm, Germany
| | - Michael Untch
- Breast Center, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Holms
- Gynäkologie und Geburtshilfe, St. Barbara-Klinik Hamm-Heessen, Germany
| | - Jens-Uwe Blohmer
- Breast Center, St. Gertrauden Krankenhaus Berlin, Berlin, Germany
| | | | - Manfred Dietel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany
- University Women's Hospital, Frankfurt, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hauri AM, Just M, McFarland S, Schweigmann A, Schlez K, Krahn J. [Campylobacteriosis outbreaks in the state of Hesse, Germany, 2005-2011: raw milk yet again]. Dtsch Med Wochenschr 2013; 138:357-61. [PMID: 23404322 DOI: 10.1055/s-0032-1332884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Campylobacter is the most frequently reported cause of acute infectious diarrhea in Germany. Campylobacter outbreaks are rare events. However, their investigation provides useful information on risks of infection and unused prevention potentials. METHODS We analyzed the Hessian database for notifiable diseases for cases of campylobacteriosis reported from 2005 through 2011. For campylobacter outbreaks including five or more cases we prospectively obtained additional information from local public health authorities. RESULTS From 2005 through 2011, 29,473 cases of campylobacteriosis were reported in Hesse, Germany (approx. 6 million inhabitants), yielding an annual incidence ranging from 53.4 to 81.4 cases per 100,000 inhabitants. Only 236 cases were part of 16 outbreaks with five or more cases. Among these, six outbreaks occurred among groups traveling outside Germany, four were associated with the consumption of raw milk. For eight outbreaks consumption of poultry was considered a probable or - based on the frequent consumption of poultry during group travel - possible vehicle of infection. Two of the raw-milk associated outbreaks were reported among two groups who visited the same farm within 18 days. Five of 14 members of several families and 77 of 117 students fell sick. The local public health authority was only informed when both groups had visited the farm. CONCLUSION The reported outbreaks can be attributed to known risk factors for campylobacteriosis - consumption of raw milk and poultry and international travel. This underlines that prevention possibilities are insufficiently used. These include avoiding the consumption of unpasteurized milk and milk products, the hygienically correct handling of raw poultry and timely identification and notification of outbreaks to public health authorities.
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Affiliation(s)
- A M Hauri
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg.
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Biganzoli L, Di Vincenzo E, Jiang Z, Lichinitser M, Shen Z, Delva R, Bogdanova N, Vivanco GL, Chen Z, Cheng Y, Just M, Espié M, Vinholes J, Hamm C, Crivellari D, Chmielowska E, Semiglazov V, Dalenc F, Smith I. First-line bevacizumab-containing therapy for breast cancer: results in patients aged≥70 years treated in the ATHENA study. Ann Oncol 2012; 23:111-118. [PMID: 21444356 DOI: 10.1093/annonc/mdr043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There are limited data on treatment outcomes in the growing population of elderly patients with locally recurrent/metastatic breast cancer (LR/mBC). To gain information on first-line bevacizumab combined with chemotherapy in the elderly, we analyzed data from the ATHENA trial in routine oncology practice. PATIENTS AND METHODS Patients with human epidermal growth factor receptor-2-negative LR/mBC received first-line bevacizumab with standard chemotherapy until disease progression, unacceptable toxicity, or physician/patient decision. We carried out a subgroup analysis of safety and efficacy in patients aged≥70 years. Possible correlations between tolerability and baseline comorbidities or Eastern Cooperative Oncology Group status were explored. RESULTS Bevacizumab was combined with single-agent paclitaxel in 46% of older patients. Only hypertension and proteinuria were more common in older than in younger patients (grade≥3 hypertension: 6.9% versus 4.2%, respectively; grade≥3 proteinuria: 4.0% versus 1.5%, respectively). Grade≥3 arterial/venous thromboembolism occurred in 2.9% versus 3.3%, respectively. Further analysis revealed no relationship between baseline presence and severity of hypertension and risk of developing hypertension during bevacizumab-containing therapy. Median time to progression was 10.4 months in patients aged≥70 years. CONCLUSIONS These findings suggest that bevacizumab-containing therapy is tolerable and active in patients aged≥70 years. Hypertension was more common than in younger patients but was manageable. We find no evidence precluding the use of bevacizumab in older patients, including those with hypertension, although age may influence chemotherapy choice.
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Affiliation(s)
- L Biganzoli
- 'Sandro Pitigliani' Medical Oncology Unit, Prato Hospital, Istituto Toscano Tumori, Prato.
| | | | - Z Jiang
- Department of Breast Cancer, Beijing 307 Hospital, Beijing, China
| | - M Lichinitser
- Department of Combined Modality Treatment and Chemotherapy of Malignant Tumors, N. N. Blokhin Russian Oncology Research Center, Moscow, Russia
| | - Z Shen
- Department of Breast Surgery, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - R Delva
- Paul Papin Centre, Angers, France
| | - N Bogdanova
- State Institution P.A. Herzen Moscow, Cancer Research Institute, Moscow, Russia
| | - G L Vivanco
- Medical Oncology Department, Cruces Hospital, Barakaldo, Spain
| | - Z Chen
- Department of Medical Oncology, First Affiliated Hospital of Anhui Medical University, He Fei
| | - Y Cheng
- Department of Internal Medicine, Jilin Cancer Hospital, Changchun, China
| | - M Just
- Internal Medicine Practice, Bielefeld, Germany
| | - M Espié
- Breast Disease Centre, Hôpital Saint Louis, Paris, France
| | | | - C Hamm
- Department of Oncology, University of Western Ontario, Windsor, Canada
| | - D Crivellari
- Division of Medical Oncology, National Cancer Institute, Centro di Riferimento Oncologico, Aviano, Italy
| | - E Chmielowska
- Department of Clinical Oncology, Bydgoszcz Oncology Centre, Bydgoszcz, Poland
| | - V Semiglazov
- Breast Cancer Department, N. N. Petrov Research Institute of Oncology, St Petersburg, Russia
| | - F Dalenc
- Department of Medical Oncology, Claudius Regaud Institute, Toulouse, France
| | - I Smith
- Breast Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
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Von Minckwitz G, Darb-Esfahani S, Loibl S, Huober JB, Tesch H, Solbach C, Holms F, Eidtmann H, Diedrich K, Just M, Clemens M, Hanusch C, Schrader I, Henschen S, Hoffmann G, Tiemann K, Diebold K, Untch M, Denkert C. Responsiveness of adjacent ductal carcinoma in situ and changes in HER2 status after neoadjuvant chemotherapy/trastuzumab treatment in early breast cancer: Results from the GeparQuattro study (GBG 40). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6 Background: Adjacent ductal carcinoma in situ (DCIS) is in found in approximately 45% of invasive ductal carcinomas (IDC) of the breast. Pure DCIS overexpresses HER2 in approximately 45%. There is uncertainty whether adjacent DCIS impacts on the response to neoadjuvant chemotherapy and trastuzumab as well as whether HER2 expression in IDC component or adjacent DCIS changes throughout treatment. Methods: Core biopsies and surgical tissue from participants of the GeparQuattro study with HER2-positive IDC were centrally examined for the area of invasive ductal component and adjacent DCIS before and after receiving neoadjuvant anthracycline-taxane-trastuzumab containing chemotherapy. HER2 overexpression in IDC and adjacent DCIS was quantified separately by immunohistochemistry using the Ventana automated staining system. Pathological complete response (pCR) was defined as no residual invasive or non-invasive tumor tissue. Results: Fifty nine (37.3%) of 158 IDCs presented with adjacent DCIS at diagnosis. These tumors showed lower regression grades than pure IDC (p=0.033). Presence of adjacent DCIS was an independent negative predictor of pCR (odds ratio 0.42 [95% CI 0.2-0.9], p=0.027). Adjacent DCIS area decreased from pre-treatment to surgery (r=0.205) with 30 (50.8%) IDCs with adjacent DCIS showing complete eradication of adjacent DCIS. HER2 status of adjacent DCIS was highly correlated with HER2 status of IDC component before (r=0.892) and after treatment (r=0.676). Degree of HER2 overexpression of the IDC component decreased in 16 (33.3%) out of 49 patients without a pCR. These 16 IDCs showed lower RGs compared to the 33 IDCs with unchanged HER2 expression (p=0.055). Conclusions: HER2-positive IDCs with adjacent DCIS is less responsive to neoadjuvant chemotherapy and trastuzumab compared to pure IDC. However, complete eradication of adjacent DCIS is frequently observed. HER2-overexpression of the invasive ductal component decreases in a subset of tumors, which showed less tumor regression.
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Affiliation(s)
- G. Von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - S. Darb-Esfahani
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - S. Loibl
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - J. B. Huober
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - H. Tesch
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - C. Solbach
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - F. Holms
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - H. Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - K. Diedrich
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - M. Just
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - M. Clemens
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - C. Hanusch
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - I. Schrader
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - S. Henschen
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - G. Hoffmann
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - K. Tiemann
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - K. Diebold
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - M. Untch
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
| | - C. Denkert
- German Breast Group, Neu-Isenburg, Germany; Charite Universitätsmedizin, Berlin, Germany; University of Tuebingen and Kantonsspital St. Gallen, St. Gallen, Switzerland; Fachpraxis, Frankfurt, Germany; UFK Frankfurt/Main, Frankfurt/Main, Germany; Barbaraklinik, Hamm, Germany; University of Schleswig-Holstein, Kiel, Germany; Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Luebeck, Germany; Onkologische Schwerpunktpraxis, Bielefeld, Germany; Mutterhaus der Boromaerinnen,
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